Non-anthracycline chemo for node positive?

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mtnchick
mtnchick Member Posts: 3

Hello, I'm an athlete and afraid of the cardiac risks associated with anthracycline based treatment.  Does anyone have experience with non-anthracycline based treatment for Node Positive BC?  2 cm IDC, ER/PR+, Her2-, Grade 3, 3/8 nodes positive.  37 years old.  Thanks!

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  • crazyride43
    crazyride43 Member Posts: 154
    edited June 2013

    I hope others will come along to help with alternate chemo suggestions. I just wanted to let you know that I had A/C dose dense followed by Taxol, and over a year out I have no heart issues. I exercise regularly and have no less stamina than before. I also continued to walk throughout chemo with no issues. I'm 44.

  • SpecialK
    SpecialK Member Posts: 16,486
    edited June 2013

    Because I was Her2+ and required Herceptin, which has its own potential for cardiac side effects, my oncologist used Taxotere and Carboplatin so as not to compound the cardio-toxicity.  I had 2 positive nodes. Some who need Herceptin also do Taxol for 12 cycles.  While the taxane drugs do not have the cardiac risks they do have the potential for neuropathy, so that would be a trade-off.

  • dlb823
    dlb823 Member Posts: 9,430
    edited June 2013

    mtnchick, I believe research shows that TC (Taxotere+Cytoxan) is every bit as effective as AC+T, or other combinations including Adriamycin, which is the specific chemo drug that poses a cardiac risk.  While it's true many oncs like to throw everything including Adriamycin at bc patients who are under age 40, I would ask for the back up research data/comparisons for whatever regimen an onc recommends.  Also, be sure any onc you have a consult with knows about your individual concerns, and don't be afraid to interview several until you find one with whom you're totally comfortable.   Chemo is one area on which they don't all think alike.  I saw three before deciding what to do, and they each recommended something slightly different. 

    I can also direct you to a video out of UCLA, where I was treated, that explains the various chemo regimens, along with comparing the stats from various research studies.  However, this would only be general info, and not based on your specific dx or concerns.     (((Hugs)))  Deanna

  • Traii
    Traii Member Posts: 1,138
    edited June 2013

    Hi

    i had hodgkins disease when I was 18 and because I already had adrymicin my onc decided not to give that again so i had 3x taxotere and 3x CMF.

    My heart scan was normal before i started so really I could have gone with the heart drug again however my onc and with several discussions he had with other oncs decided against it.

  • Denise-G
    Denise-G Member Posts: 1,777
    edited June 2013

    I had a heart attack during AC that wasn't discovered until Herceptin

    also did damage. I thought the "heart attack" was AC side effects.  I remember it well.

    The good news is, my heart is improving with the meds.  I have a great cardiology team.

    Since I was Stage 3 with a large tumor, I would do it over again even knowing

    the results.  But that being said, that was my situation.  It is wise to look

    into treatments that are best for you.

  • mtnchick
    mtnchick Member Posts: 3
    edited June 2013

    Thanks everyone!  Keep them coming!  

    In full disclosure, I was originally diagnosed with BC in 2011.  2cm, ER/PR+, Her2-, Grade3, Oncotype Dx 20.  Sentinel lymph node biopsy was negative.  Mastectomy followed by TCx4 and Tamoxifen.  

    I have returned to life and feel great.  

    Unfortunately what we thought was scar tissue and then a shotty lymph node near my Sentinel lymph node biopsy scar turned out to be metastatic.  A recent ALND revealed 3/8 positive lymph nodes so technically I am having a recurrence.  An axillary recurrence is very unusual after mastectomy and negative sentinel lymph node biopsy and my team feels that that I fall into the 3% false negative sentinel lymph node biopsy category.  Because chemo (TCx4) and Tamoxifen were not effective in killing these axillary cancer cells (with theories ranging from being too well established at time of treatment, reduced blood flow to area due to close proximity to sentinel lymph node biopsy site, and resistence to treatments done) it is recommended that I undergo an anthracyline based treatment such as AC, FAC, or FEC along with radiation and switching to an aromatase inhibitor.    Since my situation is unusual, there is not a lot of research to support best protocol.  My goal is to effectively treat the cancer while trying to reduce toxicity to my body in any way possible.  Thanks for all your input!  

  • MaryR12
    MaryR12 Member Posts: 13
    edited June 2013

    Hello SpecialK,

    I was surprised in reading your post, that your docs are following you with tumor markers, and PET scans.  My docs are refusing to do either, saying tumor markers are not relivant in BC, and before any further scans (had 1 PET, post surg/pre chemo) are needed unless I show symptoms.  My argument was, why wait until I show symptoms, I need to know if the treatment has worked.  I have Kaiser for my insurance and they are known at times to be more thrifty than proactive in treatment.  My onc, just keeps saying data and evidence doesn't support any further scans, etc.  I had a 2nd opinion (unfortunately, another Kaiser doc) and she sided with the other onc.  I am worried of chest wall tumors, and out of arguments.

    So again, I am surprised, and envioius that you are being followed with further scans.  Our tumors were much the same (ER+/PR-/HER2neu+ / 5cm / stage IIB-IIIA) (bilat mast. with immediate expanders)  I have completed dose dense AC, weekly Taxol, Herceptin every 3 weeks and are in the APHINITY trial, where hopefully I am receiving the trial drug, and not the placebo drug of Pertuzanab.  The Herceptin and Pertuzanab will continue through Feb. 2014 or as long as my heart holds at 50% or more on my MUGA, Rads start next month.

    I am interested why they say they are following with tumor markers and further scans.  Also are there others out there who are also being followed with scans and/or tumor markers?

    Blessings and care to all,

    MaryR

  • Denise-G
    Denise-G Member Posts: 1,777
    edited June 2013

    My Onc also says tumor marker blood tests and PET scans are not necessary unless symptoms present themselves.   He is well regarded in the Oncology world and well known.  If I would have been scanned for all the symptoms I had, I would have been in there steady.  Fortunately, they have mostly left now!  You all know how that goes - every ache you "wonder"...   I now call it "organ of the week."

  • SpecialK
    SpecialK Member Posts: 16,486
    edited June 2013

    mary - whether oncs scan and do tumor markers varies from doctor to doctor, it comes down to style - I just happen to have a doc that likes to scan and check my blood!  Many don't feel that it makes a difference in terms of whether or not a new primary, recurrence, or distant metastasis is found early or when it produces symptoms, but I would like to think catching it early might make things easier - or open the door to a wider variety of treatments.  A lot of docs also feel that tumor markers are unreliable, and scans can only see things when they get to a certain detectable size.  Of course, I have been happy to do tumor markers and scans because I find them reassuring - but that is only because there has been no bad news so far. There is a new thread that started regarding "what I wish I knew..." or something to that effect - I posted that when deciding on your potential oncologist ask how you will be followed going forward after initial treatment. My insurance is pretty conservative (military) but they may have approved scans in the past due to my positive nodes.

  • ruthbru
    ruthbru Member Posts: 57,235
    edited June 2013

    If you've already tried it the other way, you better go with the AC. I was worried about AC too (heart diease in the family), but at the time of my diagnosis, that was the standard of care. I had a MUGA before I started (which was very good because I do exercise), and did 4 rounds with no problems at all. My oncologist said that most the people who have heart trouble with it are those who need many rounds of it (I think he said more than 6). Since you are young & fit otherwise, I think you should be OK.

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