adriamycin...what are your experiences?

Before giving you Adriamycin, you should be given a full heart work-up to insure that you are heart healthy.  Heart damage is not a given with Adriamycin (it's a very low risk of 1.7%), but can occur with certain, pre-existing medical conditions.  If it is acute, it occurs within days; but it can be chronic, occurring years after chemotherapy.

If you had cancer treatment as a child or adolescent, it will increase your risk for Adriamycin-related cardiomyopathy.  If you are older than fifty, your risk, also, increases.  A pre-existing heart condition or heart disease, and a history of hypertension, also, raise the risk. Research, also, linked dosage to Adriamycin-related heart problems; you can, only, recent so much Adriamycin during your lifetime.  It's a cumulative thing; if you go over the "safe" level, your risk of developing Adriamycin-related cardiomyopathy dramatically increases.  And once you develop Adriamycin-related cardiomyopathy, there is a poor outcome.

These are serious concerns that you need to think about very carefully.  Yes, there are potential risks, but they are rare and there are safeguards in place to avoid increasing your personal risk, if Adriamycin is being recommended.  Make sure you talk to you oncologist - and get a second opinion, if need be - before making your decision.

Personally, I've had had no problems following combination therapy with Adriamycin.  My diagnosis was similar to yours: Stage 2, Grave 2, one positive node.  I had a mUgga (a heart function test) before starting chemotherapy and my heart was perfectly sound: no evidence of heart valve problems or heart disease which lowered my risk.  I have, since, had another heart work-up as part of my annual, regular physical exam with my PCP and, so far, so good.  No heart damage is evident.  I'm, also, very athletic and have noticed no difference in my physical abilities since treatment.

But you need to make a decision that YOU are comfortable with.  So... ask tons of questions and make sure that you understand the benefits vs. risks as it pertains to your specific situation.

How old are you?  That could impact your heart damage probability a lot. You look youngish?

You are a probably borderline case for TAC.   chemo Taxol alone is relatively effective with less side effect and less heart damage.  AC could be saved for future if you have to have it, AC is also less effective for grade 1,2 people.    

Have you already had surgery?  If not, you should go in for neoadjuvant trial of some kind (ie, some drug to go in you before surgery, a few weeks later, doctor remove the tumor and see what the drug did).   Better chance for you to save your breast.   Fast way for the doc to see whether a particular drug is effective for you specifically.

http://clinicaltrials.gov/ct2/results/map/click?map.x=159&map.y=165&term=neoadjuvant+breast+cancer&recr=Open&no_unk=Y

PM me with your location if you like.   Good luck!

I'm assuming you did a PET or bone scan or something that eliminated the possibility of mets?    

You have a big tumor and node positive.   Are you sure you are stage II not stage III?  

Given your age, I'd think AC would not harm your heart.   But given your tumor's low grade, AC may not work at all.   So if you use AC now, you just emptied your bullet case and hit yourself badly and possibly increased your tumor's drug resistance.   Taxol is the same story, but somewhat gentler than AC.

If you haven't done surgery yet and really want to join a clinical trial, neoadjuvant clinical trial is the best way to go.   So 1 or 2 doses of some drug to see whether there's any dramatic effect and possibly reduce your tumor size to do a surgery with better margin and better chances down the road.   

If you already had surgery, then it's your call for ACT or Taxol only or hormone therapy.   There will be much more effective therapy for hormone positive stage IVers approved later this year (palbociclib that beats all other therapies, chemo or not), so in case you are actually already metastatic, you could afford to use hormone therapy and wait for palbociclib.   Save ACT for the days when you really need it.   Just my 2 cents.

Best of luck!

I had AC x 4, three weeks apart.  I was given a MUGA scan (69%) before treatment; I'm 64 years old.  The only side effects I had were fatigue and a bit of indigestion towards the end of the course of treatment.  The indigestion issue is because the fast-growing cells that line your stomach are also being clobbered, like fast-growing cancers (and hair).  The indigestion was cured overnight by an over-the-counter heartburn med with omeprazole.  A/C chemo doesn't seem to come with bone/joint/muscle pain, nor have I heard of anyone having finger/toe nail problems, although my fingernails do have exactly 4 little white lines across them, not raised or brittle, which are slowly growing out now and being filed off.  Nausea can be bad if they can't line you up with a medication that will work (the problem is sometimes insurance companies do not want to pay for the higher-priced anti-nauseas).  However, all of these chemo drugs carry nausea and fatigue as side effects.

When I had finished, my MO wanted to start me on Taxotere.  I refused.  One reason is that the A/C had just about destroyed the cancer except for a wee 3mm bit left over from what had been the larger lump.  Everything else was clear of cancer -- margins, nodes, etc--  so there was no extreme reason to take another  chemo drug which could conflict with and most probably worsen my Type2 diabetes.  I certainly didn't need neuropathy, I certainly didn't need any form of damage to my feet which could lead to amputations, and for myself, I just didn't need the pain, or the possible permanent hair loss.  My GP and Internist agreed.  However, if the A/C had not done as well as it did, I would have had to take the risk with one of the taxanes (Taxotere, Taxol, etc).

Shannah, I know it is a very difficult decision to make.  Whatever way you choose, I hope you do wonderfully well and stomp this cancer monster.

EDIT:  I forgot to mention I did have to have 2 Neulastra shots to bring up my white blood cell count when it dipped just a hair below the normal range; my onc didn't believe in taking any chances with this old woman.

Shannah, I was 43 when diagnosed and had AC/T, and more than a year out have no issues.  I did neoadjuvant chemo, and even though it was lower grade and highly ER+ and PR+, my tumor did shrink down to the point where it couldn't be seen at all on my pre-surgery MRI.  This allowed for a much less invasive lumpectomy, and also helped me feel good about the chemo being effective.  If it killed the cancer in my breast, then surely it also killed any rogue cells that were floating around!  Like ruthbru, I was much more worried about not being around at all then the very small chance of long term effects from chemo.  One day at a time!