ACTH Vs. TCH

My oncologist recommended TCH since I was node negative (ie there is no cancer in your lymph nodes). He said he only does ACTH for node positive women. However, given your age, it might have some bearing on the treatment.

Here is a link to the study mentioned above: http://www.cirg.org/NR/rdonlyres/eno7mvfpseiqi5g3pernz37zzeavin4f7o5hos4zwlu76clvwkfluhskusgcmnqvyqk7ksb4gdimpmt6xcmkxppnqce/945_GS5_02_+abst+62+Jan+10.pdf

I refer to it a lot for reassurance. I was given ACTH by my onc at MGH but they reversed the order and did TH, surgery, then AC and I had a pathologic complete response with just TH. I'm still glad I did the ACTH though since the DFS incidents are slightly better in the study. A new drug has also been approved, Perjeta so that is an option too! It was not available when I had chemo.

Sorry, I know--it is confusing. I think it helps to have a doctor/institution that you trust. I started at a local hospital and then went to a major cancer center and trusted MGH's recommendation (both hospitals recommended ACTH but in different orders). I was of the mindset that I wanted the most aggressive treatment at the time and was worried I still wasn't getting enough with ACTH. I think what you end up deciding will depend on stage. For me, I wanted the highest DFS % which was ACTH regardless of side effects. I met a woman who was older than me and had a lower stage and she was given 3 options, TH, TCH, and ACTH. She ended up going with TCH. As far as side effects, my understanding is that the biggest risk with A and H is that they both can cause heart problems so TCH is less cardio toxic. So far, my heart function is fine. Also, ACTH does take longer to complete and I always thought the side effects with ACTH were worse but I don't know! My most notable side effects with TH were hair thinning/eventual loss, a lot of GI issues-mouth sores, UTI infections, throat issues. But, I still had energy and could do everything I normally did. My side effects with AC were brain fogginess, sluggishness, loss of appetite, constipation (stay on top of it!). I must have chemo brain because I really can't remember! I thought AC was the worst part but both AC and TH are doable and before you know it you won't even remember.

I was stage IV from the start with liver and bone mets. I did TCH. My onc did not want to risk any possible heart issues with Adrimycin since I will need to be on Herceptin forever and Herceptin can affect your heart too. TCH did the trick for me as I was NED after three cycles and I have stayed NED now for over 5 years. Side effects for me were fatigue that hit about 4 day after chemo, stomach/gi issues, taste changes. I worked full time throughout and missed only a couple of days here and there mostly due to diarrhea.

Jennifer