ACT Therapy and reproduction

KGB1985 · August 2014

My 29 year old wife was diagnosed with Stage 1, Invasive Ductal Carcinoma a few weeks ago. She had a lumpectomy and a 1.3 cm tumor was removed with clear margins and 4 sentinel nodes were negative for cancer cells. It was triple positive and a grade 3. She starts her ACT chemo therapy next week. The doctor told us she would do 4 treatments of AC every other weeks (8 weeks) and then Taxol every week for 12 weeks (lowering the dose each week). My first question is does this seem mild, moderate, or severe as far as therapies go for her situation? And what do you know about ACT's affects on a woman's fertility?

Secondly, we do not have children yet and we both really want to. We had being seeing a fertility specialist for a few months before all of this occurred. We went through a very fast egg retrieval process but it did not yield a great deal of eggs and only two became 1 day embryos (they are one day old today). I wish I had asked the oncologist this, but I didn't want to seem more concerned with our future children than my wife's health. My second question, what type of risk would we run if we delayed chemotherapy for a few months while we worked on fertility issues or even just one month to attempt another retrieval? How crucial is to start chemo immediately when not spreading had occurred to the nodes, etc?

Moderators · August 2014

Hi KGB,

We're sorry to hear about your wife's diagnosis, but we're really happy you found Breastcancer.org. We're sure you'll find this a helpful and supportive place for both you and your wife.

While you wait for answers from your fellow members, you may be interested in checking out a few pages on the main Breastcancer.org site, including:

Also, if you feel you need support from other Caregivers/Family members in your position, you may want to reach out to our For Family, Caregivers, Friends and Supporters forum.

We hope this helps! Please keep us posted on how things go...

--The Mods

fd1 · August 2014

Hi KGB - I did some research on this as this was exactly the treatment that I had at around the same age as your wife (31). I don't have any links but I read that this combination of drugs is one of the least likely to leave you infertile. The chances of it putting you in permanent menopause at your wife's age are quite low.

My fertility clinic suggested that I also receive Zoladex or Lupron shots during chemo to protect the ovaries although at that time there were no thorough studies to support it. These drugs put you into temporary menopause by shutting down the ovaries and there was speculation that this would protect them from the chemo drugs. I am not sure if any research has proved or disproved this treatment to date but you could speak to your fertility doctor or your oncologist.

I stopped my Lupron shots after chemo. It took a year for my period to return after that. My doctor then prescribed me Zoladex as an additional adjuvant therapy with Tamoxifen. I'll stop taking both in a year or so to try for babies!

Best of luck - the fertility felt like adding insult to injury and is very difficult for both the patient and her husband! I can totally relate.

SpecialK · August 2014

I am so sorry that you find yourself posting here and that you and your wife are facing this issue at such a young age. The most important aspect of the information you provided above was that your wife's tumor was triple positive. That means she was Her2+ in addition to having positive hormonal receptors, is this correct? If so, it is the Her2+ piece that drives the chemo decisions. Her2+ breast cancer is aggressive and should be treated aggressively, and there are a number of regimens that oncologists use. Adriamycin/Cytoxan, then Taxol and Herceptin - with the AC given dose dense every two weeks, than the Taxol given weekly with Herceptin, with the Herceptin continuing for the balance of the year is an appropriate and usual treatment. I have not seen anyone get a declining dose of Taxol though unless they develop unmanageable side effects. Some docs who worry about the cardiac issues with both Adriamycin and Herceptin (this is why they are given separately with AC-TH) and will use Taxotere with either Cytoxan or Carboplatin and Herceptin, given for 4-6 cycles every three weeks, then Herceptin continues for the balance of the year. Some docs are now using weekly Taxol and Herceptin only for smaller masses that are Her2+. Whether or not chemo has an effect on future fertility is individualized, and hard to predict. There is an optimal window of opportunity for chemotherapy - it used to be thought that 8 weeks from the time of surgery was the outside of the envelope, but recent studies have shown a shorter time has a better long term prognosis. It would be hard to find an oncologist who would administer chemo a few months after surgery, particularly for a Her2+ patient. The purpose of administering chemo is to prevent distant metastasis - and while it is great that your wife's nodes were negative, that alone is not always indicative of a lack of danger, cancer cells travel by a number of pathways. Wishing you both the best.

Quasi · September 2014

I quickly found myself in a similar situation, I am 36 (35 at diagnosis) and only have 1 child, I went through egg harvesting and my doctor had a protocol for cancer patients, generally they will try to control ER levels of the patient while trying to induce egg production, try to talk to your oncologists about delaying chemo for 1 more cycle of harvesting, if that is not an option then try the lupron shots I know that some women have had success with them, I don't know about ACT as I had FECD, but you have a lot going for you as is, your wife is very young which increases her odds of being able to conceive once all the treatments are over and it is deemed safe for her to try, also saving fertilized eggs gives your future IVF a fighting chance. BC is very tough for everybody but more so for younger couples because of conception issues, find a fertility doc who has worked with cancer patients, I believe this is key to finding a solution that will work for you. Good luck!

KGB1985 · September 2014

Thanks for the replies. I could've sworn I posted a reply the other day but I don't see it. Yes, the triple positive means both ER/PR were positive as well as HER2.

An update on the egg retrieval: We decided to go ahead and fertilize them just to see what we would have, not to mention they are more stable this way. We only got one embryo to freeze for future implantation. But hey, one's better than none. Only 5 good eggs were retrieved through the process so they said we were lucky to have gotten the one. She did not respond well to the all the meds that were supposed to make her have a bunch of viable eggs. So there is an underlying problem here with fertility that I doubt chemo is going to help very much with.

She starts chemo tomorrow so I'm past the point of asking if should be delayed. The tumor grew quite a bit from diagnosis to surgery so I feel like it's something we should get started on. We have one embryo and hope that we'll be able to try again naturally after all of this. Thanks everyone, this helped alot!

ACT Therapy and reproduction

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