Stage 2A, 11mm, Grade 3, 1/17 Which Chemo Regimen?

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ThinkingPositive
ThinkingPositive Member Posts: 834
edited November 2014 in Chemotherapy - Before, During, and After

Need to make my decision...had two regimens thrown at me and was told first visit that ACT was standard of care and then there was TC....I have been struggling with it...ACT vs. TC. Second time I was given the NCCN guidelines for stage 2 invasive ductal carcinoma and shown that both were regimens that were used. I already have my date to have port placed for Monday, I have an echo scheduled for Wednesday in case I decide to go ACT regimen....now just need to let them know which regimen by tomorrow so I can get the chemo scheduled. Really having a tough time with this.. heart risks with the ACT bothers me, but since I am grade 3, that means its pretty agressive..I am assuming thats what spread to the lymph node, which makes it aggressive as well...but it didn't go any further...the report did say extracapsular invasion, don't know exactly what that means.. But the other 16 nodes were negative.. I did have a mastectomy and the resection margins were negative, 10mm or more away on all margins... The ACT is 4 treatments every two weeks then once per week for 12 weeks...the TC is 4 treatments every 21 days.. Has anyone had to choose between two regimens?? If anyone can give me your reasons for choosing the treatment you chose it would be so helpful... I don't want to make the wrong choice... I will also be on hormonal drugs for 5 years after and possible radiation after chemo.

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  • doxie
    doxie Member Posts: 1,455
    edited November 2014

    Since you mention anti hormonal drugs you must be ER+? Was your tissue sent for an Oncotype score? This can help. Also the % ER+ and PR+ can help with the decision. How close are you to triple negative? How much will anti hormonals help? The higher ER+ and PR+ the more effective.

    Even with a spread to your lymph node, your cancer may not be as aggressive as you think. Mine at a grade 2 with no nodal involvement is more aggressive than others with grade 3. Grade 1 cancers spread to the lymph nodes but are not aggressive enough for chemo.

    My understanding is that ACT is a stronger chemo. I had TC and my MO preferred that over AC. Stronger does not mean more effective. You only need strong enough. Personally I'd avoid ACT. One less drug involved, avoiding a heart damaging drug, and one more to hold in reserve is the unthinkable happens down the line - recurrence.


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  • Sjacobs146
    Sjacobs146 Member Posts: 770
    edited November 2014

    I'm actually a little surprised that they gave you a choice and are expecting you to choose. I assume that you are not an MD. There are so many factors involved, did the doctors give you the pros and cons of each? Have you thought of getting a second opinion?

    FYI my doc says 10 years of Tamoxifen. I personally know someone who has a recurrence one year after stopping Tamoxifen. But it might depend on your age, I am only 48

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  • doxie
    doxie Member Posts: 1,455
    edited November 2014

    Sjacobs146,

    Rather surprisingly many of us were given the options and expected to make the choice. This happened with my BS, MO, and PS. Not with the RO though. I spent hours researching, but would have done that anyway. I feel for those who are not so inclined. It's a very heavy burden.

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  • ThinkingPositive
    ThinkingPositive Member Posts: 834
    edited November 2014

    doxie, I am ER+98%, Progesteron 66% and HER2 negative. Ki-67 was 28%. When they say Grade 3 with lymphovascular invasion, but there were clear margins..10mm away on all margins, I am thinking thats a good thing, but since its grade 3, which I think to mean rapidly dividing cells, something from there obviously went to the node.. and fortunately no other nodes...but the node had extracapsular invasion.. I am reading that to mean it got out but never made it to the other nodes... my fear is what is floating around if anything in my body is rapidly dividing and does one chemo regimen work better towards that than the other. I have already spoken to my MO twice and am going back today to talk with counselor for second time, Then I need to let them know which chemo regimen..once the word aggressive got into the mix thats what I am focusing on and not sure if I am thinking it incorrectly.

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  • formydaughter
    formydaughter Member Posts: 213
    edited November 2014

    I chose TC (with H because I'm HER2+). I was afraid of ACT causing leukemia, since I have family history of leukemia. I also have 2 friends who ended up with leukemia from A. They say that it is rare, but it was too much in my little world. Even though ACT is more toxic, getting through TC is still tough. I had a friend going through ACT while I was having TC and we both had SE challenges that were similar. My MO said he would usually prescribe ACT - hit it hard particularly with a younger patient (I was 40), but not where there is leukemia in the family tree.

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