Italy Chick. I did 4 x TC and H for a year. I think my MO thought 4 was sufficient in the event there were any rogue cancer cells but my good margins and no nodal involvment likely played a roll too.

Italy - I am also thinking six over four because you are not receiving an anthracycline (Adriamycin), which is more common with ER/PR- patients.  I don't think you will really find much in the way of trial or study data regarding differing numbers of infusions, I don't think it has been looked at that closely.  I feel like most of the decisions for four infusions are made due treatment SEs, or because the onc feels that there is less potential benefit due to tumor size and clear nodes.  The NCCN guidelines (linked below) show TC for 4 cycles as an accepted regimen for Her2- stage I & II tumors on page 42, but for Her2+stage I&II, which technically you are being treated for despite the borderline test result, the regimen is for 6 cycles on page 44.

http://www.nccn.org/patients/guidelines/stage_i_ii_breast/index.html#46

Just like a dog chasing its tail - the SOP is usually based on trial data, and what may well be true is that the trial data were for 4 Taxotere Cytoxan, and 6 Taxotere Carboplatin, but we can't find trial data of a head to head of those two regimens!  Typical!  You make total sense not to want to overtreat, and maybe the best choice is to do 4, and reassess - if you are hanging in, keep going. I did 6 TCH, but I had a larger than 2cm mass, was node positive, and most definitely Her2+++, so for me the road was clear cut.  I think the reason Cytoxan is usually limited to 4 doses - as it is when combined with Adriamycin in DD infusions - is that it is somewhat more toxic than Carboplatin, which is excreted more readily, and better tolerated for 6 infusions.

Italy - round 1 was tough, but I had five surgeries before I ever started chemo, which included BMX with TE, complete axillary clearance, then 2 skin excisions, and then the removal of my left expander, so I was trashed going in.  Rounds 2 & 3 were much easier, but I think it was because I was farther out from the surgeries.  Round 4 I was tired - but ok,  had figured out how to manage the SEs.  Round 5 was my worst, but I attended a wedding two days after my infusion and had company - I did too much, and really fatigue was my worst SE.  After each of the first five rounds I had at least a week of the Big D, so I worked around it by arranging not needing to leave the house except for Neulasta and a blood draw - it was enough to keep me home where I was comfortable, but not severe enough to need extra IV fluids or even meds.  I managed it with diet and my own hydration. Round 6, I waited - and nothing - felt great - no D (yay!), although tired!  So, for me, round 1 & 5 were the worst, but without the wedding I think 5 would have been ok.  My subsequent Herceptin only infusions were easy-peasy, except they sped up my first H only to 30 minutes (it had been 90 when combined with chemo) and I had awful bone pain for several days - and I had never had any at all with chemo.  I asked to slow the infusions back to 90 minutes - problem solved.  I did return to work less than 30 days after my last chemo, but only stayed a month due to needing more surgery, fills, PT - so I resigned.  I was dealing with patient care and did not feel like I could devote my full attention and didn't want to risk making a mistake, plus the department I worked in was crisis driven and pretty chaotic.  I never suffered from any cognitive issues, or what I would consider any serious SEs, throughout chemo though.  I attended a weekend-long birthday party out of town three weeks after round 6 - no problems.

Italy - that is what I would do in your shoes, knowing that if you encounter issues you have the option of stopping.  You have done very well, so keeping fingers crossed that continues for you!  It is common for fatigue to increase the farther you go so don't be surprised if that happens - just pace yourself, and many have some burning or muscle fatigue - particularly lower body, and sometimes previously normal activities will make you out of breath quicker.  This is a result of decreased hemoglobin - your muscles are not receiving oxygen as readily, and this is a normal side effect since blood cells are affected.  I recommend upping protein intake to help your body manufacture more red blood cells.  This feeling improves right about the six week PFC mark, most see a dramatic increase in energy and a lessening of any burning muscles in their legs.

Hi Italy. I did 6 TC treatments as I am strongly Her2+ and had one node involved. I am currently continuing with Herceptin only treatments through the end of October. My 'worst' treatment was #4. #5, was actually not too bad. But I think that was partially due to my MO lowering my steroid dose for the last two treatments. That really helped to ease my GI symptoms. The main thing I remember about #6 is that the fatigue hit me stronger and lasted longer. I still have some residual joint and muscle pain 11 weeks PFC, but I don't know if that would have been different had I only had 4 TC treatments.

Good luck with your decision! This forum is a great place for questions as there are so many knowledgeable Ladies here.

omg why is something line salad forbidden! I making a broth soup now. The veggies are super soft. I am sure the scan is scary as hell!!! I had a ct of the chest as work up for something else and all this stuff came up in my lungs!! Said nodules. I FREAKED OUT!!! Turns out it was old bronchitis infection. I would like to do a scan one day. It would relieve me of a lot. I have white coat hypertension. I cannot imagine my BP day of and following until I get results. Plus I can view my results via iPhone app after the dr releases it.But it's more nerve racking I find.

I'm gonna inquire about a scan. I'm sure Onc will say it's not necessary. Or that ins won't approve based on Dx. But I imagine it would be at some point as my treatment is to prevent recurrence.

You do have a tough decision bec u wanna be at peace with it and not haunt you. Perhaps see how u feel after 4 or just do 5 which is a compromise.

Italy - what is making you decide against rads?  Is it something specific?  Have you had a consult with a RO and asked about your individual percentage of risk reduction - or about Canadian Protocol rads for a shorter time period?   I think you are correct in thinking that your ER/PR- is what bought your ticket to the scan.  The lack of adjuvant treatment means they need a true picture for treatment planning.

One thing I wanted to mention is for anyone noticing neuropathy - I took 30g of L-Glutamine and a B6 capsule daily during chemo to try to minimize neuropathy - I had numbness and tingling of hands/fingers, feet and weirdly, my tongue, which resolved after each treatment until the halfway point.  The numbness stayed but I kept taking the supplements and within about 90 days of finishing it was gone.  This was very mild and did not keep me from doing anything except wearing very high heels for long periods.

OK - that makes sense.  We all have to weigh the pros and cons of each aspect of treatment.  I did not have rads either - I had ALND, and asked both my BS and MO if I needed rads - both said no.  Twice, because I asked each of them again at a later point to see if I would get a different answer, lol!  I was happy they were consistent with each other, and by themselves.  I had a discussion with a RO at an NCI center a couple of years later while at a consult with a friend and he said he would have recommended with my stats.  There is no one right way to do any of this.

Special K thanks for the info on neuropathy. I'm praying it does resolve for me too. I do t have L-Glu but a B complex which has the 6. I grew weary of pill popping at times and now is one bec I need to eat with my supplements. Not big on eating bec of funky guts. I recently put my supps back in my pill dispenser. Guess I'll add yet another. Also R and L-acetyl Cartinine and Alpha Lupotic Acid resolves neuropathy. But I've read that as an anti-oxidant can give cancer cells an escape channel (?) Meanwhile Sloan Kettering offers low cost acupuncture at $50 after initial consult. I'm looking fwd to that!

Thanks! You're very encouraging. A much needed voice in this world.

maryjc - I took acetyl l-carnitine during chemo (in 2011) but it is no longer recommended during chemo based on some studies more recently completed. I have continued to take it after chemo also for the brain benefits. Take the L-glutamine in powder form - I did 10g 3 times a day - dissolved in a cold drink. Don't mix the powder with food - trust me on this, lol!

maryjc - don't worry - the doses in the studies were pretty big, it is doubtful that anything you took could do harm.  I took 1500mg, but later research indicates that is more than the body can absorb at any given time, the optimal dose is 500mg.  The study doses with negative effect were 3,000mg - which is a boatload!

Italy - in those big doses, the study cited used 3000mg, which is a lot.  Optimal dosing is 500mg a day.