Chemo choices: A+C vs T+C

Hi Swami:

I am sorry to hear that. There is a lot of experience here on getting through chemotherapy and endocrine therapy.

"TC" is docetaxel and cyclophosphamide.

"AC" is included in a variety of different regimens (see some examples below). Are you sure the recommendation was for "AC" alone?

• Dose-dense AC (doxorubicin/cyclophosphamide) followed by paclitaxel every 2 weeks

• Dose-dense AC (doxorubicin/cyclophosphamide) followed by weekly paclitaxel

Others:

• Dose-dense AC (doxorubicin/cyclophosphamide)

• AC (doxorubicin/cyclophosphamide) every 3 weeks (category 2B)

• AC followed by docetaxel every 3 weeks

• AC followed by weekly paclitaxel

Do you have an appointment scheduled with the MO to discuss the nature of the risk estimates from the Oncotype report in more detail, get a copy of it, and discuss the treatment options further? If not, please request an in-person appointment.

You need to be clear on the details of the regimens, and obtain a reasoned explanation of the basis for why the MO prefers one regimen over the other in your wife's particular case. A phone call is not adequate.

BarredOwl

When my MO floored me with the news that I would need chemo after all, she did not describe the different regimens or offer me any choice. In fact I had to ask for the names of the drugs, she was not offering that info. Anyway, she said that there are two kinds that are equally effective, and the only reason for choosing the one for me (TC) was because the other one is higher risk for heart damage, and I have a strong family history of heart disease. After researching it myself, I presume the "other one" she was referring to was adriamycin.

seems strange that an MO would even give you a choice. Isn't that what they went to med school for? Puts a big burden on the patient to choose. You don't say what diagnosis she has but with that high of a number she must have nodes involved. The Dex is a steroid, I believe, to counteract reactions to chemo

Strange an MO would offer a choice. She should have an echo done before starting chemo to make sure her heart is good as chemo like Adriamycin can affect the heart. Had I been given the choice I have no idea what I would have said so I'm glad my MO looked at my #s and said no choice but do chemo and rads and she had me do Adriamycin/Cytoxan and then Taxotere. I asked why Taxotere instead of Taxol and she said in her busy practice, Taxotere SEs are less dibilitating than Taxol. For me I had hardly any SEs on Taxotere and my hair did come back. As stated already, ask MO details. It's so individual as they look at your age and overall health as well and not just the tumour alone.

If your wife is ER+ then she'll likely be offered hormonal therapy which brings down the recurrence chances. Unfortunately there is no such thing really as low chance because many of us who had a low chance of getting cancer anyway are here on this board. Make decisions the best you can and all you can hope for is NED forever. GL

I had T/C for the same reasons as Jennie93 describes.  It made perfect sense to me.  However, I was not warned about the possibility of permanent hairloss from Taxotere and I'm one of those women who have permanent hairloss.  This is a big deal.  You should ask about it.  Of course, you may be told that your oncologist has never seen it happen in all of his/her years of practice (because that is what they all say).  Well, they sure seem to be seeing it more and more now!  Anyway, IF I had been warned and IF I had known that Taxol was another option, I would have chosen Taxol.  Beats being bald forever, believe me.  No matter what chemotherapy is offered, they all come with their own set of side effects, both long and short term.  I would likely not have taken the risk of heart disease from A/C because of my family history and blood pressure and cholesterols issues.   I probably have taken the risk of permanent hairloss from T/C, but I feel strongly that the options should have been described to me and that the decision should have been mine.  We are given all this information at a time when we are vulnerable and frightened, so it is always good to have a fresh set of ears and the ability to ask questions and get honest answers.

I did dose dense AC with Neulasta shots. Everyone's experience is totally different, but I did okay during treatment. I took the anti-nausea medication religiously, felt like I had a slight case of the flu but was able to work full time, do everything I had to do & most of the things I wanted to do too. If she can exercise (at any level, even if it's just walking around the house in a circle) that will help her feel better. I did not have any permanent long term after-effects.

Yes my oncodx was 34 and i was offered ac & taxol or doctor said we could do longer cmf. There are choices but to get the risk reduced it requires strong chemo. CMF is the easier chemo. My chances were 23% vs 15% with chemo. But those risks are using tamoxifen. If your wife can get on AI drugs the risks are lower to start with.

I chose no chemo against my mo wishes and took anastrozole then exemestane it has been 5 years and I havent had a reoccurrence. I wasnt willing to take chemo, the risk to my health was unacceptable. But chemo does kill cancer cells but so do AI drugs.

hi Swami7774, I was offered a choice of chemotherapy: TC or AC+T

TC chemo was taxotere and cytoxan, 6 infusions, three weeks apart.

AC+T chemo was adriamycin and cytoxan, 4 infusions (I think), then 12 weekly infusions of taxol.

Everyone's situations are different. I have a family history of heart disease so went with the TC chemo.

In my cocktail was the dexamethasone, a steroid to prevent allergic reaction, and an anti-nausea drug.

My blood counts stayed high enough I didn't need Neulasta. Yes, I lost my hair but it came back.

There's no doubt that chemo sucks but it may not be as bad as you fear. Best wishes! ((Donna))

Hi

I wasn't offered a choice either but I started doing my own research and I am pushing for the T-C regimen , since I have a strong family history of heart disease. I have heard oh it's fine , no it's not they can't predict who will have cardiac issues from A-C. One doctor finally said its the standard regimen and that's what we do.

Have you gone for a second opinion? We are currently on our third and they are more upfront and patient involving than the other two I saw.

I saw someone mentioned a cold cap. The one opinion we went to said they would absolutely refuse to allow their patients to wear one so please ask that also if she is interested. As the nurse told me if they aren't use to using it they will just say not allowed

My labs were good thru chemo as well. The thing is though you don't know if it'll suddenly plumet, causing delay in your next round. So you have to weigh the plusses and minusses of Neulasta, even if you've had good #s so far..

On the other hand, the group I was in for chemo experienced a lot of issues with neuropathy on Taxol. Taxotere tends to have less severe side effects over all, which I what I did. And all my hair is coming back. There is no one way to go be all as everyone is different. It's about like a coin toss this Taxol v Taxotere.