TCH treatment for HER2

cindbo · December 2006

I am interested in hearing from others who have opted to treat with TCH vs A/C. I am new to discussion/chat, thanks for hanging in there with me.

janet11 · December 2006

I'm on TCH -- will have chemo #6 (last one) on Dec 27.

Janet

Chelee · December 2006

I am a stage IIIA, her2/neu 3+++, er & pr positive, 5 of 16 positive nodes and for what ever reason I was NEVER told about AC. I was told I would be on TCH. (PERIOD) I wasn't told my options? No mention of AC at that time.

My onc must of been concerned about the cardio risk since AC is hard on the heart, and herceptin can cause problems. They have found that TCH is almost as good as AC. They just had the big yearly breast cancer conference in Texas...and I am not sure...but I *think* they are leaning now towards TCH now. Its had great results with less side affects and problems.

I finished my chemo in June....just doing herceptin at present. So far as I know from my scans...I had a complete response from TCH. All my ECHO's on my heart have come back great. I started at 70%...and my last ECHO was 70% again. No telling what it would of been with AC?

Let us know exactly what you want to know about it? Be glad to answer your questions.

Chelee

cindbo · December 2006

Good info. Yes the latest research out of UCLA was presented by Dennis Slamon. I live in the Seattle area and the docs up here still still lean toward AC, I think b/c it has been used some commonly, even when used alone it has some cardiac issues. The herceptin can compound it, so there is that extra caution. I think the results still have some favor toward AC, but you have to factor in the risk to the heart. The data is suggesting that might make a difference. The heart risk is still small but if you get hit with it, my understanding is it can be fairly serious and may even prevent continuing on herceptin. There is another marker called TOPO2. Do you know if they ran that on your pathology? They did not on mine and I have asked, but I am not sure as of yet if my onc will be able to get it done. Currently it is not commonly done, but I think the research coming out it will become more standard. I guess there is some indication of TOPO 2 ampification that AC could be beneficial. We have so many options, that we didn't have before herceptin, so I am very grateful for that. Glad all is going well with you. I am starting to lose my hair, just in time for Christmas and my one finger nail feels like i hit it in the door, a little nervous about losing it. I have tea tree oil and they had me soak my fingers in ice during treatment. I also put on some Sally hard as nails. Did you take any glutamine powder during your taxotere?

Chelee · December 2006

I wish they would of had that TOPO II test when I was DX. I would of felt better about my onc choice of using the TCH. I would almost like to have it ran now even though its after the fact to see if I was TOPO II positive or negative out of curiousity? But they would probably tell me no...insurance wouldn't cover it after the fact. From everything I have heard...that TOPO II test should be the standard protocol now when women are DX. It would only make sense since its proved to be very beneficial in choosing trt. Any time you can avoid AC its always better. Less risk of course.

But I am thankful for herceptin as you are and so many others here. Its made a world of difference for so many of us.

So sorry to hear you are losing your hair...it doesn't take long. Once it starts falling out...you might as well cut it off. Its a bummer, but it does grow back. I missed my eyelashes and eye brows more then my hair at times. Silly...but your face looks pale with no make up on the eyes. What we have to go through.

As to that taxotere...that was HARD on my finger nails. Three nails on each hand turned black and blue. They started to raise up and finally fell off. Lost half the nails on those fingers. The just my TWO big toes turned colors and had a hard time with them. The others toes were fine. So good luck...hope you don't lose yours.

And no, I did not take any glutamine powder. Everything I asked my onc if I could take...he said NO. He acted like all of it could interfer with my chemo. So I didn't take anything. I did hear the ice during trt works..although I never personally tried it. My nails seemed fine through most my trt so I thought I was going to get away with it. But around the 5th or 6th trt...the started turning black on me. But I got through it all...thats all I care about. Hang in there...sounds like your doing ok so far. Like they say...its not fun..but it is doable. I thought they were kidding me when I started...but I made it to the other side just fine.

Wishing you happy holidays and a aweseome New Year.

Chelee

jan125 · December 2006

If you mean taxol, carboplatin, and herceptin, then I call that coctail a miracle!!!!!

I was dx this May (29 years old) with stage 4 bc. bone and liver mets.

Now they call me NED, there is a smjall spot on my liver where the biggest tumor was, but they think it is scar tissue (this is from the CT with contrast)

My PET/CT scan was clean. Will continue herceptin and hormonal therapies as I am er/pr+ and her2+...

I got my gift early this year, NED is great, may Santa deiver him to all!!!!!!

daisybell · December 2006

I was not given a choice about TCH. I think the original data showed that it was slightly less effective than A/C TH, but a good choice for people with existing heart problems. As far as I know, the TOPO II test is not standard and I'm not sure how many labs are even offering yet. I work in a lab where we do the FISH for Her2 and have not heard anything about TOPO II yet, so it may still be experimental.I read the newer data on TCH on medscape and it said that TCH may be as effective as A/C TH with a MUCH LOWER risk of cardiac problems and they have seen no risk of secondary leukemia in the TCH group. That would be a real kick in the pants to go through all of this and end up with leukemia. I did the AC and am half way done with taxol, herceptin. I'm not sure why some oncs use taxol and some use taxotere. So far the side effects aren't bad. My MUGa before AC was 76% and after was 73% which is considered to be the same. Hope it stays that way. See, in a way TCH nay be better, because if you do have a heart problem it could prevent you from finishing herceptin , and the herceptin is probably more benficial than the AC.

Sue

lucy59 · December 2006

Hi. I have just begun on TCH. I was told it was easier on the heart. Second treatment will be tomorrow. My blood counts dropped after the first treatment so hoping that doesnt repeat again but the first one was a five hour infusion and this one will be much less. Herceptin alone seems fine and I too am greatful for this. Hair wasted no time in falling out right after first treatment but after the initial shock am dealing with it pretty well. Will have to wait and see about the nails . I did have to trim them very short and they have begun to break. Oh well - when all is said and done we will be pretty darn tough ladies. Merry Christmas. Love, Lucy

Chelee · December 2006

Lucy, Don't worry about your counts dropping so quickly. Thats pretty normal with any of the chemo combo's. Thats why every time you go in they run a CBC and keep an eye on your counts. They will give you Neulasta for white count to bump it up if it takes a dive...and Procrit if your red blood count drops too much. They are pretty good about staying on top of all this. Also towards the end your platelets can drop...but they can handle that too. These days they have it pretty well covered.

On another note...your right...herceptin itself is not bad at all. I am close to finishing my year of herceptin and its cake after the taxotere and carbpotin.

As to your nails...you will find they will get pretty thin, weak and won't grow very well. But its a small price to pay in the long run. I did have a couple nails get black and blue...lost a couple. I hear some women put ice on their nails during chemo and it prevents that from happening. I didn't know about it until after the fact.

Good luck on your second treatment tomorrow. Since you got through your first one...that initial worry and anxiety about it all settles down a bit because you know pretty much what to expect.

Good luck...after tomorrow ONLY four more to go. Hang in there...this too will pass.
Sending you warm healing thoughts and prayers.

Chelee

cindbo · December 2006

I have had a harder time w/ the TC, maybe it is b/c it is my second. Lots of mouth and throat goop, biotene mouthwash helps a little. I started w AC but switched for the heart reasons, I am nervous about adding the herceptin next time, how that will add. I had been told that TC would be easier than AC, but that was not my experience...I am feeling a bit better today. I go in for my G shot here in an hour. Last time they gave it to me on my second day, this will be 7 day wonder if that makes a difference? Hope you are enjoying the holidays. c

lucy59 · December 2006

Hi girls: I had my 2nd tx today and it went well. They said I didnt need the Benadryl. I am wired from the Decadron,bad taste and have flushed face but other than that doing well. I know I wont sleep tonight from the Decadron and I am afraid of Ambien though I have it next to the bed in case. I will try Tylenol PM first. I dont get Neulasta but this time they sent me home with Neupogen shots daily for the week to prevent the lows I had last time. Nurse said the Neupogen doesnt cause as much bone pain because the dose is spread out daily rather than a Mega dose of Neulasta. I guess all Oncs have different views. My TCh will be 8 tx instead of 6, followed by radiation and Herceptin will continue for the rest of the year. Hope you are all doing well. great to have you here. I get SO much more info here than from the docs. I get to see him once a month for 15 minutes. Whooppee! Onc Nurse is great but she had 8 patients today (by herself) after working at the hospital until 2am last night. Doc is on vacation until January. So we have to be tough on our own. Stay strong. Believe! HAVE FAITH! lOVE, Lucy

janet11 · December 2006

Hi Lucy and all,
Had my last TCH today (#6). FYI: in the last couple weeks, I've started noticing some discoloration on a few fingernails and a couple toenails. No idea if I'll lose them, but it's interesting that it didn't hit until after treatment 5. Thank goodness for people on these forums! Because of reading that this can happen late in the treatment, I knew what this probably was instead of being worried. I still think the idea of losing nails is gross, but what comes, comes! So am not obsessing about it.

I'm looking forward to 3 weeks from now when my taste buds should start improving!!!!!! Am drooling over the idea of eating something with catsup or salad dressing!!!! Yummmm... (*laugh*)

Janet

lucy59 · December 2006

Hi Janet: Glad to see you back here. Congrats on your last. I had my 2nd yesterday. But I am receing 8 so only 6 more to go. Actually last week my tastebuds were pretty good and I ate well. Today (another story). I had read that too about the nails late in treatment. Yippee! Something else to look forward to. I am just adjusting to my baby monkey hairdo. Were your treatments every 3 weeks with TCH? Are you also going for radiation now?

Lucy

Chelee · December 2006

Lucy, Congratulations on getting through your trts. I did the 5 trts of TCH also. And yes...having your nails turn black & blue is a real bummer. I thought I was going to be fine too and it was about the 5th trt and the sixth they were really bad. But...its strange...it was only the thumbs on both hands, index and middle fingers. It seemed worse on JUST the left hand??? (Strange) I had some on the right too...but the left was hit harder for some reason?

But my baby fingers and the ring fingers on both hands DIDN'T have any problems? Again..just the index & middle fingers discolored. I wasn't happy about the thought of my nails falling off. But it took a LONG time and they just kind of stayed discolored and the nails would NOT grow...and the darned nails would NOT fall off. My chemo nurse told me I should just tell people I am going with the Gothic look. LOL But a good two or three months later after FINISHING chemo they FINALLY broke off in the MIDDLE of my nail. Never lost the entire nail...just part of it. Its been six months since I finished TCH and my nails finally look semi normal. They have some ridges in them...but at least they are clear. I THOUGHT I was going to get through it without any NAIL problems. It waits till your almost done and then WHAM.

Anyway...glad your done and have that behind you. I laughed at your waiting till your food tastes good again. Thats what I was waiting for. The entire time through trt food was GROSS to me. Be it the taxotere of carbpotin...I played heck eating. I always had a TERRIBLE taste in my mouth and my teeth felt covered in a coating. The thought of eating was awful. I LOST 42 pounds during my chemo and most said they gained weight. I don't know how? I had to FORCE myself to eat. But your RIGHT...about the third week things are back to normal and you want to EAT anything you can get your hands on. lol Everything tastes so good. Plus you can finally eat all the things that you couldn't for all that time. Its darn right dangerous now for me because I am hungry all the time now. I have to really behave myself.

Hang in there...a couple weeks and you will feel back to normal.

Chelee

janet11 · December 2006

Hi all,
Chelee, thanks so much for the info on the nails. That really helped when in the middle of the 5th cycle, I started noticing changes to some of my nails for the first time.

Taste changes for me started about mid first cycle (about when I got "sewer mouth" which is usually days 5-10 of each cycle for me). That's when my Biotene mouthwash was a lifesaver!!! After that, it converts to "metallic mouth" where things taste ok, but I'm constantly generating saliva because of that metallic taste. Wierd. The first couple cycles, the metallic taste only lasted a few days. After that (remember, the TCH is cumulative), it lasted through the end of the cycle.

From the beginning, anything with vinegar or wine was out for me. Those tasted so sour that things were inedible. And I noticed changes in how much salt and sugar was needed to taste "normal". By cycle 3, it was tomatoes that gave me indigestion (and didn't taste good). There went pizza. Oh, and chocolate chip cookie dough (which I love)-- all I could taste was the yucky baking soda. Drat.

By cycle 4, nothing tasted 'normal' although week3 was always the best. Now I'm finding things that taste good enough to eat and not worrying about the long list of things that don't taste good. Nothing tastes "normal", but "good enough" is fine.

Things that still work:
- Veggies (no sauces or gravies on them) work fine. I blanched cauliflower and made a veggie tray for Christmas (also adding carrots and sliced cucumber). And I enjoyed it. No dips though (*sigh*). They all taste sour to me.
- Meat (yes meat works for me) as long as there're no gravies or lots of spices. A little salt is ok. So a hamburger with no fillers or binders, a steak, roast beef is great. Pork with no garlic or other flavorings is ok, especially with applesauce (unsweetened) on the side.
- Chicken is good, but no sauces (although I've found an Alfredo sauce that works for me!!! Just can't use a lot of parmesian cheese (sour), no wine (sour).
- Lettuce is fine as long as I don't try to use a salad dressing. But it actually tastes good as a TV snack -- no sticky fingers (*smile*).
- Eggs surprisingly taste ok, but bacon now (*sigh*) is out.
- Fruits: berries are ok, citris isn't (a real hardship on me since I grew up in So. Calif and was used to a lot of home-grown citrus.

Anyway, everyone's different, so thought I'd simply give you some things to think about. I'm DREAMING about making a pasta salad (with vinegar in the dressing). And putting catsup on a hamburger. (*laugh*)

All the best,
Janet

atdec05 · December 2006

I did AC + Herceptin, but according to recent interim results released at the San Antonio Breast Conference Symposium, TCH is better for early stage er/pr- her2+ women.

"Of note, TCH (combination of
Taxotere(R)/carboplatin/Herceptin(R)), the regimen without anthracycline,
demonstrated similarly significant improvement in disease free and overall
survival as the AC-TH arm. However, the TCH arm yielded a five- fold
decrease in significant cardiotoxicity when compared to the
anthracycline/Herceptin(R)-containing arm.
These data were presented at the 29th annual San Antonio Breast Cancer
Symposium (SABCS) in San Antonio, TX - USA.
"This trial demonstrates an optimal therapeutic index for these
patients with the use of TCH (which did not include doxorubicin), thus
avoiding the significant cardiac damage related to the sequential use of
anthracyclines and Herceptin(R)," said Dennis Slamon, PhD, MD, Co-Chair of
the BCIRG 006 study and Director of Clinical and Translational Research at
UCLA's Jonsson Comprehensive Cancer Center. "In this interim analysis, 6
cycles of chemotherapy in the TCH regimen provided similar benefit as AC-TH
(8 cycles of chemotherapy in total) without increasing cardiotoxicity. In
addition, no secondary leukemias have been observed so far in the TCH arm
compared to four leukemia events in the anthracycline-containing arms,
although further long term hematologic adverse event follow up will
continue. These data should help influence daily practice with TCH being
considered an option for women with early stage HER2 positive breast
cancer, irrespective of nodal status."

http://www.prnewswire.com/cgi-bin/micro_...mp;EDATE=Dec+18,+2006

cindbo · December 2006

Do you know what labs might run the TOPO2 test?

janet11 · December 2006

From what I've been reading, they may not even bother with the TOPO2 test in the future... if TCH is about as effective with far fewer permanent side effects, it may become the treatment of choice for ER- PR- HER2+. It's certainly going to be interesting to follow this.

Janet

cindbo · December 2006

Yeah there is some suggestion that TOPO2 is more responsive to the anticythralines, I am not sure about ER/PR status, I am positive on both---is that what the tomoxifen is used to treat?

daisybell · December 2006

Tamoxifin blocks the estrogen receptors on the tumor preventing it from growing. It is only effective if you have an ER+ tumor, and it's for premenopausal women. After menopause they a giving aromatase inhibitors like arimidex.
Sue

Chelee · December 2006

Janet, Is the TCH ONLY good for er & pr negitive women? For some reason I missed that. They didn't give me ANY choice/options when I was DX last year. I was TOLD I was going to do TCH. (Back then I knew nothing...I was just scared and ready to do anything I was told.)

I was er & pr positive. (Weakly positive...but positive just the same.) Does it ONLY work for negative?

Chelee

Chelee · January 2007

Seb44, Your the FIRST person other then me that I have heard was given TCH and NOT given a choice. No one told me about the AC option. Everything I read says they are SUPPOSE to tell us all our options rather we choose to do it or not.

But I knew nothing when I started and even if I had I might of still went with the TCH because less risk to the heart. But I would of appreciated my onc telling me about ALL my options.

So NO ONE told you about OTHER chemo options either? They just told you that you will be on TCH...PERIOD?

Side note: You said your not sure why some onc use Taxol verse's Taxotere? My oncologist told me its a "East coast, West coast" thing.

Chelee

prayer · January 2007

I never had the topo 2 test and was told that I needed AC. I asked about taxol and was told that it would only be 1% benefit and therefor it was not sugested. I did however get the herceptin. Is TCH better than AC?

Chelee · January 2007

Prayer, They have done studies of AC followed by TH verses TCH...and TCH has had good results with much less risk to the heart. But they are still leaning towards AC from everything I've read. Even this years ACSO conference had alot of great things to say about TCH...but it seems the standard of care is still AC.

You were told only 1% benefit. Wow...I hope that wasn't the case for me? Like I said in my above post...I wasn't given a choice for whatever reason? I think this TOPO II is semi new. I am not sure they were doing that test when I was DX Dec. 05? But I wish I could have it now even though its after the fact.

Chelee

daisybell · January 2007

Chelee
I had AC followed by taxol and herceptin, I meant I was not given the choice of TCH. The reason TCH may be preferred, especially in women with less than perfect cardiac function is because it doesn't give you the cardiac risk associated with A and then amplifying the effect with H. Also, no apparent risk of secondary leukemia. So it's all about balancing effectiveness with risk. I don't know what I would have done if given a choice, I was so distraught with my diagnosis, which just seemed to keep getting worse. I went to have a mastectomy knowing I had 1.5 cm of invasive area and was hoping that was it, but ended up with 2.6cm and another 0.9cm area and 2 nodes+. I guess the nodes were my biggest dissappointment. Then the fact that it was so aggressive and ER- and Her+, although now I think the HER2+ might not be such a bad thing as long as the ER was neg.
The reason Prayer may have been told just a 1% benefit may have been because of the staging, I think in stage 1 they may just give AC, but I'm not sure. I know that taxanes appear to enhance the effect of the herceptin, rather than taking either alone. I don't think anyone is offering the TOPO II test routinely. So, I have 4 more TH left, then more surgery and radiation (wasn't expecting that either). I've pretty much worked through the whole thing, but am home today with a bad cold!
Chelee-congrats on being one year out, it seems like this is going on forever!

Sue

prayer · January 2007

Chelee,
I think it might have something to do with my tumor size and negative nodes. I was 7mm and node negative so 2/3 onc told me that it would not be a huge benefit to me.

cindbo · January 2007

What is the relationship between ER/PR status and Her2 status? I did not know there was a connection. I am + on both. Yes A/C is still the main stay of treatment for us Her2 neu woman because all of the main studies have used that regime. There is an added heart risk, so Slamon out of UCLA decided to run a trial 3 years ago to compare a non anthracycline w/ herceptin vs. the AC. Most recent shows the two regimes similiar in disease recurrence rates. I did push to have my TOPO2 test run, but there were delays so my chemo has been pushed out until the test comes back in...which should be early next week. If TOPO2 is positive then I will proceed w/ AC, if not then I will follow TCH. Cindbo

janet11 · January 2007

I didn't think there WAS a relationship. I'm ER- and PR-, but HER2 pos. And just finished 6 cycles of TCH.

Janet

cindbo · January 2007

Seb44 referenced the fact that HER2neu might be less of a concern if ER/PR - Seb44 what have you read about that? Cindbo

daisybell · January 2007

Cindbo
If you have to have an aggressive(poorly differentiated) tumor it would probably be best to have it be Her2- and ER/PR+ because there are more treatments available that are effective. If you are ER/PR - and have an aggressive tumor, at least if it is Her2+ you have a target to hit with Herceptin and maybe Tykerb soon. Of course, it's best to have a lower grade tumor if you have to have something.
Sue

Chelee · January 2007

So that means its really bad for me if I understand it because I am her2/neu, 3+++, Er & Pr weakly positive, 5 of 16 nodes, Richardson scale 9 of 9, (poorly differentiated). No wonder my onc never has anything positive to say. Just my luck.

Chelee

TCH treatment for HER2

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