AT vs ACT for Triple Negative

superfilbert · May 2018

Hi all,

My sister was recently diagnosed with stage 1 triple negative breast cancer (1.8 cm mass). Her doctor recommends regular AT (A and T at the same time) every three weeks (in contrast to sequential AC-T or a dose-dense regimen). I'm a bit worried that this is a very light regimen given that she has grade 3 TN which can be aggressive, and is multicentric to boot (the other mass is a 0.8mm hormone positive papillory carcinoma), and about 3 years ago she had multifocal DCIS in her other breast and had to have that breast removed. She doesn't have any lymph node involvement or lymphovascular invasion. She had a mastectomy about 3 weeks ago. I was wondering if anyone is aware of any comparative studies. Her doctor actually wants to use epirubicin which I hear is equivalent to Adriamycin. He also wants her to stay on Tamoxifen, which I find a bit odd.

Any help is appreciated.

foreverfaith · May 2018

Hi there Superfilbert. So sorry your sis is going through this...again. I was diagnosed with triple neg in April. I underwent a lumpectomy because we originally thought the tumor was 1.0-1.5 cm. Which was stage 1, however grade 3. From my first visit with the oncologist he said chemo was in order. After lumpectomy, the tumor was 2.8 cm. My onco had me start dose-dense AC right away. As in the week after we got my path report back after lumpectomy. I will follow my dose dense AC (infusion every 2 weeks for 4 sessions) with 12 weekly infusions of taxol. I had lymphovascular invasion present and ultimately ended up at stage 2 due to the size of the tumor.

I do not know much about epirubicin. My onco seemed pretty cut and dry about the treatment, according to him there is a standard of care for treating triple negative breast cancers. He did say that he chose dose dense because he I'm young (39) and in good health so he sees no reason to spread out the treatments, unless I were to have some awful side effects. Which thankfully, have been fairly manageable. My lymph nodes were clear too.

I would imagine the doc wants your sis to remain on Tamoxifen because she at one point had a cancer that was hormone receptor positive. If there were multiple types of cancers going on for your sis then it sounds like it makes sense to keep her on the Tamoxifen in order to try and prevent reoccurence of that specific type of cancer....the cancer that is hormone receptor positive. The way my onco explained cancer reoccurence is that once a cancer is treated...the same type can reoccur or a whole new type. Which sounds like the case for you sister. Getting cancer (esp if younger) is some indication that maybe there is some defect in the persons genes. Even if BRCA is negative, it only tests for the genes that science is aware of and can test at this point. There are likely many, many more.

Again, I am so sorry your family is going through this. It's a so much information to absorb at one time and things tend to move quickly...putting the pressure on to try and make the right decisions for treatment. I hope you and your sis get your questions answered and move forward as confident as possible.

superfilbert · May 2018

Thanks foreverfaith - that's what I was surprised by, AC+T seems like a pretty standard treatment for triple negative, and I can't even find much info on AT. She had the genetic testing the first time and she's not BRCA positive, but yeah we suspect there's some genetic issue at play here since she had a multicentric cancer in her right breast within 3 years of getting diagnosed with DCIS in the left one, having a mastectomy for that and using tamoxifen for 3 years - go figure. Mind you, she actually initially went to the doctor for cysts in her left breast, and they found DCIS in that breast at that time. She has still fluid leakage in that breast because of her mastectomy - has been dealing with complications from that surgery ever since and now this. She has been under fairly frequent control ever since, mammograms every 6 months, and they have been suspecting something in the right breast for about a year, but they decided to watch it for a while saying they don't need to biopsy it for now. Here we are a year later with 2 masses in her breast.

You're exactly on point - the time pressure and all the conflicting opinions are is driving my sister crazy. I'm trying to keep her calm, but it's been hard. I'll push her to get a second opinion. If anyone has any ideas for my sister on how she can keep calm that'd also be really appreciated.

foreverfaith · May 2018

My heart aches for your sis and you. I have an older sister who is 2 years older than me. We are very, very close. I think she started taking Xanax even before I did, after I was diagnosed. My diagnosis has weighed heavy on her. About 3 weeks after diagnosis, I finally asked my onco for something for the anxiety. I could barely sleep at night. My anxiety level was so high. If your sis is open to the idea of taking Xanax or Ativan, than I would recommend it. I know she is being hit with information overload right now...but if she has time, she can visit her local cancer center. Not sure where you are located, but most Counties have 1 or 2 cancer centers that offer many free services. I live in Southeran Cali and have access to cancer centers that offer free visits with social workers, a nurse navigator (which may be very helpful to your sis in understanding her doctors treatment plan), yoga, licensed therapists, support groups. And it's all free! I'm getting ready to take advantage of the yoga and the therapist!

Best wishes for you both.

GAWarrior · June 2018

I was diagnosed with TNBC in March. Like foreverfaith, my MO says there is a "standard of care" that he goes by for treating TNBC and it comes from the National Cancer Institute. In fact, when I was diagnosed, he talked about T with Carboplation after DD AC and now says we won't do the Carboplatin because the tumor has shrunk and the ASCO doesn't list it as a standard of care, just as an adjunct if needed. And, though they diagnosed me as stage 1, I won't have surgery until the fall (after chemo) so I might have been a more advanced stage and he chose to treat me as stage 2, just in case, since many ladies turn out to be more advanced than the ultrasound or MRI can show (just like foreverfaith had with hers).

FYI, my cancer institute gave me a book about everything you'd ever want to know about breast cancer when I was diagnosed. It lists the chemo drugs - epirubicin (Ellence) is in the same class as A (Adriamycin), so they are both anthracyclines and both alter the structure of cellular DNA. Cytoxan is an alkylating agent that interferes with cellular metabolism and growth, which is why they are complimentary. I don't understand why your sis would get two of the same thing and not one of something else, you know? If it were me, I'd get a second (or even third) opinion. This isn't anything to mess with! (Also, my MO says that ALL TNBC's, by nature, are classed as grade 3 - aggressive...)

Hugs and best wishes to you and your sis!

AT vs ACT for Triple Negative

Comments

Categories