chemo regimen for HER2

Many opinions out there about what is "the best" , what is the "most aggressive".

AC,TH then H is commonly used. TCH is out there too. I had FAC, TH + H.

I think er/pr- tumors are particularly vulnerable to anthracyclines so are usually used in that situation. Are you Er/PR-.

We all have obsessed about our prognosis, especially in the beginning. Remember that these numbers only give a statistical chance so help you decide how aggressive to be. The numbers can no tell you as an individual your survival. Stage 2 is a curable stage,many women survive this stage and go on to live full productive lives. Why not you?

Once you have made your decision you will find thing a little easier. Best of luck with your treatment.

Fists up!

pnpmary,
I'm curious as to where your oncologist got that number? It sounds high to me, perhaps that is your risk of recurrence if all you get is the lumpectomy and nothing else. I would also question his reasoning for calling you stage III when you are clearly stage IIA, like me. As you can see below, my tumor stats are similar to yours and I am also only 30 years old (which is a worse prognosis) and my risk of recurrence after chemo, radiation and tamoxifen is about 20%, but with herceptin, may be 10-12%.
As far as what chemo regimen works best, it is controversial. studies have been published to show that AC/TH and TCH are statistically the same for disease free survival and mortality rates, but AC/TH has more cardiovascular effects. My oncologist suggested TCH for me because she thinks the most important medication is the herceptin (and tamoxifen for me since I'm ER/PR positive)and she would hate to see my heart function go down to the point where I can't get the herceptin. Also, since I am so young, she wants to avoid any serious cardiovascular side effects that can occur as i get older.My oncologist is also a major breast cancer researcher at a major university/teaching hospital.
She said you ask 10 oncologist what they think, and 1/2 will say AC/TH because that is what they are familiar with and 1/2 will say TCH. Good luck, but i would definately suggest a second opinion.
Leslie

pnpmary...I too wonder how your onc got from Stage II to Stage III? 2nd opinions are good! I am Stage I and am doing TCH as my onc did not want to risk a healthy heart with A plus Herceptin plus he feels that Herceptin is the key to my cure, not the chemo. My first onc said DD AC then T plus H, my 2nd opinion said the same, but TCH was out there, but may not be as good but much safer for the heart. I changed onc's within the first oncology group (didn't like the first one) and he would only consider TCH every 3 weeks, with H sandwiched in each week,then H every 3 weeks for a year. He said he has been too many cardiac problems with A plus H so if he can SAFELY avoid it, he will every time.

Let us know what you decide on!

Wendy

HI Mary. I really am stage 3A, her 2 pos, hormone neg and I had exactly the regimen your second onc recommended, a/c every 3 weeks, then t/h. (lump, rads, herceptin for one year) I'm two years out and doing very well. In my unscientific opinion, your second onc is also right that herceptin really has made a difference for us her 2 girls. My onc started giving it to node pos (but w/o mets) patients off label six or seven years ago. Not one of those women has recurred!
I worked during my chemo, which was important to me -- and that was why my onc did the 3 week regimen. She didn't think it would be possible for me to continue working on dense dose. However, I've since read studies that say dense dose has better stats, and so wonder if I shouldn't have done that.
Good luck. Chemo is no fun, but you'll get through it and you should do really well. I suspect another concern is wanting you to avoid any heart stress (a/c can be hard on the heart) to make sure you can tolerate the full year of herceptin. Ask about that.
A

I'm stage 1, grade 3, HER2+++. For chemo, I did 6FEC instead of AC - seems to be less heart problems with this combo. It's still not used much in this country, but is common in much of the rest of the world. I'm now doing Herceptin every three weeks for a year.

6FEC is six rounds of 5-Fluorouracil, Epirubicin and Cyclophosphamide (often called by it's trade name Cytoxan). Usually is given every three weeks.
AC is Doxorubicin (usually called by it's trade name Adriamycin) and Cyclophosphamide. It is usually given in 4 rounds either every two or every three weeks.

I had very few problems with the FEC. Had chemo on Thursday, felt ok Thursday and Friday. My worst days were Saturday and Sunday (kinda like a bad case of the flu without the nausea). I just slept as much as possible those two days and didn't even try to accomplish anything. I started feeling ok on Monday and was pretty much back to feeling (mostly) ok by Tuesday. Main thing was to take the anti-nausea meds whether I thought I needed them or not for the first 4 days and drink as much water (or whatever) as possible. About a week after chemo, mouth sores tried to get established, biotene (over the counter at most pharmacies) took care of that problem. Fatigue does creep up on you over the course of the chemo. Overall though, it's really not that bad - doable is to term you will see often on these boards. The anticipation before starting chemo is actually much worse than the reality of it.