TCh vs. ACTh

Hi Cathy,

My diagnosis is very similar to yours except that I was highly ER+. My Her2/neu was borderline so they are treating me as if it was positive. I had 4 AC, then 4 taxol. I started herceptin with the taxol and will have it for a year total. My onc said they are moving away from the anthricyclines (sp?) but many doctors are reluctant to eliminate a tx. I had a really strong MUGA so wasn't that concerned about heart problems. For me, I feel more comfortable knowing that I have had all the tx I could. I would hate to have a recurrence and then feel like I could have avoided it if I'd had more tx. But that's a personal decision. AC was bad but so was Taxol--just in a different way. Herceptin is a breeze--just a runny nose for a few days after. I'm on a 3 wk cycle now that chemo has ended.

If you haven't already, find a group on here that is starting chemo at the same time as you are. The June 2007 group is really what got me through it.

Good luck to you!!

Cyndi

cathy--i am er- pr+ and her2-borderline.  being treated as positive because some score was over 2.  gonna ask more about that at my onc appt tomorrow.  anyway, i'm getting taxotere, carboplatin and herceptin.  my doc said a year ago i would have been getting act but now tch is the way to go.  i guess i'm glad because the tc side effects are supposed to be easier (???).  getting 6x every 3 wks and then herceptin every 3 wks for the remaining year.  getting to do herceptin from the start is a good thing too i suppose, getting done sooner?  they are splitting the h from the tc, i'm starting the h this thurs and then tc on friday. do you know why your borderline changed to positive?

cyndi-do you know why your borderline is being treated as positive? 

I'm getting left side radiation right now so yes, it is a triple whammy! But like I said, my muga was great and I had an echo after chemo and it was great too. It's so scary before you start but you CAN get through it.

I had a copy of my path report but I neglected to print a copy out and I can't open the format it was sent in now. I can get it again but at this stage, I don't care so much. I finished chemo in Nov. and will be done with rads on Feb. 6. Like I said earlier, I am the kind that wants all the tx!

I have a port on the right side of my chest and yes, I hated it but with AC it is a must and now that I've had it for so long, it doesn't bother me too much. Way easier than an IV every time.

I strongly you to find a group on here that is starting chemo at the same time as you. It will be an invaluable resource and great support. There is nothing like "talking" to someone going through the same thing at the same time. I said that before, didn't I! Chemo brain! See, you get to blame forgetfulness on chemo! There are some good points...

I think the risk for heart se's with herceptin is actually really low. Probably can find it on here somewhere.

I got whiny too so don't feel bad--still do sometimes and I still have days when I just feel so sad. But looking back, I am proud of getting through it!

Cyndi

Cathy,

You might check out the HER2 website which has lots of information on various chemo routines.  I did TCH and before my oncologist even suggested Adriamycin I had already decided against it because of its well documented heart toxicity.  Just recently, at the yearly conference held in Texas (don't remember exact name--San Antonio I believe) there were a number of papers on Adriamycin.  Dr. Slamon, who is one of the researchers responsible for Herceptin, suggests that Adriamycin only works better than other chemos for people who also over express the Topo II and HER2 gene, about 8% of the HER2 population.  Some doctors are taking a wait and see position on Adriamycin, but it's not their hearts.  I also believe that there is evidence that taxol works well for women with HER2+. I really do suggest you check the posts on HER2 regarding chemo treatments: lots of published research there that is very current.  It's doubtful, but not impossible, that your oncologist checked for Topo II.  It's an expensive test so very few doctors do. Good luck whatever your decide. 

With respect to whether Herceptin is recommended for everyone with amplified HER2, I believe that currently it is.  I was 5mm, Stage 1a, and had herceptin for one year.  I had many of the side effects associated with herceptin, including edema in feet and lower legs, but it was a relatively easy drug to take compared to taxol and carboplatin and it gave me confidence that I would not have a recurrence (knock wood!). Just be sure to have Muga's or echo's every three months even if not suggested by your oncologist! 

cathy - met with my onc today and he has decided to test my tumor before proceeding with treatment.  original testing done on the biopsy sample so maybe i'll get different results as you did.  unless they change my er- status i'd like to stay the same.  i was coming to terms with my tx being easier than ac.  i'm wondering what changed your "unspecified" to positive, maybe i have too many questions!  please post what your onc says about your treatment.  i'm very curious.

My onc stays up with the current research (as I hope all of yours do as well), and suggested I go on TCH (I finished it a year ago) because of the heart tox.  Since even just the Herceptin affected my heart, I think that was a very good decision.

Janet 

Cathy,

Good luck on Monday! I was so nervous for the first infusion since I didn't know what to expect. I had a friend and my husband with me and we just talked through the whole thing and it was not so bad. I think ativan (anti-anxiety med) is usually given during chemo--I had it but I was getting AC and there are anti-nausea properties to it too. I don't remember if I got it with Taxol. I did get benadryl with the Taxol at first but after the first one, had them cut it down and I don't get it with the herceptin. The first infusion takes a long time.

My worst side effect with Taxol was achiness all over. I didn't get much neuropathy but do still have a little in my feet (finished on Nov. 15). Get pain meds just in case--there are no prizes for suffering! Also, my onc nurse told me to take B6 to minimize the neuropathy.

Any other questions, just ask! Someone here will help--this is the best place I found for support.

Cyndi

Miss Shapen,

I read your post where your LVEF dropped to 33% and was wondering whether it had gone up when you got tested again.  Are you on Coreg?  My LVEF dropped to 20% and I started on 6.25 mg Coreg and ended up on 80 mg Coreg CR.  I was just tested after 7 months and my LVEF is back up to near 55%.  It was tough going from the lower dose Coreg to the higher dose but my cardiologist says it's responsible for my increased LVEF.

Debbie

Dear Maryanne,

You should take a look at the HER2 support group site, where there is much information about chemo regimes for HER2+ breast cancers.  I'm hesitant to recommend a particular chemo based on my own views, as I'm not a doctor or involved in oncology, beyond my role as patient.  There's lots of information there and it's very easy to do a search--try "Adriamycin" or "Dr. Slamon," or just read some of the posts.  As you may have gathered from the discussion here, some of us refused Adriamycin because of its toxicity to the heart.  I believe recent research presented this year at San Antonio (see Dr. Slamon) suggests that Adriamycin works better in women who amplify HER2 and have the Topo II marker, and in his research that's about 8% of women with HER2+ BC, a small number.  There is also some information there about the benefits of taxol and taxotere for women who are HER2+.  You might also join the board and ask the same question there that you did here.  It would probably help if you read some of the research there so you can form your own opinion. It's important to trust your doctors, but it helps a lot in creating this trust when you know something about the treatments that are being proposed.  You can tell, of course, from reading the posts here that some of us rejected Adriamycin as a chemo treatment. Best of luck in making your decision.

Cathy--thanks for correction on 8%.  If that's how Slamon arrived at that number, it seems to be a bit shifty!  I should mention, however, that it's not just problems with heart that is pushing some oncologists not to recommend Adriamycin.  It's one of the chemo treatments most often associated with later-developing Leukemia. It's difficult for any woman to know what to do, and the new medical guidelines are to give patients the information and let them decide, which is wonderful in some ways, but it does push the decision back on us, and that's not easy.  The most important thing is to do your research, ask your team why a treatment is recommended, that is, what benefits the treatment confers on you in particular, given your medical history and pathology.  And after your treatments are finished, don't look back and question your decisions.  

Thank you all for responding to my post.  I have looked at the data for the ACTH regimen vs. the TCH regimen and I see that they are very, very close in efficacy (what I have read is that the difference is statistically insignificant).  The only thing is that there are more studies showing the efficacy of ACTH and only one study (BCIRG 006) showing the efficacy of TCH.  I was curious to know how your oncs are interpreting this data.  Are most of them coming to the conclusion that the regimens are equal in efficacy?  Or do they still have reservations?  I thought by  polling everyone, we might get a global perspective on the issue since we can't all visit many oncs.  Also, is it mostly California folks who are using TCH or is it now being offered by oncologists around the country?  P.S.I've heard that UCLA has now eliminated the use of the anthracyline regimen and uses only TCH. 

Cathy - Hope all went well today and that you are feeling fine.  My thoughts are with you today.