AC-T versus TC
My wife has Stage IIIA breast cancer. Had bilateral skin saving mastectomy. Oncologist recommends TC 6X. 2nd opinion from Oncologist at MD Anderson recommended AC 4X followed by Taxol. Discounted risk of heart problems so long as magscan was ok. Said no evidence of leukemia since historical dosages were reduced when problems started to aise several years ago. Also says about 5% increase in efficacy from AC-T vs. TC.
Our concern is the heart issue. Pfizer site acknowledges heart issue and provices %s of risk based on cumulative dosage. Can't find other good info on the potential heart risk. Anyone have good comparative info?
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How old is your wife? I haven't started treatment yet but was offered both option. TC 4X or AC 4X + Taxol 4X. I was told by both onc that TC has better rate succes than ACT but onc #2 wants me on dose dense of ACT and they don't have yet the info to say wether it's better or not. I will be doing TC because of the heart risk of ACT that I am not willing to deal with. I'm only 33 and I just don't want to have a weaker heart for the rest of my life. If I was older, I might feel otherwise, but right now there's no way I would get near Adriamycine.
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May I ask what type of breast cancer your wife has? Judging from what I'm reading, that can make a great difference in the efficacy of anathracycline-based treatments like AC-T, which seem to be most effective against HER2 positive cancer.
A significant article on anathracycline cardiotoxicity is avaliable online at http://www.annals.org/cgi/content/full/125/1/47. As this was published in 1996, presumably adjustments have been made in the dosage of Adriamycin since then. However, if you compare the current recommended dosage to the information in the article, you will discover that bad reactions occurred at less than the current recommended dose. Furthermore, many of the effects did not materialize until years after the treatment, so I don't see how anyone can be sure that the same thing will not continue to occur, though perhaps at a reduced rate. In my experience all oncologists who recommend anthracyclines dismiss the cardiac issue as insignificant.
I don't know where the 5% figure comes from. If this has been demonstrated I have not found the documentation. If you find it, please let me know.
As for the relative merits of TC, AC,and Taxol, see the articles at
http://www.cancer.gov/clinicaltrials/results/HER2-anthracycline0108'
htttp://www.medpagetoday.com/Hematology/Oncology/BreastCancer/2308
http://www.professional.cancerconsultants.com/print.aspx?id=41014
http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=85301
You can find many more by using your browser.
Best wishes for your wife's recovery.
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I can see Caroline's point, but who wants a heart problem at any age? And older women are more vulnerable to this side effect. Even it it's a small risk percentage wise, it's a nasty one. And since we're both HER2 negative, Andriomycin probably wouldn't help us either.
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I agree, heart problem wouldn't be fun at any age or any of those side effects. I didn't realized that A was being used on HER+. I'm still waiting on my FISH test to determine if my tumor was really HER-, hopefully it will stay that way.
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I was giving the option to do either. After the research I opted for TC. My oncologist was happy with my choice and in fact it was her recommendation. I had two other opinions, all said TC was a good choice. I have one more treatment left. I am pretty sure that the recommendations might have to do with the type of cancer and whether or not there is lymphatic involvement.
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Adriamycin is being used in more than one regimen, and the other anthracycline, Ellence, is also used. They seem to be most effective for HER2 + and other more aggressive subtypes, or advanced stage disease. Several studies I've read suggest that they don't do much if anything for early stage, HER 2- tumors, but there are probably exceptions, depending on the specific genetic makeup of the tumor.
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She is 60. She decided to go with TC to avoid the heart risk. The Pfizer website suggests that the risk is still there and not inconsequential. Her 1st chemo session was last Thursday and it went quite well. No nausea or significant other side effects. Just tired on day 3 and the occurence of some thrush. She used Emend before the treatment. It came highly recommended from women who had nausea and then used it and it seems to have worked.
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Thanks for the info. ER+/PR+/HER2-. 5.5 cm tumor. One sentinel node positive. 8 others removed, all negative.
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Please educate us about the FISH test.
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FISH test is to find out if tumor is HER2 + or - The way I was explained, is that they stain the tumor and get numbers from 0 to 2. 0 is -, 1 is still -, 2 is still - but close enough to + and 3 is +, on my biopsy, my numbers were 0, 1 & 2 on different slides. FISH test is more involved so when they removed the tumor, they ordered the test to be sure of the negativity. If HER2 is +, then you want Herceptin on top of the chosen chemo. Just one more test out there! Glad to hear your wife is doing ok after first treatment, I hope she gets to enjoy Thanksgiving.
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Apart from the size of the tumor, which is not necessarily crucial, your wife's situation looks very favorable. I believe TC was a wise choice. Happy Thanksgiving to you both.
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my med onc in reno recommended TC 6x. i went to a breast cancer expert at UCSF for a second opinion, and he strongly urged AC 4x then taxol 4x. i am triple negative, and he said this is the standard treatment, highly aggressive, but necessary especially for triple negative and grade 3, with family history of BC. he said that chance of having heart trouble was extremely low.do i believe him? not really. but i'm going to go the aggressive route because so many women i know who are multi-year survivors took AC/T.
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Hi!
I am starting TC x6 in April. Any side effects/advice you would like to share?
Thank you all for your support!
PdlC
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I was given the choice of AC versus TC and chose the TC.
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