Studies 4 Vs 6 Cycles of Chemo
When I was first diagnosed with Stage II breast cancer I saw a MO in Thailand at Bumrungrad Hospital, one of the best in Asia. MO there said: "4 cycles are adequate, anything over 4 provided very little benefit". Since I lived in the Philippines I decided to do my Chemo at Makati Medical Center in Manila. The MO there stated she preferred 6 cycles. Even after that I sought a third opinion at a hospital closer to my home and MO stated 8 cycles. So I proceeded with 6 cycles, at the end of four I could take no more. I stopped and proceeded to radiation treatment. Since then I returned to Bumrungrad Hospital and the MO restated 4 cycles was adequate and referred me to this Web Site, it is fairly technical: http://www.anco-online.org/Majure2016.pdf. Refer to Abstract 2 starting on page 7. Note second slide titled, Background with the following line: At a median f/u of 7 years, TC x 4 was superior to AC x 4 (Jones, JCO 2009). X 4 stands for 4 cycles. Also here is a second study supporting 4 vs 6 cycles: http://www.medscape.com/viewarticle/734367.
Please note: the first study is current as of August 2016.
Good luck and pray for all!
Jay Anne
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I replied back to your other post. I'm not a MO but always, you as a patient is also involved in the decision making of your plan of care. Your MO in Thailand will be the best person to follow since I do think he is updated to the latest literature evidence regarding chemotherapy compared to your other MO in the Philippines. I would ask, what would be his basis of doing 6 cycles? And also the MO in Thailand, what is his basis of 4 cycles? At this time, I'm not sure if you have the Oncotype DX testing to determine recurrence and need for chemo, but I know how you feel regarding not able to take anymore sessions from 4. If Oncotype DX testing is not an option, then I would follow what the MO from Thailand says and just follow up with him very closely as in every 6 months to make sure that you are being monitored closely for anything that may or may not come up.
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Kinnie:
I have also read several studies that say the benefits of 6 treatments over 4 (in certain situations with certain cancers) is not that great.
Although I cannot explain it clearly, there is a difference in the way statistics are often presented in these studies and reports. ABSOLUTE risk is what you want to know, RELATIVE risk is what is often presented and cannot be taken at face value.
Not every medical oncologist is an expert in understanding statistical data. Statistics are slippery fish and the value of any report or study is in how well the statistical data can be put so that regular old people (like you and me) understand it.
But I am hoping for 4 rounds of chemo instead of 6. And I will not go down without challenging what my doctor 'prefers'. His comfort is not my number one priority. Some doctors, like all people, get set in ways of doing things that might not be based on the best science. You must be your own advocate.
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Hi Kinnie
I am having chemo therapy at Bumrunggrad hospital. My MO is Dr. Harit. He suggests me to have 6 rounds of TC due to young age and TNBC
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I was ready to quit chemo after 3 rounds due to SE's. I specifically asked my MO how they could know that I would need 6 rounds instead of 3 or 4. He just (as always) quoted the need to follow past proven regimens.
I knew that it had to be working - I could no longer feel the lump. But I also knew that I would kick myself if I didn't do what was recommended and proven and it came back. So I sucked it up for the rest in hopes of never having to do it again!
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by the third cycle i was ready to quit due to SEs. my MO ordered mri at the end of the 4th bec we cannot feel the lump anymore and we were planning to stop. but mri showed 50% shrinkage( mo is hoping those are dead cells) so i sucked it up and continued and next week is my 6th!i cannot wait
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My MO is also at Bumrungrad and right off the bat he said six cycles of TAC (which is pretty aggressive) because I am 36 (35 at diagnosis). Adriamycin killed my veins (before I got a port) and he considered removing it from my protocol and doing the remaining four with just TC. I have four positive nodes so borderline in some ways. I think it's all about doing your best to calculate the cost-benefit ratio of treatment.
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It has been just over 3 years since my cancer was identified. I get a mammogram and or ultrasound every 6 months. I am still cancer free. However, the tamoxifen created severe conflicts in the uterus. I had two D&Cs due to thickening of the uterus lining and polys. The Dr gave two options: IUD or hysterectomy. IUD was put aside ride away, the Mirena IUD has a warning stating 'íf you had cancer or have a potential for cancer you should not use this product'. So we proceeded with the hysterectomy. Since I was pre-menopause there was a concern about removing the ovaries in surgery. Removal of ovaries has addtional conflicts to it as well. After research it was advised to get a BRCA 1 and 2 test. The test came back negative mutations. So we decided to remove the cervic, uterus and fallopian tubes. Why the fallopian tubes, removed, the fallopian tubes have little fingers attached to ovaries. This area has the highest percentage of the start of ovarian cancer. Also realize that people that have gone through breast cancer chemo is at a limited risk for ovarian cancer. It has now been two months since my open surgery hysterectomy. I was initially was going to do laparoscopy and decided open surgery would give a better view of internal organs. A bikini cut was done. During the open surgery the surgeon found endometriosis on the ovaries, so she was able cauterized them. I doubt under laparoscopy surgery it would have been found and treated.
A side note: My BRCA 1 and 2 testing was done at Bumrungrad Hospital, Bangkok, Thailand. The cost was $1000 less then that was quoted in the Philippines. The labs were sent to the US for analysis. Saw the MO there again, and again he said 4 cycles of chemo was adequate.
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