AC-T(adriamycin, cytoxin, taxol) vs. Carboplatin and taxotere

[Mary Jo]

Hello everyone,

Just a question. Why do some receive AC-T treatment and others receive Carboplatin/Taxotere treatment? I have been hearing about the carboplatin lately and just wondered about it. I am a stage 2 - er/pr neg. her2 - positive - grade 3 tumor. First sentinal node had one microscopic cell in it - 2nd sentinal node was clean. I started treatment Nov. 30th 2005 - dose dense (bi-weekly) first 4 weeks received A/C - next 4 weeks received taxol and herceptin. Had bi-lateral mastectomy - cancer right breast - no cancer left breast.

Thanks for your answers.

marejo

God's Peace to all!

[mindersue]

My doctor recommended against combining adriamycin with Herceptin because both can adversely affect the heart. If I hadn't been on Herceptin, I would've done the AC-T.

[CPA]

The discussion revolves around different arms of the herceptin adjuvant trials. Early on, there were multiple studies using herceptin in conjunction with different adjuvant chemo regimens.

Eventually, the two studies were combined into one large study. Both the AC->TH and TCH arms showed significant improvement in survivability over the non-herceptin arms.

There are advantages/disadvantages to both AC->TH and TCH regimens.

AC->TH can, in some patients, harm cardiac muscle. If a patient has a previous cardiac history, then this regimen may be considered risky. However, the interim results of the study showed a slightly greater success rate with this treatment. It was not known if long term follow-up would show a statistically significant difference between this and TCH.

TCH has lower cardiac toxicity rates, but may be less effective against tumors that co-amplify TOPO2. There are no easy tests for the co-amplification. I think only one or two labs are available to do this test and most insurance will not cover.

Essentially, it is a trade-off with "most" oncologists preferring the AC->TH regimen unless there is a reason to go with the TCH regimen. Of course, this may change next week or next month as new information becomes available.

For a discussion of the combined study see the info on BCIRG 006 at the following website.

www.bcirg.org

[Becky]

Without testing your tumor for the Top IIA marker, those that are Her2+ should receive an anthracyclin (ie: adriamycin, epirubicin) because about half the people who are Her2+ are also Top IIA+. Anthracyclins really wipe out Top IIA+ bc. This is probably the reason that in the trials the AC followed by TH has better results than the TCH (because some of the women randomized to this arm might have been Top IIA+ and would have benefited more by having adriamycin). In the future, I am sure this marker will be tested and appropriate treatment will be given based on the result. However, if you are already starting out with some cardiac issues, TCH is gentler on the heart than AC followed by TH.


Jean (a member of our group) did get her tumor tested and she was Top IIA negative and is taking TCH since adriamycin or epirubicin would not benefit her.

In the trials, the AC followed by TH had a recurrence rate reduction of 52% while the TCH arm had a reduction of 39% (but as I noted above, I believe the difference comes from lack of testing of the Top IIA marker).

Hope this helps

Kind regards

Becky

[janet11]

I just got my test results back this afternoon, and I'm also Topo II negative, so am starting 6 cycles of TCH on Tuesday.

Janet

[Shell]

Becky or Janet-

This was an interesting thread, as we are looking at changing chemo regimes for me.

Is testing for the Topo IIA marker done reguarly - if so, what would I look for? If not, I suppose I can ask my onc to add it because i'm getting labs for the ca 27-29...

Thanks,
Shell

[Becky]

Shell


The Topo2A marker testing has to be done on a sample of your tumor (it is not a blood test).

Kind regards

Becky

[janet11]

And it's definitely not a routine test. The tissue sample has to be sent out specifically for it.

Let us know what happens with you, OK?

Janet

[Shell]

Thanks Janet and Becky-


thanks for pointing out that it's the tumor that's tested, I went back and saw that you did say that clearly in your posts - this stuff is tough for us non-medical folks!

i'm going to look at my path reports to see if they tested for that...would they have done that as a matter of course in 2003 i wonder?

Thanks,
Shell

[MJo]

They don't routinely test for TOPO2 today, so I'm sure they didn't in 2003. I hadn't heard about the test in 2005 so I didn't push for it. Got the Oncotype SX test instead. I were entering treatment today, I'd push my onc for the Topo Test. I made it through three A/C treatments. Would have spared myself if I could have.