TCH: X4 vs. X6 ???

DLL · 10-28-2008, 07:31 PM

I am on the 3rd of 4 TCH treatments (every three weeks). I am concerned that most (all?) posters I see on this bulletin board who are on the TCH regimen are having 6 treatments.

I asked my oncologist about this, and she said those with 6 treatments are probably node-positive (I am node-negative), so that is the difference. But I'm not so sure that statement is validated by what I am seeing on the posts on this bulletin board. Hmm... Is my oncologist making a mistake? I want to get the maximum protection from chemo. Should I be pushing hard for 6? (Not that I love chemo and wouldn't be delighted to be done at 4, but after going this far, I don't want to leave a crack in the door if 6 treatments would close it!!)

Can anyone share any wisdom (or research?) on 4 treatments vs. 6 treatments of TCH? And I'd love to hear from others who were/are similarly scheduled for only 4 treatments of TCH (and what the rationale or research was for that decision). THANKS so much!

DLL: Age 47, Dx 7/2008, IDC, 1.1cm, Stage Ib, Grade 2, 0/4 nodes, ER+/PR+, HER2+, pre-menopause; otherwise in good health! :-)

P.S. The C in TCH is carboplatin.

P.S.S. I am aware that the NCCN Practice Guidelines call for 6 cycles of TCH. But those were published in January of this year, so I'm wondering if there has been some new research or protocols that suggest 4 is enough in certain cases (and, if so, which cases)???

Jackie07 · 10-28-2008, 08:37 PM

Sounded like your doctor is following a new protocol based on the FinHer study that 11 weeks of Herceptin can achieve 98% of the effect of one full year.

Since yours is a grade 2 and mine is a grade 3 (faster growing), I wonder if that is also a factor for your doctor's decision.

The more important thing is to keep close watch of your 'scar'. My 'recurrence' was growing out of the left over tumor and for four years it was deemed to be 'scar tissue'. So please pay close attention and do your self exam frequently. My follow-up mammagram had always been painful because there was tumor there still. But everybody misdiagnosed it and I did not demand an answer soon enough.

Chelee · 10-28-2008, 11:03 PM

DLL, I did TCH and did have 6 cycles...but I was node positive. That being said it seems to me that most if not all that get TCH do have six treatments. (Anyone that knows different feel free to correct me.)

It's been a while since I finished my chemo so things could have changed...but I am surprised I have not heard of this?

I would feel exactly as you do...I would want the full six treatments regardless if I had negative nodes. As you know her2 bc is more aggressive so I would want to hit it as hard as possible the first time around. The only way to have complete piece of mind is to know you went after it as hard as possible when you had a chance. And as far as I know the standard is six cycles of TCH regardless of node status. Speaking for myself I would push my oncologist for the last two.

I give you alot of credit for doing your home work and being so proactive...that's so important when going through something like this. You are on the right track so keep it up. Give you oncologist a call and talk to him/her about your concerns.

Chelee

Lori R · 10-29-2008, 04:55 AM

DLL,

You are seeing the power of the wonderful ,experienced people on this board!!!

While I can't provide specific guidance in regards to the 4 vs 6 rounds of TCH. (I had 6 rounds of T&H)....

I can support Chelee's words of wisdom....Push your Dr. If it will provide you with years of reassurance, go for the gusto. (I believe that coming out swinging has been the preferred approach of most on the board)

It was through the support of this site that I challenged my Dr. to receive radiation. She had pretty much told me radiation wasn't given to women that were metastatic. After I said that I wanted it, to her credit, when I returned for my next visit she was on board 100%.

So....if you are up for another couple rounds of the ride...my vote is to "go for it".

Good for you for educating yourself and actually having an opinion!!! So many patients don't know enough to ask.

Keep us posted!! Lori

Becky · 10-29-2008, 06:20 AM

Most folks on this board know I keep up even though I have been done with treatment for years. I have NOT heard of 4 TCH treatments or any studies on doing less than 6. I would ask your oncologist to forward those studies to you and tell her that you have not heard of less than 6 and would like to know what the standard of care with TCH is. Also, are you getting the full year of Herceptin (herceptin to continue alone until one yr?).

I do want to state that I keep up and may have missed things so approach your onc in a nice manner but I am sure someone on this board would have picked up on any new early bc protocol (and I have gone to the big shows and seen the most up to date studies).

duga35 · 10-29-2008, 06:25 AM

I also had 6 rounds of TCH and was node negative. In fact, after about the 4th or 5th round I asked my doctor if I could just quit because the side effects that I had were very severe, and I was sure that there couldn't be any bad cells left after going thru that, and he advised me not to stop.

Good luck to you!

kcherub · 10-29-2008, 07:40 AM

As you can see from my stats, my diagnosis was very similar to yours, and I was scheduled for 6.

I agree with Becky...ask to see studies on 4 vs. 6 because you can't find anything about it yourself.

Take care,

Jean · 10-29-2008, 07:51 AM

To tag on...node negative...6 TCH treatments
this was advised by Dr.Slamon....

I think you are wise to question!
Best of luck.
Jean

Lien · 10-29-2008, 11:38 AM

Dear DLL,

Reading your path statistics I think that perhaps you would not have received chemo at all in Europe. An Austrian research group found that for ER/PR + women, hormone tx was just as effective, sometimes even more effective than chemo.

Having said that, you obviously feel you are not getting optimal tx. You should discuss this with your onc. Perhaps she weighed the pro's and cons without explaining them to you? I think you are entitled to have your say in this. You may want to consider having a second opinion.

I decided on hormonal tx when the oncology panel that reviewed my case didn't think it was necessary. I asked for a second opinion and the onc at the Dutch National Cancer Intstitute gave me my options, showed me what my odds were in Adjuvant online, and told me that I would have to decide for myself.

I felt that, because my youngest child was only 3 when I was diagnosed, and my 8 yr old was having behavioral problems, I had to do anything to up my chances of seeing them grow up.

Ofcourse, there are no guarantees. Anybody can have a recurrence. I know a woman who had mets to the liver 12 years ago, who has been NED for years. I know a woman who was diagnosed with a more favorable path report at the same time as I was, who had more aggressive tx, who developed mets within a year.

You have to do what feels best to you.

Hugs

Jacqueline

BonnieR · 10-29-2008, 05:12 PM

I only had 4 doses of TCH. (Now this thread is scaring me!)

There was alot of discussion about my course of treatment. I was in a "grey" area because my cancer was "small" albeit aggressive. I got 3 opinions, all different. One very accredited oncologist/researcher said I needed NO treatment and thought any chemo would be OVER treating me. Another recommended TCH "Without the carboplatin"! My own onc inititally was going to administer Herceptin alone. After my Oncotype came back highly positive we decided to do the full boat.
But we stopped at 4 doses because of her concern about permanent neuropathy and other side effects. She felt I had a sufficient course as long as we continued for a year of Herceptin. I feel I got the best of both worlds. I hope.

'lizbeth · 10-29-2008, 05:42 PM

I was node positive, with 6 treatments of TH (I opted out of C). Just had a Pet scan with no evidence of cancer critters.

'lizbeth

Rich66 · 10-29-2008, 06:18 PM

'lizbeth,
I love that your post is laden with obscure medicalese yet ends with "critters"

CindyE · 10-29-2008, 08:05 PM

I had only 4 treatments of chemo and was node negative. I didn't have Carbo though. I was told only 4 rather than 6 as nodes were clear.

Sherryg683 · 10-29-2008, 09:13 PM

My friend who had the reoccurance is on ACH, which is very similar to taxotere is doing 4 rounds. Our oncologist recommended 6 because that is what is the standard. She went to Sloan Kettering in New York for a second opinion and was told 4 treatments would be enough. I had 5 treatments of Taxotere Xeloda and Herceptin, I was scheduled for 6 but when my scans showed I was NED after 5, he said that I could stop the Taxotere and Xeloda. I offered to do one more but he said it wasn't necessary...sherryg683

talbrig13 · 10-30-2008, 01:13 PM

I had 10 TCH every 2 weeks from Feb 07 until Jun 07...then Herceptin alone until Feb 08 every 3 weeks. I believe my onc tailored my treatment to minimize side effects.

Mariposa · 10-30-2008, 03:23 PM

Only about 1 to two months ago I talked with a lady sceduled for 6 (I think FEC) After the fourth she stopped due to the fact while she was given the fourth she had a leak in the porth a cath so of course she had serious troubles. They investigated afterwards the portacath and couldn't find the problem. So the onc advised not to take the risk having the two last ones, since the more chance to survive was only and it is so stupid because I don't really remember it. It was ridiculous low. I think it was 0,7%. I for sure will ask this again.

rebecca0623 · 10-31-2008, 01:16 PM

I was node negative and am having 6 rounds of TCH. One oncologist wanted me to do this with avastin despite being node negative with a 1.2 cm tumor (small she said) but she said node negative does not mean certainly negative, just may be too small to detect. I opted out of the avastin.

DLL · 11-05-2008, 05:44 AM

Thanks, everyone, for your helpful comments! After talking with my oncologist about my concerns, we've decided to extend my treatments from 4 to 6, more for my peace of mind than anything! Apparently this is kind of an unsettled area for node-negative HER2'ers, at least among some oncologists. I will have treatment #4 next Monday. Onward!

Chelee · 11-05-2008, 02:50 PM

I'm glad your going to get you six cycles. In the long run I think you will be so glad you did. You can look at those last two cycles of chemo as added insurance to kick "it" into the twilight zone. There are alot of node negative women on the boards and it seems most all of them had 6 treatments regardless. So this should help you rest easier at night when your finished.

I'm glad you were proactive in your care. Hang in there...it won't be long now and this will all be behind you.

Chelee

Paris · 11-06-2008, 07:14 AM

I'm glad you were able to come to a decision. It is so tough to come up with the "right" solution. We are making critical life decisions based on ever changing research. The best we can do is educate ourselves as best we can which you were smart in doing and then hoping it was the right choice. We are looking at studies from past years and who knows what the studies will show in future years? You just have to find a way to keep your chin up and stay hopeful.

As for me I did four rounds of taxotere and cytoxan followed by one year of herceptin which turned out to be only 12 rounds. Perhaps if you do carboplatin you need the six rounds? Like one of the other posters felt, it is scary to see all the six round people and not many four round. I saw two oncs who had the same treatment protocol one of whom was involved in the clinical trials for herceptin so I was/am confident in his philosophy. In a way I'm glad I didn't do six rounds because I broke out in an very bad case of hives after round three and I was on so many drugs to keep it under control I would hate to think what it would have been like to have to do the two additional rounds.