Chemo regimens?

[Chelee]

I am stage IIIA, Her2/Neu 3+++, Er & Pr positive, 5 of 16 postive nodes, Richardson scale 9 of 9. My chemo regimen has been Herceptin, Taxotere, & Carb....followed by weekly herceptin.

The first oncologist I had is the one that decided on this treatment plan for me. Since then...I have switched oncologist in the middle of my treatment because I wasn't happy about the 1st oncologist for several reasons. This new one seems much better.

But I just recently asked her why with my stage IIIA prognosis...why I wasn't given AC first just out of curiouosity...then followed up with something else after the AC like most others are? Plus it looks like I see a node under my clavical getting larger and I am still in treatment with the above chemo drugs I mentioned.

Well the new oncologist I have said she can always let me finish this last round of herceptin, taxo, & carb...then go ahead and give me Adriamycinn & Cytoxan chemotherapy after my taxotere and carb therapy. And herceptin would be continued for the whole year.

Why would she want to do that now? I am suppose to start rads after this last treatment of herceptin, taxo, and carb. Just because I asked...she wants to give it to me? I don't want any extra chemo just for the heck of it. (Maybe I just don't understand what she means?)

I thought you WEREN'T suppose to have "AC" after herceptin? I might be wrong? She has got me confused. Does this sound right? I always thought they do AC FIRST before other chemo treatments with a stage III DX. Can anyone make anymore sense out of this then me?

Chelee

[Christine MH-UK]

Your first oncologist was basing your treatment on a trial whose results were announced in December. This trial indicated that herceptin + carboplatin + taxotere->year of taxotere produces significantly fewer heart problems that AC->(taxotere+herceptin)->year of taxotere without being significantly less effective. Herceptin's inventor was very involved in the trial and indicated that it raised questions about whether the risks of anthracyclines were worth it for her2 positive patients, given that the AC->taxotere+herceptin->rest of year of herceptin combination seems to cause long-term heart damage. The study also showed that the patients with topoIIa benefitted from the addition of anthracyclines, such as AC chemo. Other oncologists, however, question the advisability of dropping AC chemo or anthracyclines.

It may not be that you shouldn't have AC after herceptin. It may be more likely that herceptin after AC is the problem, since herceptin seems to aggravate heart problems started by AC. Unfortunately, there have only been two rather small trials using anthracyclines after herceptin-based chemo, although the results have been favourable, including a trial of herceptin, cisplatin, taxotere followed by AC in stage III women that had an 83% three-year disease free survival rate.

My concern with the HCT->AC->year of herceptin combo was that it might be really hard on the heart, since the HCT trial did have some added cardiotoxicity even without AC and this mix has never been studied in any trial I have ever heard of. So, here are some thoughts:
1) Get tested for topoIIa before making a decision. You may be negative.
2) I believe there was a study of HCT->AC without the herceptin tail announced at San Antonio in 2004. It was a phase one trial, but the result was 7/8 complete response in 8 patients, 7 with stage III and 1 with stage IV breast cancer. You might see if there was any followup to that at ASCO, since this is a small number.
3) Some oncologists have replaced AC with EC (epirubicin) chemo, which is easier on the heart. However, even with this combo, there have been heart risks.