Is it too late for a different chemo combo?

[yanyan]

I have always had doubts about my current treatment TCH ever since my surgery in May 2011. Although my tumor shrunk after 4 rounds of TCH, i still had 10 positive nodes with macro mets. My oncologist didn't think too many chemos would benefit me. He decide we will just finish the planned 6 rounds and one year of herceptin. I asked my radiologist about tumor chemo sensitivity test. To my surprise, he said it is not very commonly done because cancer responds differently in a lab environment than in our own body. I am 4 months from my last chemo (TCH) and the though of not getting the right chemo combo or dosage are daunting on me. I am going for my herceptin shot this week and will ask my onco for a 2nd opinion. Chances are i will not get any more/different chemo unless i have evident diseases that validates " medical necessity". I am thinking maybe i should get it else where.

[Jackie07]

Hi,

The fact that your tumor 'shrank' duing chemo indicates to your doctor that the treatment has been effective. TCH + Herceptin has had a good track record for several years now. Only recently have we seen the new trend of having 4 AC (anthracycline) and then TH before completing H for a year.

You can participate in clinical trials after you've finished the one year treatment if you are interested. (Remember that the fewer chemo agents you use, the less chance for you to be 'excluded' from future trials.) By that time there will be more research information available for you and your doctor to make a better decision.

I understand it is nerve-wrecking, but different chemo agent carries different side effect - anthracycline is harsh to the heart, for example.

Sending you good vibes ...

[JillaryJill]

As you can see from my signature I am Stage IIIc also. My onc who is at a very large teaching hospital in Chicago and has been at the forefront of care for Her2 positive breast cancer patients says TCH, 6 rounds is the standard of care, followed by 1 year of Herceptin and Radiation. Dr. Slamon is also on record as saying he is in favor of TCH, over Andracycline based chemos, due to the cardiac risks. TCH also gives you the Herceptin right away also. I don't know why your doctor split the dosage, 4, then the last two.

[norkdo]

anthracycline (AN-thruh-SY-klin)

A type of antibiotic that comes from certain types of Streptomyces bacteria. Anthracyclines are used to treat many types of cancer. Anthracyclines damage the DNA in cancer cells, causing them to die. Daunorubicin, doxorubicin, and epirubicin are anthracyclines.

Jackie,
Can you please go into this a bit more for us? I too have been curious why the canadian and english and australians on here get what I got: FEC (E being epirubin, the red devil, an anthracylcline) times three, followed by three taxoteres;

[norkdo]

what does TCH stand for, for instance, etc

[Jackie07]

Here's an abstract about using sequential Taxane (the T [equivalent to Paclitaxel] in TCH ('Texatere, Carboplatin, Herceptin' - a standard combo for Her2 Breast Cancer from about 2005. 'My understanding' is that the anthacycline [such as Epirubicin in FEC] prevents cell division http://en.wikipedia.org/wiki/Anthracycline and Taxanes
http://en.wikipedia.org/wiki/Paclitaxel affects microtubules inside of the cell [thus influence the cell division] while Herceptin http://en.wikipedia.org/wiki/Herceptin binds to the Her2 protein receptors on the surface of the cell http://her2support.org/her2-breast-c...cancer?start=1
) and FEC. This abstract talks about using gene tests (such as the 70 gene tests cited here) to see if a patient is a good candidate for a pariticular chemo combo.


Cancer. 2011 Aug 15;117(16):3682-90. doi: 10.1002/cncr.25953. Epub 2011 Feb 8.
Prediction of pathologic complete response to sequential paclitaxel and 5-fluorouracil/epirubicin/cyclophosphamide therapy using a 70-gene classifier for breast cancers.

Naoi Y, Kishi K, Tanei T, Tsunashima R, Tominaga N, Baba Y, Kim SJ, Taguchi T, Tamaki Y, Noguchi S.
Source

Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.

Abstract

BACKGROUND:

Sequential administration of paclitaxel plus combined fluorouracil, epirubicin, and cyclophosphamide (P-FEC) is 1 of the most common neoadjuvant chemotherapies for patients with primary breast cancer and produces pathologic complete response (pCR) rates of 20% to 30%. However, a predictor of pCR to this chemotherapy has yet to be developed. The authors developed such a predictor by using a proprietary DNA microarray for gene expression analysis of breast tumor tissues.
METHODS:

Tumor samples were obtained from 84 patients with breast cancer by core-needle biopsy before the patients received P-FEC, and the gene expression profile was analyzed in those samples to construct a classifier for predicting pCR to P-FEC. In addition, the authors analyzed the gene expression profile of tumor tissues that were obtained at surgery from 105 patients with lymph node-negative and estrogen receptor-positive breast cancer who received adjuvant hormone therapy alone to determine the prognostic significance of the classifier.
RESULTS:

The 70-gene classifier for predicting pCR to P-FEC was constructed by using the training set (n = 50) and subsequently was validated successfully in the validation set (n = 34), revealing high sensitivity (88%; 95% confidence interval [CI], 47%-100%) and high negative predictive value (93%; 95% CI, 68%-100%). Specificity and positive predictive value were 54% (95% CI, 33%-73%) and 37% (95% CI, 16%-62%), respectively. Among the various parameters (estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki-67 status, etc), the 70-gene classifier had the strongest association with pCR (P = .015). In an additional study, genetically assumed complete responders were associated significantly (P = .047) with a poor prognosis.
CONCLUSIONS:

The 70-gene classifier that was constructed for predicting pCR to P-FEC for breast tumors was successful, with high sensitivity and high negative predictive value. The classifier also appeared to be useful for predicting the prognosis of patients with lymph node-negative and estrogen receptor-positive breast cancer who receive adjuvant hormone therapy alone.

[yanyan]

Thanks ladies! I started Chinese herbs since my visit to a well known doctor in china. I will also look into clinical trials after the herceptin treatment ends in feb. i have 4 more treatments and hopefully that keeps cancer at bay. Ny oncologist office usually does surgery after 2 or 3 treatments. Since I was not sure about mastectomy we continued chemo while waiting for brca gene test result.