Pros vs Cons? (AC chemo with or without T)

[mekasan]

Hello everyone,



This is my first question.



Today, I noticed that according to the Clinical Care Options Oncology- 2005 San Antonio Breast Cancer Symposium website, (found at http://clinicaloptions.com/Oncology/Conference%20Coverage/Breast%20Cancer%20Dec%202005.aspx), TC chemo is superior to AC chemo for early stagers. My understanding is that Docetaxel/cyclophosphamide is TC and doxorubicin/cyclophosphamide is AC. Please see the following article for my source if interested. Docetaxel/cyclophosphamide superior to doxorubicin/cyclophosphamide in early-stage operable breast cancer.



My background: In August 2005, at 29 years old I was diagnosed with stage 1 IDC (two small tumors – .7 cm and .4 cm) and DCIS (4 cm dispersed throughout left breast). I have no node involvement. I am ER-,PR- ,and HER2Nue +++. I had a mastectomy on the left side in August before chemo and a preventive mastectomy on the right side last month. I received 4 rounds of AC three weeks apart and immediately began my 1 year of Herceptin on Dec 21, 2005 spaced every three weeks.


When which chemo treatment plan, my oncologist conferred with oncologist at Sloan Kettering, UCLA, and others. He cited an unpublished study from UCLA that compared AC to AC-T and found no difference when given with Herceptin to treat Her2Nue+, early stage, no node invloved, breast cancer. He concluded that AC plus Herceptin was equally effective as AC-T. He felt the T (docetaxel) was unnecessary, so I did not ask for it. At that time less chemo sounded better than more. I trust his research. However, that was in September 2005 and the article above was published in December 2005. Because I know it is possible for early stagers with no node involvement to experience a metastasis, I would like my treatment to give me the best chance at never seeing a recurrence anywhere in my body.


My questions: Is anyone with a similar background also not receiving T (doctaxel) chemo? Is it too late for me to add the T in now? Does anyone have any thoughts about the pros vs. cons of receiving or not receiving the T chemo?



I am looking for a starting point to help me make a decision about getting T and any type of input would be greatly appreciated. Sorry for the length of this question.



Sincerely,

Shannon (screen name: mekasan)

[Sheila]

Shannon
You are right to question this as there are women out there that go from Stage 1 to Stage IV...I had a .7cm tumor, neg nodes, ER PR - and Her2 3+++, Stage 1, then 1 1/2 years later I had mets to the neck nodes....have you asked your oncologist? He seems like he has researched it...I do remember seeing this discussed on this board before, maybe someone who has had the Taxol will respond....glad to see you are getting the Herceptin....sounds like you are covering your bases.

[karenann]

Hi Shannon,

I was diagnosed in Jan '05 with a 1.3cm tumor, node negative, er/pr+, grade 3 and Her2+++. My onc treated me with, dose dense, AC & T every two weeks and two weeks after my last Taxol, I started a year of Herceptin. We never talked about the benefit of Taxol at that time but part of that had to do with the fact that, I was not that savvy about the whole breast cancer thing yet.

I know I have read articles about Taxol/Taxotere (sp?) and long time survival in early stage bc, but I can't find the articles now.

If you feel strongly about being treated with with one of the above drugs, then tell your doc that's what you want. Originally my onc said I didn't need Herceptin, but I got 2nd and 3rd opinions and now I am on it.

Hope this helps.

Karen

[tricia keegan]

not sure if this helps but my onc says if there is no node involvment Taxol is unnecessary.
Tricia

[Michelle]

My onc. also stated taxol was not necessary for negative nodes(overkill as he put it). I decided it was necessary for my peace of mind, and he relented. Do your research , and go with what you can live with. I have not regretted my decision, but my onc. felt it was a little more tx. than I needed.
Best wishes
Michelle

[G. Ann]

Hi Shannon--I was diagnosed 2/04 with 2.5 cm tumor with mastectomy, ER/PR-, HER-2+++, no cancer found in 16 nodes, grade 3 for tumor, and Stage 2a. I only had 4 AC treatments. My onc had just attended 2004 conference and didn't think the benefits of Taxol or taxotere warranted the risks for a node negative patient. Since I was struggling with chemo, I said OK, let's stop. I have had doubts if this was a good decision or not, but it's too late now to go back.

I began Herceptin five months ago and this has helped my anxiety over feeling that I did everything possible to prevent recurrence since I did not do the 4 Taxol/taxotere txs. My onc seems very focused on the node negative aspect and less concerned over HER-2 status, so I'm NOT 100% trusting his assessment.

The main thing is to speak up and help ease your concerns. There doesn't seem to be one size fits all tx, plus new info is changing all the time. This website helps keep us sane.
G.Ann

[Cathya]

Shannon;

Perhaps, if you end up not being able to take taxol at this time and are uncomfortable with this, you could consider a vaccine trial? I am not sure what qualifications one needs for these but many on this board are very familiar with them. Also, perhaps your onc would use tumor markers to monitor the serum her2 levels, etc. in your blood and keep a handle on any potential cancer cell development in your body. Gina monitors herself in this way and should her serum her2 levels rise she takes a booster of herceptin to knock down the disease. If you read her posts I think you would find her approach of interest. Given your youth and being her2+ this does not seem an unreasonable request.

Best regards,

Cathy

[mekasan]

I would like to thank you all for responding. Before I initiate a conversation with my doctor about the pros/cons of starting chemo again, I would like to educate myself a bit. I feel that I can get the basic facts if I do my homework, like reading up and asking the experts (you all) about past experiences. This way my discussion with my doctor become more meaningful and pointed.

Thanks again for your help in my quest to understand the complexity of treatment choices when dealing with illness.

I still welcome more opinons about the Pro/Cons of "T" chemo, if anyone wishes to add.

Thank you,
Shannon

[Barbara2]

I can comment on not having Taxol, but my situation was quite different from yours. In Oct 02, I was stage 2b, very close to stage 3A. Because I was over 50 yrs old (52) my onc convinced me I should not have taxol. He showed me documentation in big onc book that said it wasn't that effective for women over 50 years of age.

I received CEF (similar to AC) which made me very ill. I wanted the taxol, but because I had been so sick with chemo, I agreed to stop after the CEF.

Later, after learning more about Her2+ (mostly from this site) I regretted not getting the Taxol. When starting late herceptin, my onc agreed to give me taxol if that was my wish. After much prayer and deliberation, I decided to skip the Taxol. I am ER+ and taking Arimidex, so I also would have had to stop the Arimidex.

I have been able to "let go" now, of the no Taxol issue. There are some people who don't bebefit from taxol, so who knows, maybe it wouldn't have helped........

One more thing. My onc doesn't get that excited about Her2+. He said it increases your chance of recurrance by 15% more than other types of breast cancer, but that's it. Although I do know he treats it aggessively, so maybe he is trying to keep my anxiety level at an even keel.

Good luck on your decision. I've been there......
Barbara