TCH Therapy...6 OR 4 Cycles...

[SusanN]

Hello Ladies!

I JUST had my first cycle of Taxol/Carbo last Tuesday...
(Monday...started Herceptin...)

My therapy will be 6 cycles every 21 days along with weekly Herceptin...then a year of Herceptin.

Let me tell you...WOW...I "thought" I was doing okay after my infusions...a few days later...WHAM!!!!
I was down for nearly 4 days...my white blood count was 1.6 this last Mon...and I still got Herceptin...will see what it is this Monday!

Anyhow, I had a followup with my BS, he was questioning "why" I was getting" 6 cycles as to 4.
He knows my Medical oncologist and is going to talk with him about it as he believes that 4 is as beneficial as 6...

Thoughts...input...Thanks!!!

PS...this TAXOL is TAXING...WOW, I lost 4 pounds in about 4 days!!! UGHHH!!!

[Becky]

Standard of care is 6 cycles.

[Kellennea]

I did 6 cycles as well. A full year of Herceptin and 33 rounds of radiation

[chekmark]

I also had 6 but was told I could have 4 of a different cocktail but there was a shortage of it at the time so I had to have TCH. I believe the other was adriamycin or something like that and it would have been 4 so maybe that is why he thinks 4. Good luck to u!!!

[Jaimieh]

I had a 1.3 cm tumor and I had 6 rounds of TCH. I kept looking and praying that there would be a study that showed 4 was fine. I never found it and I made it thru the 6. After the fact I am glad I did because I know that I did all that I could.

BTW, I lost 30lbs during chemo . I sadly now have found it all and some more. Hang in there. My saving grace was emmend.

[LoisLane]

I had 4 cycles TCH followed by 18 infusions of herceptin which were done every three weeks.

[lasarles]

You can read in my signature what my dx was and my onc said 4 was sufficient. I have often wondered why others with similar dx as mine, had 6.

[Jean]

I had the standard of 6....I believe that 6 was what Dr. Slamon used and set standard of care from the trials.

[Jackie07]

A year back 4 doses of AC+TH schedule was being used by several new members. http://her2support.org/vbulletin/showthread.php?t=40240 Wondered if this is a new compromise. Also noticed the two ladies who had used 4 TCH all had Grade 2 tumors (not as fast growing as Grade 3) Another old thread had discussions on the topic: http://her2support.org/vbulletin/showthread.php?t=23543

Breast Cancer Res Treat. 2012 Jan;131(2):713-21. doi: 10.1007/s10549-011-1862-y. Epub 2011 Nov 8.
Adjuvant therapy for HER2+ breast cancer: practice, perception, and toxicity.

Rocque G, Onitilo A, Engel J, Pettke E, Boshoven A, Kim K, Rishi S, Waack B, Wisinski KB, Tevaarwerk A, Burkard ME.
Source

University of Wisconsin Carbone Cancer Center, Wisconsin Institutes for Medical Research, 6th floor, 1111 Highland Avenue, Madison, WI, USA.

Abstract

Multiple adjuvant regimens are used for HER2+ breast cancer, but experience in routine practice is not reported. We evaluated whether oncologists' perceptions of these regimens matches clinical experience. We surveyed Wisconsin medical oncologists throughout the state regarding factors impacting selection of TCH (docetaxel, carboplatin, and trastuzumab) or anthracycline-based therapy. We also reviewed 200 cases of HER2+ breast cancer treated at the University of Wisconsin and the Marshfield Clinic and collected data on patient and tumor characteristics, chemotherapy regimen, and toxicities. Two-thirds of surveyed oncologists prefer anthracycline-based therapy, particularly for node-positive cancers. However, TCH was preferred for early-stage (T1a-bN0) tumors. Half of oncologists use prophylactic G-CSF with TCH. In the 200 cases reviewed at our centers, acute toxicity occurred more frequently with TCH. There were fewer dose modifications or delays for AC-TH (doxorubicin, cyclophosphamide, paclitaxel, and trastuzumab) than TCH (31% vs. 47%, P = 0.07), possibly due to higher use of prophylactic G-CSF with AC-TH (77% vs. 34% with TCH, P < 0.001). Fifteen patients received prophylactic G-CSF during TCH; none developed neutropenic fever. In contrast, 25% developed neutropenic fever during TCH without G-CSF. There were modest declines in median left ventricular ejection fraction reaching 9% with AC-TH and 3% with TCH at 12 months, but early cessation of trastuzumab was similar for both regimens. We conclude that TCH and AC-TH are common adjuvant regimens used for HER2+ breast cancer. The preference of TCH for early-stage disease and anthracycline-based therapy for node-positive disease suggests that many oncologists perceive that TCH is safer and AC-TH more effective. Myelosuppression from TCH is greater than AC-TH, but can be mitigated with routine G-CSF.

[JillaryJill]

6 cycles of TCH is standard of care at Rush University Chicago, top Chicago hospital. If I would have chosen ACTH, that is 4 rounds of AC, then 12 rounds of T, then Herceptin for a year.

[carlatte7]

I was scheduled for 6 but tumor melted away and they cancelled the last 2. I kept saying, Are you SURE? I can do 2 more!" All the while thinking that i really, reeeeeally dont wanna do it again down the road. He said 4 was fine. Srgery showed. NED in breast.

[SusanN]

Thank you so much for all of your input...Jackie, I always appreciate the time you take to help me with your "knowledge!!"
Carlatte...what a story...Miracle...God is in this...I truly believe!!!
Jaimeh, as to the weight loss, I'm sorry to hear that...I'm not a big person...and am trying my hardest to keep EVERY pound on...to put weight on, so this is going to be a battle that I WILL WIN!!! I started at 112...after my first cycle, the YUCK side effects, etc...dropped to 108...I'm not gonna play around with this though...I was in the Army for 13 years...NO WAY...!!!!!!

[jaykay]

I did 6 of TCH, Herceptin every 3 weeks until November. Started radiation last week, will do 28 times.

I didn't want to lose weight either so ate whatever tasted good which was not much. Cookies, danish, sweets. Ate real food, too :-). Ended up losing 5 during the 1st week following chemo and gaining it back when I felt "normal" during the 2nd two weeks.

['lizbeth]

December 16, 2010 (San Antonio, Texas) — Are 6 cycles of adjuvant chemotherapy for breast cancer better than 4?
This was one of the basic questions asked in Cancer and Leukemia Group B (CALGB) 40101, a phase 3 clinical trial of 3173 women with "good-risk" breast cancer that began in 2002.
"Many studies have looked at 4 vs 4 cycles or 6 vs 6 cycles of different regimens," said lead author Lawrence Shulman, MD, from Dana-Farber Cancer Institute in Boston, Massachusetts. However, this CALGB trial is the first time that 4 and 6 cycles have been compared, he told Medscape Medical News.
The study's results, which were presented here at the 33rd Annual San Antonio Breast Cancer Symposium, were anticipated by 2 prominent breast cancer medical oncologists.
"It's a question many clinicians wonder about. We assume 4 cycles is enough," said Peter Ravdin, MD, PhD, before the start of the symposium in an interview with Medscape Medical News. He is codirector of the annual meeting and is from the University of Texas Health Science Center at San Antonio.
"Does the duration of therapy matter?" asked Kathy Miller, MD, about the trial. She commented on the trial in her Miller on Oncology videoblog before the annual breast cancer meeting. She is from Indiana University Simon Cancer Center in Indianapolis.
The answer is now in: "Six is no better than 4 for the general population in the study [or for the] subgroups," said Dr. Shulman.
That is to say, in women with good-risk invasive breast cancer (0 to 3 positive lymph nodes), relapse-free survival at 4 years was 91.6% for those randomized to 6 cycles and 91.8% for those randomized to 4 cycles (hazard ratio, 1.10; (95% confidence interval, 0.87 - 1.39; P = .42). Relapse-free survival was the primary end point of the study.
At a median follow-up of 4.6 years (range, 2.5 to 8.0), the number of relapse-free survival events is 288 (138 with 4 cycles and 150 with 6 cycles). The average age of the women was 52 years.
Overall survival was a secondary end point, and both durations of therapy were, again, roughly equivalent in terms of percentage (in the mid-90s).
Which Drugs? What's the Design?
In one section of the study, the investigators randomized patients to either 4 or 6 cycles of the combination of doxorubicin (Adriamycin) plus cyclophosphamide — which "has been the backbone of many adjuvant breast cancer regimens," said Dr. Shulman.
In the other section of study, the investigators randomized patients to either 4 or 6 cycles of the taxane paclitaxel (Taxol).
The approach is known as a 2×2 factorial design and suited the investigators purposes.
At the beginning of his presentation, Dr. Shulman spoke about the study's agents and design.
Taxane-containing regimens have been compared with the workhorse combination of doxorubicin plus cyclophosphamide, and have shown favorable results but increased toxicity, he said. However, studies of locally advanced disease have "raised the possibility of equivalence of a single-agent taxane to [combination doxorubicin plus cyclophosphamide]-based regimens, avoiding the anthracycline and potentially reducing short- and long-term toxicity," said Dr. Shulman. The "ideal duration" of adjuvant therapy is not known, he added.
The study examined the ideal duration of doxorubicin plus cyclophosphamide and paclitaxel, and compared the combination with single-agent paclitaxel.
Dr. Shulman did not disclose the results from the showdown between the combination and paclitaxel because the data are not yet mature.
However, the investigators are comfortable in their assessment that 4 and 6 cycles have equivalent outcomes when patients receive either doxorubicin plus cyclophosphamide or paclitaxel.
"We can feel very comfortable giving women in this good-risk group 4 cycles," said Dr. Shulman.
The investigators of the multicenter trial also looked at subgroups of women. There was no comparison of women with positive and negative lymph nodes because 94% of patients were node negative.
But 64% of participants were estrogen-receptor positive and 20% were HER2 positive. Still, there was no statistically significant difference between the 4- and 6-cycle subgroups for either relapse-free or overall survival, reported Dr. Shulman.
Adverse Events Worse With 6 Cycles

The treatment schedule in the trial was changed twice; ultimately, chemotherapy was delivered every 2 weeks for both doxorubicin plus cyclophosphamide (60 and 600 mg/m2, respectively) and paclitaxel (175 mg/m2), and each was given for 4 or 6 cycles.
Serious adverse events were worse in the 6-cycle groups than in the 4-cycle groups. "Not surprisingly, 6 cycles of therapy is more toxic than 4," Dr. Shulman said.
In the combination groups, grade 3/4 neutropenia was most notable. It was higher in the 6-cycle group than in the 4-cycle group (34% vs 26%).
In the paclitaxel groups, grade 3/4 neuropathy was most notable. It was higher in the 6-cycle group than in the 4-cycle group (13% vs 6%).
The authors have disclosed no relevant financial relationships.
33rd Annual San Antonio Breast Cancer Symposium (SABCS): Abstract S6-3. Presented December 11, 2010.

['lizbeth]

The information I posted above is from:

The Cancer and Leukemia Group B (CALGB) is a national clinical research group sponsored by the National Cancer Institute, with the Central Office headquartered at the University of Chicago and Statistical Center located at Duke University. Founded in 1956, the CALGB brings together clinical oncologists and laboratory investigators to develop better treatments for cancer. CALGB has grown exponentially over the years into a national network of 26 university medical centers, more than 200 community hospitals and more than 3,000 oncology specialists who collaborate in clinical research studies. These studies aim to reduce morbidity and mortality from cancer, relate biological characteristics of cancer to clinical outcomes, and develop new strategies for the early detection and prevention of cancer.


This was a large study with over 3000 women. You seem to fit the criteria good risk invasive breast cancer with 0 to 3 positive nodes.

Your breast surgeon has likely seen the results of this study.

You can feel confident that 4 treatments of the taxane will be enough. You will have an entire year of Herceptin.

Please consider a vaccine trial, diet/exercise study or other study to reduce risk during or subsequent to your treatment.

Wishing you the best of health.

[BonnieR]

My onc stopped me after 4 cycles. I remember she said I had a "small cancer" I assume in reference to the sort of criteria stated in the studies. We stopped because I was developing neuropathy in my feet. It lingers slightly still
Keep the faith

[SusanN]

THANK YOU ALL...

lizbeth, so very much appreciated!!

I had found an article a couple of days ago...
Elsevier Global Medical News, 2011 Jan 5, B. Jancin

I NEED to start "linking" these...(to figure it out...just take the time to do it!)

It talked about 0-3 nodes as 4 to 6, the ratio toxicity, etc...

It will be interesting to see how my appointment goes Monday with my oncologist!!

I'll go for the 6, I want to have this GONE...however, the least lasting effects that may be overkill...I'm quite confused at this point and may be doing too much "googling"...

Again, thank you all so very much!

['lizbeth]

Yes, this article is another summary of the trial I posted. The results of the CALGB 40101 show that 6 treatments are no more effective than 4 treatments. The addition 2 treatments results only in additional toxicities.

This is a large phase 3 study by a government agency that has no financial stake in the outcome. Based on this information, the best treatment option is only 4 cycles. You will likely receive no health benefits from doing 2 additional cycles of chemotherapy. This is based on the taxane Paclitaxel, or simply Taxol.

Are you doing Docetaxol (Taxotere) or Paclitaxel (Taxol)?

[SusanN]

lizbeth,
With my "Chemotherapy Orders" in my hand...I am doing Docetaxol.
SO glad you brought to my attention! At my initial consult with my medical oncologist, he said some of his patients do better on one or the other. I would be on "taxol."
Now, as I said, I'm looking at my orders and have been the entire time I've started as to my dose, etc!

Everytime I go to my appointments, I've got my list of questions,...this last visit with my BS, I, of course said I have some questions, his response, "Of course you do!" He is a very knowledgeable/compassionate doctor! Cancer Surviver, too!!

Last Mon, 3rd Hercepin, had quite a scare (you may have read my thread...), however I had a reaction, heart palpitations, racing pulse rate, tingling tongue...asked nurse to slow infusion...and to please take my BP...she told me I was probably having a "panic attack"...got going again...(I was talking with mom...all was going smooth before this came)...started again, I asked her to "stop" it!
She Finally called my onc, he ordered a steroid...she acts as if I "annoy" her, needless to say, LONG DAY...

Making a long list of questions & info for my Mon appointment with my oncologist!!

Always so grateful for you knowledge and input!!

['lizbeth]

I had similar experiences. I found out after the premeds of my first infusion that my oncologist had switched from paclitaxel to docetaxel. I had done 6 months of research and was comfortable with the plan.

This was traumatizing to me. I didn't know anything about Taxotere.

After the 3rd treatment of Taxotere I had diarrhea so bad it seemed like the lining of my intestines where trying to come out. It was horrible. I was too sick to go to ER, argh. I make it in to the oncologist and the nurse is telling me it is just anxiety. The new NP ran a blood test and found I was extremely low in potassium. Gave me a prescription for it and as soon as I took it the problem resolved.

My nurse Jennifer was just amazing. So lucky to have had her. But many of the nurses acted like I was just annoying too.

Welcome to the interesting world of cancer treatment. Not what you would expect.