HER2 Support Group Forums - Anthracyclines

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Hello all. I've been looking around the various forums (usually I only come to this main one, the volume here is quite enough!), for a recent discussion of the anthracycline question, but I don't see anything. My sense is that most on this board have gone the TCH route for adjuvant treatment, is that correct? And that most agree with Dennis Slamon's stance on anthracyclines, and TOP2a, etc?

So what do you think of the JCO article, with so many eminent co-authors? Burstein, Piccart, Perez, Hortobagyi, Wolmark, Albain, Norton, Winer, Hudis. They are not ready to say there is no place for anthracyclines, in high-risk HER2+ cancers. They rather carefully go thru the evidence -- the concerns about toxicities, the possibility that Herceptin trumps its chemo partner, etc. Yet they still conclude:

"Until more data are available, however, we encourage patients and clinicians to consider the most highly studied, highly effective adjuvant trastuzumab regimens—those that also incorporate anthracycline treatments—as the mainstay of therapy for women with higher-risk HER2-positive tumors. To date, such regimens offer the greatest chance of preventing breast cancer recurrence."

http://jco.ascopubs.org/content/30/1...9-814c8e52b833

At the bottom of this article, you'll find a link to another one in the same edition of JCO, noting a steady decrease in anthracycline use, since 2005 (when Herceptin was approved for adjuvant use).

I think JCO has a grace period before they will post rebuttals and letters in response to an article. There probably will be rebuttals, don't you think?

I'm not just asking out of idle curiosity. I'm asking for the newly-diagnosed woman who is trying to do her homework and make a reasoned decision about treatment -- yet she is finding recommendations (from experts, not just from local oncs) in both directions.

It's not that unusual for the answer to treatment decisions to be: "there is not enough difference between these two choices for us to tell you which is best -- you pick". That is hard enough for most women, to accept that the answer is not known. But it's more unusual (and more frustrating for the patient) to have the same evidence in front of everyone, and to get conflicting interpretations of it. And most oncs (both in the trenches and in academia/research) seem to be taking a stand, rather than sitting back and saying "we don't know for sure". What's a woman to do!?

Thanks in advance for your thoughts on this.

Debbie Laxague

Re: Anthracyclines

Debbie - I am doing the ACTH routine. I asked my MO about TCH back in May and he agreed that it was certainly an option for me, but felt the stats support the ACTH more. I didn't read this article until after I started treatment, but it has brought me some comfort. Most triple positive women I meet are doing TCH. I had a UMX with one positive node and will also be getting radiation - yet another twist in recent months.

Re: Anthracyclines

Debbie I did the ACTH seven years ago and with three positive nodes at the time I'm grateful I was treated this aggresively by my Onc as really did'nt think I'd be here still but will watch other replies with interest:)

Re: Anthracyclines

"... at the time of analysis, not a single patient had died as a result of heart failure. Indeed, the 1% numeric difference in overall survival between the arms, translating to approximately 10 patients and favoring ACTH, clearly suggests that the toxicities of ACTH did not compromise the overall survival of patients in that arm and that a survival advantage remains within the realm of possibility for patients treated with anthracyclines. "

I'd had FEC in 2003 and did some research on anthrocyclines at the time since 'E'pirubicin belongs to that class. It carries the risk of damages to the heart, but it also destroys cancer cells in a certain manner that it brings up survival rate.

There are certain features of the cancer cells that help determine which chemo combo will be more beneficial. This article did not go into details - but I've read from other sources and know that my doctors had made their recommendation based on clinical evidence.

My 2nd Brother (10 years my senior) chose to have (optional) chemo (5-Fu) in 2007 after his colon was removed. He's been doing fine. Mother had needed some persuasion on her chemotherapy for NHL in 1998. She' also been doing well.

Ask your doctors about the features of your cancer cells. Ask them whether or not you will benefit from anthracyclines. 1% sounds tiny, but it's huge if you happen to be one of them!