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TAC vs TC

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Faith18 View Drop Down
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    Posted: Jan 18 2018 at 2:55pm
My oncologist gave me 2 options for my adjuvant chemo treatment that involve these durgs.  She said she can't decide for me.

Taxotere (T), Cytoxan (C), Adriamycin (A)

1st option: 
T C every 3 weeks × 4

2nd option
 T A C  every 3 weeks x 6
May affect the heart and increases chances of leukemia by 1%. Increases survival rate by 3%.

I had Stage 2A 3.5 cm negative lymph nodes, BRCA negative.
Which one would you choose?


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gordon15 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote gordon15 Quote  Post ReplyReply Direct Link To This Post Posted: Jan 18 2018 at 5:36pm
Maybe a second opinion, if possible,  is a good idea if unsure?




Edited by gordon15 - Jan 21 2018 at 8:54am
wife: IDC/Lobular Stage2B 2008 lumpectomy/TAC+rads
TNBC Stage 3A/w/metaplastic/squamous Nov2015 Carboplatin-Gemzar chemo/masectomy Taxolchemo+rads 4-16
PET scan stable 9-2016/ 1-2017
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Tamara View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Tamara Quote  Post ReplyReply Direct Link To This Post Posted: Jan 18 2018 at 10:29pm
Faith,
I was given options and after asking questions, decided together with my oncologist to go with ACT. Cancer diagnosis was my first major health issue so needed guidance from professionals. My team of doctors were commited to me as a person, not as a number. I asked for their recommended course of treatment, especially when there were options on the table, but ultimately it was my decision and I chose to follow their recommendations. They did not decide for me but we worked together as I gathered information about each option. I am so grateful for each one of my doctors and nurses who were caring, kind and professional every step of the way.
Ask questions about each option, then you could ask your oncologist's opinion/recommended treatment based on your individual diagnosis then make your decision based on the information you gathered.
Keep us posted
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jan 18 2018 at 11:37pm
Faith,

Can you get a 2nd opinion?  When I was diagnosed in 2009, TC (chemo lite) was sometimes given for early stage bc with smaller tumors.  I noticed through the following years, that the standard of care (chemo) was usually AC followed by T or vice versa.  More recently, oncologists are adding Carboplatin to Taxol.  

Is there a reason for TAC together and not sequentially (A/C, then T or vice versa)?  

I haven't noticed that many women getting TC anymore, unless it's a small tumor or if there is a medical condition preventing the women from getting A (Adriamycin).  

I'm wondering why your onc can't decide?   Are there underlying health risks she's concerned about?  I really think another opinion from a different cancer center will make you feel better about your choice of treatment.  



Donna

DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Lisa s View Drop Down
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Lisa s Quote  Post ReplyReply Direct Link To This Post Posted: Jan 18 2018 at 11:37pm
I agree with Tamara. I am in Chicago area and my son went thru chemo when he was 10. So when it was my turn i asked the docs what was best and they said Act . i agreed with fhem. I am a total internet fiend so I am a little curious why they didn't suggest carboplatin after seeing so many women doing this on this site.but I will be asking that question at my next appointment
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123Donna View Drop Down
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Post Options Post Options   Thanks (1) Thanks(1)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jan 19 2018 at 1:36pm
Faith,

A couple of links to look at:

Current treatment strategies

Triple-negative breast cancer

Chemotherapy is the mainstay of adjuvant treatment for patients with triple-negative disease. We consider adjuvant chemotherapy for tumors >0.5 cm or axillary lymph node involvement. For node-positive disease, typically, we would recommend dose-dense AC-T.39 However, TC is a reasonable adjuvant therapy choice for node-negative or low-risk node-positive breast cancer.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197909/




Sequential AC-weekly paclitaxel or every 3 week docetaxel

The ECOG E1199 trial was designed to identify the optimal taxane and schedule. This trial enrolled 4,954 patients with stage II–III breast cancer who received standard AC followed sequentially by taxane therapy using a 2 × 2 factorial design. The study found no difference in the primary comparisons of taxane (paclitaxel vs docetaxel) and schedule (every 3 weeks vs weekly); other pre-specified analyses included a comparison of the standard every 3 week paclitaxel arm (175 mg/m2) for four cycles (P3 control arm) with weekly paclitaxel (80 mg/m2) for 12 weeks (P1 arm), docetaxel (100 mg/m2) every 3 weeks for four cycles (D3 arm), or weekly docetaxel (35 mg/m2) for 12 weeks (D1 arm) [100]. After a median follow-up of 5.3 years, the P1 arm was associated with improved DFS (HR, 0.73; P = 0.006) and OS (HR, 0.68; P = 0.01) compared with the P3 arm. Although improved DFS was also observed for the D3 arm (HR, 0.77; P = 0.02) without a survival benefit, it was associated with substantially more toxicity than the P1 arm. In an updated analysis after a median follow-up of 12.1 years, DFS was significantly improved and OS marginally improved for both the P1 arm (HR, 0.84; P = 0.011 and HR, 0.87; P = 0.09, respectively) and D3 arm (HR, 0.79; P = 0.001 and HR, 0.86; P = 0.054, respectively). Although weekly paclitaxel improved DFS and OS (HR, 0.69; P = 0.010 and HR, 0.69; P = 0.019, respectively) in triple negative breast cancer, no experimental arm improved OS for hormone receptor-positive, HER2 non-overexpressing breast cancer [101]. Another trial found no difference in outcomes comparing weekly paclitaxel (80 mg/m2 for 12 doses) with biweekly paclitaxel given at a higher dose (175 mg/m2 for six doses) given sequentially after AC, although there was more toxicity with biweekly higher dose paclitaxel schedule [102].

Sequential versus concurrent taxane administration

The NSABP B30 trial addressed the question of whether docetaxel is best given concurrently with or sequentially following doxorubicin [103]. The study included 5,351 patients with node-positive breast cancer to receive four cycles of AC followed by four cycles of docetaxel (sequential AC-D), four cycles of doxorubicin and docetaxel (AD), or four cycles of doxorubicin, cyclophosphamide, and docetaxel (concurrent DAC). After a median follow-up of 73 months, DFS was improved in the sequential-AC-D arm compared with the AD (HR, 0.80; P = 0.001) and the concurrent DAC arm (HR, 0.83; P = 0.01), and OS was likewise improved in the sequential-ACD arm compared with the AD arm (HR, 0.83; P = 0.03) and concurrent DAC arm (HR, 0.86; P = 0.09).


DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Faith18 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Faith18 Quote  Post ReplyReply Direct Link To This Post Posted: Jan 24 2018 at 4:07pm
I got a 2nd opinion.  I will now be getting AC every 2 weeks for 4 weeks.  After that , Taxol once a week for 12 weeks.  Thanks for all your comments
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