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TC vs ACT

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Allydp View Drop Down
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    Posted: Feb 20 2014 at 11:06am
Hi, this is my first post here. I'm 33 and was dx with TNBC, IDC, 2.4 cm, stage IIa, grade 3, node negative, BRCA TBD. Tx recommendations from two reputable hospitals are recommending neoadjuvant chemo followed by a double mastectomy with reconstruction. I agree. However, they're both recommending TCx4 over ACx4/TCx12. My onc said if it was her, she'd absolutely do the TC - that the risks of ACT far outweigh the rewards. She also admitted that if I were to get another opinion, they might disagree and recommend ACT, but that she still stands firm on the TC. I'm just not sure I want to go with the "lighter" regimen. I'm young and healthy and feel I'll bounce back from ACT. I feel like a Tneg grade 3 tumor is nothing to mess around with. Why not throw the kitchen sink at it now and ensure best chances for survival without recurrence? 

I've been reading around the board here and realize this is a hot button topic with no right or wrong answer. I have a call into my onc to discuss my concerns, but would really appreciate some opinions either way. Thanks so much. 
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KristiG View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote KristiG Quote  Post ReplyReply Direct Link To This Post Posted: Feb 20 2014 at 11:50am
I was diagnosed in September 2012..had a bilateral mastectomy and then started 8
treatments of Cytoxan and Taxotere.  I didn't have to have radiation because of the
mastectomies.  I wanted to be as aggressive as possible and I'm glad I did.  My last
chemo treatment was 5/2/13.  I've had a PET scan and a CT since that time and everything
still looks okay.  YAY!!  The side effects of chemo really didn't hit me hard until the
end of the chemo treatments.  My body just hurts all the time now but hopefully that
will subside at some point.  I wish you the BEST!!
 
Kristi
 
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Lillie View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lillie Quote  Post ReplyReply Direct Link To This Post Posted: Feb 20 2014 at 1:52pm
Dear Allydp,
 
Welcome to the TNBC site. 
Your  statement saying, Tneg grade 3 tumor is nothing to mess around with.  Why not throw the kitchen sink at it now and ensure best chances for survival without recurrence.  I totally agree with you. 
A lot of girls get TC and do fine.  It is the preference of a lot of them.
Since you feel you would like to have the TAC regime, I think you should have it.   Some oncologist are more liberal in their treatment of cancer and others are stricter.
When I hear an oncologist say, If it were me, or my mother, or my sister I'd go with the lighter treatment "MY ANTENNA GOES UP".....
My sister-in-law who was diagnosed with Stage IIIc, grade 3, and 13 positive lymph nodes, 2 years ago, heard her oncologist say he would recommend "TO HIS OWN MOTHER" CT x 6 every 21 days and then radiation.  She believed him and she is now near death.  I was in the meeting when this was said. 
Please follow your heart and risk the TAC.  I did and 7 years later, I'm glad.  Good luck with whatever you choose.
 
God Bless,
Lillie
Dx 6/06 age 65,IDC-TNBC
Stage IIb,Gr3,2cm,BRCA-
6/06 L/Mast/w/SNB,1of3 Nodes+
6/06 Axl. 9 nodes-
8/8 thru 11/15 Chemo (Clin-Trial) DD A/Cx4 -- DD taxol+gemzar x4
No Rads.
No RECON - 11/2015-9 yrs NED
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Charlene View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Charlene Quote  Post ReplyReply Direct Link To This Post Posted: Feb 20 2014 at 4:07pm
I would certainly be interested if anyone could post any research studies comparing the two regimens for TNBC, as far as recurrence rates go.  I think it might be difficult to find many, because there are lots of variables involved in one's diagnosis:  grade, node involvement, tumor size, BRCA status, age, etc.  Because of these factors, there is no one chemo regimen that works for everyone.  If there was, it would be called a cure.  I think it's great that you are getting more than one opinion and if you would feel better having ACT, then I think that's very important, too.  You don't want to have any lingering doubts about whether you did all you could.  I wish you the best as you make this decision. 
Charlene
DX 3/10 @59 ILC/TNBC
Stage 1, Grade 2, Multifocal; Lumpectomy/re-excision
SNB 0/4 nodes, BRCA-; Taxotere/Cytoxan X4, 30 rads
3/14:NED
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Allydp View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Allydp Quote  Post ReplyReply Direct Link To This Post Posted: Feb 21 2014 at 10:57am

Kristi, so glad to hear you’re doing well! Thank you!

Lillie, thank you so much for your candor and honesty. I know this is a highly personal decision, but it helps to have that kind of perspective. As of now, I’m leaning towards ACT and starting to feel at peace with switching. I am so sorry to hear about your SIL and wish you both all the very best. 

Charlene, thank you. For what it’s worth, my onco said there is about a 5% decrease in rate of recurrence with ACT. So it boils down to - is that 5% worth the 1-5% chance of later cancers or heart disease. For my specific case, I'm looking at 20% recurrence with TC and 15% recurrence with ACT. Wishing you all the best. 

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Post Options Post Options   Thanks (0) Thanks(0)   Quote mainsailset Quote  Post ReplyReply Direct Link To This Post Posted: Feb 21 2014 at 11:45am
Somewhere around here in the cobwebs is the article that reports research shows that Taxol first had better results that last. Good thing to keep in mind.

I'm thinking that there is a 3rd option out there and maybe a 4th. Once that will give you Lillie's great phrase of 'kitchen sink' approach and followup on your onc's advice.

We talk alot about clinical trials around here. Tneg is now the beneficiary of many branches of research and trials. My trial took the standard TAC and added Sutent to the Taxol portion so it gave me the comfort of knowing we were using what had a good track record but then added a stick of dynamite to the mix. Since I was Stage III I was pretty anxious, as you can imagine, to go the extra mile.

Do ask your doctor about trials their office offers and then, if nothing more than the education benefit, do think about going to a 2nd doctor or even a large facility like a University hospital in your area. I found that at our Seattle Fred Hutchinson I had the opportunity to meet at a round table with the oncologist, surgeon and radiology oncologist. I came away with many things resolved which was a relief.

Best of luck to you
Mainy
dx 7/08 TN 14x6.5x5.5 cm tumor

3 Lymph nodes involved, Taxol/Sunitab+AC, 5/09 dbl masectomy, path 2mm tumor removed, lymphs all clear, RAD 32 finished 9/11/09. 9/28 CT clear 10/18/10 CT clear
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Allydp View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Allydp Quote  Post ReplyReply Direct Link To This Post Posted: Feb 21 2014 at 11:58am
Mainsailset, huge congratulations to you on beating that stage III!!! (I'm assuming from you sig.) I'm so glad you were able to find a great team that went the extra mile for you. I actually had a second opinion at the University of Michigan in Ann Arbor. My case was presented to the tumor board and surprisingly, they also recommended TCx4. In fact, they recommended the exact same treatment plan as my current hospital. I do love my team at my hospital, so I stuck with them and thought I was good to go. It wasn't until I started seeing online that the vast majority of tnegs were treated with ACT. This prompted to me to reach out to my friend at Sloan Kettering and here we are today. Google is an evil thing sometimes, but I'm glad to be informed!  
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Feb 21 2014 at 4:27pm
This is truly a tough decision.  I had TC and ended up with a recurrence.  I've known other women who had a similar diagnosis to me or even Stage 2 that had TC and never recurred.  Personally, I think without analyzing the chemosensitivity of the individual tumor it's all a crap shoot.  The good news for you is you are doing neoadjuvant chemo so you'll have something to measure.  Those of us that had surgery first, then chemo, don't know if the chemo was effective or not.  I agree with the others about throwing everything at it the first time and hope it doesn't come back.  I really like the studies that suggest adding Carboplatin to the mix increases pCR.  Can you ask about getting Carboplatin/Taxol, then A/C?  Many of us TNBC respond well to the platinums.  Here's a study showing the improved neoadjuvant response by adding Carbo.

http://forum.tnbcfoundation.org/adding-carboplatin-increases-pcr_topic11688_post118731.html?KW=Carboplatin#118731

Whatever you decide, wishing you the best,

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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Post Options Post Options   Thanks (0) Thanks(0)   Quote littleradish Quote  Post ReplyReply Direct Link To This Post Posted: Feb 26 2014 at 4:10pm
I had neoadjuvant chemo 4 rounds of TC. I did not get pCR as we first thought. No one could feel the tumor nor could it be found on the ultrasound. After my double mastectomy it was found that there was still 50% of my tumor but it was full of holes basically it looks like swiss cheese that was why no one could feel it.

My oncologist suggested 4 rounds of gemzar/cisplatin which I did just in case anything was floating around in there.
Diagnosed March 2013, TC chemo from April-July 4 rounds. Double mastectomy Aug of 2013 clear margins and no lymph nodes involved. 4 rounds of gemzar and cisplatin September to October
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Allydp View Drop Down
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Allydp Quote  Post ReplyReply Direct Link To This Post Posted: Feb 28 2014 at 1:48pm
I just thought I'd come back with a quick update. I decided to go with ACT and had my first infusion Tuesday, the 25th. I'm doing great so far. No nausea, just very tired, jittery, sensitive to light and having trouble concentrating. I think some of that is the anti-nausea meds and steroids. Thank you all so much for your input and feedback. It was a tough decision, but I feel at peace with the aggressive regimen, as does my husband. Here's hoping to a pCR!!!
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grma View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote grma Quote  Post ReplyReply Direct Link To This Post Posted: Feb 28 2014 at 9:54pm
Allydp yes, steroids can make you jittery. Are you able to sleep?
You may be able to get something from your Dr. Or you might try melatonin or chamomile tea. I was on taxolx12 and then FECx4
followed by surgery and then radsx36. F is flourouracil. E is epirubicin and C is cyclophosphamide. This was a research studyin 2010. You'll see if you are NED after surgery. I was not, but after radiation, I have been NED since 2011. I started at stage 3, grade 2. Continue to come to this site and question your DRs.
God Bless
dx5/26/10 5cm/5nod/stg3gr.2 neadjuv Taxol 12/FEC 4
mast.Dec.2010/6wks.rad 3-11
NED NO RECON
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Allydp View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Allydp Quote  Post ReplyReply Direct Link To This Post Posted: Mar 28 2014 at 4:10pm
Hi ladies, I wanted to come back and update this thread for those that might be reading at a later date. I tested positive for BRCA2 and as a result, my onc is recommending we add Carbo to my chemo regimen. I have one more round of AC left and will start Carbo/Taxol. in a few weeks. So far I'm doing really well on the AC and hoping that's an indicator of how I'll do on the weekly treatments. 

grma - my sleep is much better. I'm taking an Ativan and Benadryl at night and it's helping. Thanks so much again for all the great feedback. I greatly appreciate it! 
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Lillie View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lillie Quote  Post ReplyReply Direct Link To This Post Posted: Mar 29 2014 at 9:45am
Dear Allydp,
 
So glad to hear you are tolerating the chemo fairly well.  I'm sorry you tested positive for BRCA2, but what a blessing that you chose the more aggressive chemo and now the onc is adding the Carboplatin for extra insurance. 
 
God Bless you in your journey.  Keep updating us on your journey.
 
God Bless,
Lillie
Dx 6/06 age 65,IDC-TNBC
Stage IIb,Gr3,2cm,BRCA-
6/06 L/Mast/w/SNB,1of3 Nodes+
6/06 Axl. 9 nodes-
8/8 thru 11/15 Chemo (Clin-Trial) DD A/Cx4 -- DD taxol+gemzar x4
No Rads.
No RECON - 11/2015-9 yrs NED
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