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weekender09 View Drop Down
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    Posted: Apr 15 2013 at 11:12pm
After suffering most side effects in the book today was my last AC chemo.  I had 4x every other Monday.  I am relieved to hear that 90% of recipients say that Taxol is easier then the AC.  I will have Tx4 every other week.  

Hoping you all have successful transitions as I am praying for.  Love and prayers to you all. 

Barb
02/12/13 DX TNBC, Grade III, Stage 3, 3.3cm tumor, IMN and 1 lymph Positive, Chemo A/C T complete 6/13
BRCA1-/BRCA2+ Variance, BIL 7/13, 33 RADS complete 10/13 Remssion :)
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arabella View Drop Down
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Congrats on finishing your AC, Barb!  Wishing you the best with Taxol.

Kaye
Dx TNBC 1/2013; age 63; 1.1 cm; Stage 1, Grade 1(?); lumpectomy clear margins; ALND -; severe SEs to first TC and treatment stopped; radsX25; BRCA -
Recur 6/2015 Mastectomy
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Points: 214 		Post Options Post Options   Thanks (1) Thanks(1)   Quote Katdoll Quote  Post ReplyReply Direct Link To This Post Posted: Apr 15 2013 at 11:54pm
Congratulations!  AC deserves its nickname "red devil" IMO.  In comparison, Taxol was not a walk in the park for me.  No nausea or sick feeling at all.  I was tired a lot, but that was fine - I enjoyed the sleep because I'd had insomnia with AC.  I had some minor irritations like runny nose, sore throat.  I had peripheral neuropathy, but not terrible, and it dissipated after treatment ended.  I hope you are part of the 90% that finds Taxol easier to bear.  XXXOOO.
Tested positive for BRCA1 mutation (187delAG) in 4/09 @ age 44; BSO 9/09; diagnosed w/TNBC in 10/09; 1 cm Stage 1 TNBC IDC, grade 3 + 1.5 cm DCIS; BMX 11/09, nodes clear; chemo (AC/T).
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Hooray! Happy for you, I hope you find Taxol easier. I just started it myself on Friday (in combo with carboplatin) and so far I find it much easier to handle. Good luck to you!
dx 12/27/12 age 34
lymph, liver, & lung mets
BRCA1+
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YAY, Taxol easier for me, but bone pain after Neulasta off the charts (not everyone gets this)
Natalie
TNBC stage1 size 1.8, grade3 no nodes 4/11 Lumpectomy 5/11 4cycles DD A/C 4cycles DD Taxol. Double Mastectomy 12/11 BRCA all neg
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Dear Barb,
 
I had the 4X AC and then 4X T/gemzar.  The AC was really hard for me.  The T/gemzar was easier.  I had side effects with T/gemzar which were quite bothersome.  Overall it was easier side effects to deal with than with the AC.   Everyone is different and I hope your T side effects aren't too bad.
 
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 - 11/2018-12 yrs NED
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Barb,
Congrats so happy you are finished with the AC sure hope the taxol is a much easier road for you,love and prayers to you also.
Hugs
Denise
DX Idc 10/07,st2,gr3,2/6 lymphnodes
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Congrats Barb, good to hear you were able to get the last one in.  I had my 3rd today and am ready to get the 4th done with also.  After these next few days AC will be a distant memory for you, hopefully one you forget.  :)  

Talk to you later

Julie
Dx 3-7-13 TNBC, 5cm pT2N1M0
3-19-13 ACx4, 5-14-13 Taxolx4
7-17-13 BMX ypT1N2M0(.9mm) 4/24 nodes.
10-8-13 completed Rads x 30
12-3-13 completed Eribulin Trial
10-18-13, 3-19-14 Bone/Ct Scan Clear
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MLindaG View Drop Down
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Points: 380 		Post Options Post Options   Thanks (1) Thanks(1)   Quote MLindaG Quote  Post ReplyReply Direct Link To This Post Posted: Apr 19 2013 at 10:36pm
Congrat's on finishing the A/C!  I marvel at all of you that have the A/C every two weeks..........I had it 4x every three weeks and could barely stand it!! Yes, I did have a total melt down the day I had my 4th treatment!!  I could NOT stop crying!  Taxol was much better.......didn't have a melt down day at all!!!  I'm not saying it doesn't have it moments but certainly not like A/C.  Good luck!  Hope it eats up all the cancer!!
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Points: 49 		Post Options Post Options   Thanks (0) Thanks(0)   Quote annafriday Quote  Post ReplyReply Direct Link To This Post Posted: May 08 2013 at 12:54pm
Hello everyone...I am getting ready to start AC in the next 1-2 weeks. Getting a port placed and 2nd opinion at UCLA with a TN Specialist to see if she has a different opinion or clinical trial for  me.  My Vegas Oncologist wants me to do 6 cycles of AC every 21 days. Wondering why he did not recomment Taxol. Maybe UCLA dr will have another plan for me.  Im wondering if everyone gets steroids during chemo. I hope I don't have to because I know steroids increase blood pressure and blood sugar levels..the elevated sugar worries me because they say sugar feeds cancer. Just a thought.  Thanks for all the posts of you that have been through this journey before me..with helpful suggestions and encouragement. xoxo

Anna
DX:3/20/13 right breast multifocal stage 3a TNBC. Bilateral Mastectomy 4-18-13 largest tumor 6.2cm. 1 microscopic sentinal node positive. KI-67 77%. ACx4..doing Taxol now x12 weekly.
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ClapCongrats to you!!! Now hopefully it gets easier from here!! Have you had surgery?Do you need radiation? Wishing you the best outcome.

Anna
Smile
DX:3/20/13 right breast multifocal stage 3a TNBC. Bilateral Mastectomy 4-18-13 largest tumor 6.2cm. 1 microscopic sentinal node positive. KI-67 77%. ACx4..doing Taxol now x12 weekly.
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Points: 84 		Post Options Post Options   Thanks (0) Thanks(0)   Quote MarissaK Quote  Post ReplyReply Direct Link To This Post Posted: May 08 2013 at 1:34pm
Congrats, Barb on this first half of treatment. I, like Natalie, had unbearable bone pain after each neulasta shot while on the Taxol. It was mainly in my legs and knees, preventing me from walking at times. If you get it really bad, regular pain killer doesn't cut it! I don't think this is as common a side effect as neuropathy is though (which I didn't have a problem with at all). So, just be aware you may get one or the other, or both. Taxol is definitely easier on the digestive tract, it seems as though we can all agree on that! Good luck to you.
DX 5/18/12 at age 34. Stage IIIC IDC TNBC, grade 3, 3 cm (multiregional nodal involvement). DD ACT complete 9/5/12. BMX 10/15/12, ALND: 0/12 nodes. pCR. Rads x 25 + 3 boosts completed 2/6/13. BRCA neg
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Lee21 View Drop Down
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anafriday

I am glad you will be getting a second opinion. Your onc's recommendation of AC every 3 weeks x 6 cycles is not standard.

Standard of care regimens:
1) Dose dense AC (AC every 2 weeks x 4 cycles) -> Dose dense Taxol (every 2 weeks x  4 cycles)
2) DD AC -> Taxol weekly x 12 cycles (in clinical trials, they may switch the order and team up Taxol with an experimental drug)
3) T (Taxotere)AC every 3 weeks x 6 cycles
4) T (Taxotere)C -- I am not as familiar with the evidence-based recommendations for this regimen.

A couple of issues:
1)  There is a limit to the total adriamycin you can get before you run into problems down the road with cardiac issues. 
2)  AC every 3 weeks x 4 cycles has been shown to be clinically inferior to AC every 2 weeks x 4 cycles
3)  Adriamycin dose is reduced in the TAC x 6 so as not to exceed the maximum cumulative dose.
12/9/11 @59,IDC,grade3, TNBC,3cm(MRI),SLNB0,stage IIA, BRCA1 variant
1/30/12 DD AC-T, 6/7/12 Lumpectomy, ypT1b(0.8 cm), 7/9/12 Rads x 30
11/9/12, clinical trial cisplatin/rucaparib, cisplatin-only arm
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Lee21,
Just so you know when I had a discussion with my onc last July before starting my A/C every 3 weeks x 4 cycles and this is at University of Pittsburgh Medical Centers Cancer Center.  He said that it is customary for Centers on the East Coast to use the done dense every 2 week cycle but in UPMC's opinion it was not necessary..........patients had more problems with white blood counts and the results ended up the same.  So I'm not sure it is inferior.........in everyone's opinion........certainly not in my Onc. As it turned out  I never had my white blood counts go low......I never had to take the neulasta shot........I never had to miss a dose of my chemo and I had a CPR. I had a 3.5 cm lump and 3 lymph nodes involved and chest wall lymph's.   As for her getting it 6 times..........I've never heard of that either and would question that...............
Dx TNBC 6/12; age 59; Stage 3, Grade 3; 3.5 cm, 3/10 nodes + chest wall nodes; A/C x4, T x 12 completed 12/12 with PCR, 2/13/13 lump; IMRT Rads x 33 completed 5/22/13 BRCA 1 negative.
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Lee21 View Drop Down
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Points: 752 		Post Options Post Options   Thanks (1) Thanks(1)   Quote Lee21 Quote  Post ReplyReply Direct Link To This Post Posted: May 08 2013 at 8:00pm
Here is the study that showed DD scheduling is better than conventional scheduling. Women on the dose dense regimen are given Neulasta for WBC support while women on the conventional schedule are not.

We're not talking black and white or 0 vs 100% -- these are population studies so as expected, some women will do quite well on the conventional dosing.

It does boil down to the particular institution.  For example MDA uses a different regimen altogether and centers in Europe use entirely different regimens, frequently much more aggressive than the ones in the US.

However AC x 6 q3 weeks is not standard, no matter how you slice or dice it.

Conventionally Scheduled and Sequential Versus Concurrent Combination Chemotherapy as Postoperative Adjuvant Treatment of Node-Positive Primary Breast Cancer: First Report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741

  1. Larry Norton

+ Author Affiliations

  1. From the ProHEALTH Care Associates, LLP, Lake Success; and Memorial Sloan-Kettering Cancer Center and Mt Sinai School of Medicine, New York, NY; University of Texas M.D. Anderson Cancer Center, Houston, TX; Cancer and Leukemia Group B Statistical Office and Data Operations, Durham; Comprehensive Cancer Center of Wake Forest University, Winston-Salem; and University of North Carolina School of Medicine, Chapel Hill, NC; Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Massachusetts General Hospital, Boston, MA; Northwestern University and Cancer and Leukemia Group B Central Office, Chicago, IL; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, and National Cancer Institute, Bethesda, MD; John Wayne Cancer Institute, Santa Monica, CA; University of Washington, Seattle, WA; Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; University of Alabama at Birmingham, Birmingham, AL; and University of Vermont, Burlington, VT.
  1. Address reprint requests to Marc L. Citron, MD, ProHEALTH Care Associates, LLP, 2800 Marcus Ave, Lake Success, NY 11042; email: mcitron@prohealthcare.com.

Abstract

Purpose: Using a 2 × 2 factorial design, we studied the adjuvant chemotherapy of women with axillary node–positive breast cancer to compare sequential doxorubicin (A), paclitaxel (T), and cyclophosphamide (C) with concurrent doxorubicin and cyclophosphamide (AC) followed by paclitaxel (T) for disease-free (DFS) and overall survival (OS); to determine whether the dose density of the agents improves DFS and OS; and to compare toxicities.

Patients and Methods: A total of 2,005 female patients were randomly assigned to receive one of the following regimens: (I) sequential A × 4 (doses) → T × 4 → C × 4 with doses every 3 weeks, (II) sequential A × 4 → T × 4 → C × 4 every 2 weeks with filgrastim, (III) concurrent AC × 4 → T × 4 every 3 weeks, or (IV) concurrent AC × 4 → T × 4 every 2 weeks with filgrastim.

Results: A protocol-specified analysis was performed at a median follow-up of 36 months: 315 patients had experienced relapse or died, compared with 515 expected treatment failures. Dose-dense treatment improved the primary end point, DFS (risk ratio [RR] = 0.74; P = .010), and OS (RR = 0.69; P = .013). Four-year DFS was 82% for the dose-dense regimens and 75% for the others. There was no difference in either DFS or OS between the concurrent and sequential schedules. There was no interaction between density and sequence. Severe neutropenia was less frequent in patients who received the dose-dense regimens.

Conclusion: Dose density improves clinical outcomes significantly, despite the lower than expected number of events at this time. Sequential chemotherapy is as effective as concurrent chemotherapy.

Full text is available here: http://jco.ascopubs.org/content/21/8/1431.full
12/9/11 @59,IDC,grade3, TNBC,3cm(MRI),SLNB0,stage IIA, BRCA1 variant
1/30/12 DD AC-T, 6/7/12 Lumpectomy, ypT1b(0.8 cm), 7/9/12 Rads x 30
11/9/12, clinical trial cisplatin/rucaparib, cisplatin-only arm
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MLindaG View Drop Down
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Points: 380 		Post Options Post Options   Thanks (0) Thanks(0)   Quote MLindaG Quote  Post ReplyReply Direct Link To This Post Posted: May 08 2013 at 8:52pm
Thanks for providing that extensive info.  I decided to do a little investigation and found the study from 2002 that you quote.  Here is some follow up info that I found in 2005:
 

"Comment in May 2005

These results were updated by Dr.C.Hudis in an educational session at the ASCO meeting in Orlando in May of 2005.  The analysis that included outcomes for all patients showed a less impressive picture for the impact of dose dense therapy on DFS (HR = 0.81 [0.67 - 0.96], p value = 0.02) and on OS (HR = 0.82 [ 0.68 - 1.04], p value = 0.12

) than the initial presentation in 2002. "

Apparently there are not a lot of studies concerning this dose dense application and the long term benefits of it.  I do wish I had more info when I started this journey!! Thanks for writing.....the more info I have the more I can discuss with my onc.!

Linda

 

 
Dx TNBC 6/12; age 59; Stage 3, Grade 3; 3.5 cm, 3/10 nodes + chest wall nodes; A/C x4, T x 12 completed 12/12 with PCR, 2/13/13 lump; IMRT Rads x 33 completed 5/22/13 BRCA 1 negative.
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MLindaG View Drop Down
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Here is another study I found and their comments - this is from 2003.

GONO M1G1 Trial

 

The one other clinical trial, GONO M1G1 evaluating the “pure” dose dense therapy has also not been unequivocally so supportive of dose dense therapy (4).  In fact it suggests that, if there is an advantage for dose dense therapy, the benefit is modest. 

Linda
Dx TNBC 6/12; age 59; Stage 3, Grade 3; 3.5 cm, 3/10 nodes + chest wall nodes; A/C x4, T x 12 completed 12/12 with PCR, 2/13/13 lump; IMRT Rads x 33 completed 5/22/13 BRCA 1 negative.
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I think you'll find, as you look more and more into oncology studies, that the benefits are frequently less than earth shattering, particularly when it comes to testing new drug efficacy in the metastatic setting. A prolongation of a couple of months of disease free survival (and frequently not even overall survival) is often hailed as breakthrough treatment. Sometimes the initial benefits do not seem to hold up with longer followup, often for reasons that are not clear.

Regarding CALGB 9741, while the benefit appears less when all patients are considered in the longer term followup, it still exists for ER- patients (DFS, HR 0.76, p 0.01; OS, HR 0.79, p 0.04).

Regarding GONO M1G1, the arms being compared are FEC q2 weeks x 6 vs FEC q3 weeks x 6.  Comparing GONO and CALGB 9741 is like comparing apples and oranges since different drugs, dosages and cycle numbers are involved. Even in the M1G1 trial though, a benefit was observed for ER-PR- patients. This is the link to the actual report:
http://jnci.oxfordjournals.org/content/97/23/1724.long
(for some reason, I can't get the hyperlink to work so you'll have to copy and paste into the URL).
12/9/11 @59,IDC,grade3, TNBC,3cm(MRI),SLNB0,stage IIA, BRCA1 variant
1/30/12 DD AC-T, 6/7/12 Lumpectomy, ypT1b(0.8 cm), 7/9/12 Rads x 30
11/9/12, clinical trial cisplatin/rucaparib, cisplatin-only arm
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Thanks for the info! I am a reading machine these days! :)
Dx TNBC 6/12; age 59; Stage 3, Grade 3; 3.5 cm, 3/10 nodes + chest wall nodes; A/C x4, T x 12 completed 12/12 with PCR, 2/13/13 lump; IMRT Rads x 33 completed 5/22/13 BRCA 1 negative.
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Hi girls,
I will shout LOUD and CLEAR.  AC x 6 every 21 days is "NOT" Standard of Care.
 
Lee21 has listed different Standard of Care regimen that should be considered.
 
I was stage IIb, 1 node involved.  I had a left mastectomy.  DD A/C x 4 followed by
DD Taxol/Gemzar x 4.  I was in a clinical trial, thus the addition of Gemzar.  I had neulasta following each treatment to help insure good counts.  (The trial I was on did not require radiation since I had a mastectomy vs lumpectomy)   I worried for a few years about not getting the radiation, but on June 9th of 2013 will be 7  years since my diagnoses. 
 
I'm just saying, do not accept anything less than Standard of Care unless you have reasons that make you believe you will be OK otherwise.
 
I have a SIL diagnosed in Dec 2011, stage IIIc, numerous lymph nodes invoved.  Her oncologist let her do the weakest arm of an avastin clinical trial.  She got C/Taxatere x 6 every 21 days, followed by radiation.  She had recurrence in the bone soon after treatment ended. 
She might have had recurrence anyway sometime in the future, but she was not given a fighting chance from the get-go.  DON'T SETTLE, GET WHAT YOU NEED, FROM THE BEGINNING, FOR THE BEST OUTCOME FOR YOU!!
 
Love and 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 - 11/2018-12 yrs NED
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