URGENT-TC versus TAC-opinions needed |
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Weaver1 
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 Topic: URGENT-TC versus TAC-opinions neededPosted: Jul 01 2009 at 4:08pm |
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Hi,
I have been diagnosed with Triple Negative grade3 breast cancer. After a mastectomy my first Oncologist recommended chemotherapy TC. My local Oncologist has offered me the option of TAC and I am betwixt and between in decision-making. I am aware of the risk factor re: the use of Adriamycin and it's possible effects on the heart. I am a healthy 71 year old with no weight, high blood pressure or heart problems. I could use feedback, please. I understand that Triple Negative has a higher re- occurance rate. Edited by Weaver1 - Jul 01 2009 at 4:10pm |
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mefowler
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Posted: Jul 01 2009 at 4:31pm |
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Dear Weaver1,
Could you be more specific about TC, do you mean carboplatin and taxotere or cytoxan and taxotere or cytoxan and taxol? Or something else altogether? Where was your first oncologist? Could you get either therapy through your local oncologist? Have they done an echo or a MUGA scan to assess your heart? I am so sorry that you have been diagnosed and are faced with these choices. When I know more, I can give you better information.
Maire
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53 yo, dx'd 11/08 at 51, 2.9 cm IDC, node-neg, neoadj chemotx with Taxotere/carboplatin q3wks x 6, lumpectomy 4/09, path showed pCR, margin reexcision 5/09, rad'n 6-8/09, intermittent Tarceva, dc'd
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Weaver1
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Posted: Jul 01 2009 at 4:43pm |
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Dear Maire,
Thank you for responding...My first Oncologist practices at Froedtert's new Clinical Cancer Center in MIlwaukee, Wi. He has recommended using both Cytoxan and Taxatare together-4 treatments 3 weeks apart. My second Oncologist in Sheboygan, Wi. is offering the option of using both plus adding Adriamycin to the mix. I will be using the 2nd Oncologist for treatment. There would be 6 treatments 3 weeks apart. I have had an Echocardiagram and will hear the results tomorrow during my appt. w/the Sheboygan Oncologist. My results should read normal, and if so, I am back to decision-making as must start chemo soon. Fran |
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NINASUZIE
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Posted: Jul 01 2009 at 6:36pm |
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Fran,
I am sorry to hear that you are diagnosed with triple negative (TN) at young 71 and being in good health is fabulous to think the best in outcomes!
If you could give the specifics of your tumor/cancer? Size/grade/stage, etc and if you would add that, most "gold standard" is AC/T. But, in earlier stage TN CT is considered appropriate. My onc gave me a head to head study on CT vs AT and actually Ct was somewhat more effective. Some research lately is showing that Adriamycin isn't as effective for some earlier breast cancers.
My question to you and with Maire would be could Carboplatin is used adjuvant (after surgery). The specifics b/w taxol and taxotere are somewhat different. What say you Maire and Weaver1? Take Care,
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Suzie
************** Dx: 1/09 Metaplastic TN IDC/3.5CM/DCIS/1.0;4/09 L mastectomy;6-11/09 Cytoxan/Taxotere X6;BRACA-; Recurrance 11/10 bone mets broke arm;Lung mets;rads X15; chemo/parp tbd 1/11 |
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Trixey
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Posted: Jul 01 2009 at 7:42pm |
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Suzie,
I am Fran's daughter and will try to answer your questions since she is not currently on line and eager to hear from others. She was diagnosed as having Stage I grade 3 TNBC with tumor size between.5-1 cm, node negative. She was offered a more aggressive treatment with Taxotere, Adriamycin and Cytoxan because it was felt she was "physiologically younger than her actual age". However, even her oncologist is "on the fence" about it. We are trying to weigh the risks of adding Adriamycin to the possible slight reduction of reoccurance and were wondering about other's experiences. I cannot find a lot of data on TNBC in women > 70.
Appreciate anyone's thoughts/experiences.
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SagePatientAdvocates
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Posted: Jul 01 2009 at 9:31pm |
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Dear Fran and Trixey,
I am really beat so I was only able to do a short search...will try again if I have the energy.. this doesn't answer your specific questions but perhaps it is somewhat helpful re: chemo in general? Clinical Oncology Volume 17, Issue 4, June 2005, Pages 244-248 Copyright © 2005 The Royal College of Radiologists Published by Elsevier Ltd. Overview Chemotherapy for older women with early breast cancer R.C.F. Leonard, and K.M. Malinovszky South West Wales Cancer Institute and Swansea University Medical School, Swansea, UK Received 14 December 2004; accepted 20 December 2004. Available online 9 April 2005. Abstract The incidence of breast cancer increases with age, reaching over 300 per 100 000 in women aged 70–75 years in the UK, increasing to almost 400 per 100 000 in women aged over 85 years. As a healthy 70-year old woman can now expect to live for an average of 15 years, control of breast cancer is likely to significantly affect survival. Variations exist in surgical care, radiotherapy and chemotherapy, depending on age; however, virtually all elderly women with hormone-responsive disease are given adjuvant endocrine therapy, usually tamoxifen. For older women who do not have hormone-responsive cancer, and who have high-risk disease characteristics, questions remain over their best management. Overview data of adjuvant chemotherapy in clinical trials show a significant benefit of chemotherapy for women up to the age of 69 years but, for older women, there are too few data to draw any firm conclusions. When considering treatment options for older women, assessment is critical; functional status and comorbidity are some of the factors linked to shorter survival. Article Outline Breast cancer in older women Lack of clinical trial data Adjuvant chemotherapy for breast cancer Anthracycline-based regimens Current management of older patients with breast cancer Oestrogen-receptor status Toxicity Myelotoxicity Cardiotoxicity Mucositis Renal function Treatment considerations Trials for older women with breast cancer Conclusion References Author for correspondence: R. C. F. Leonard, South West Wales Cancer Institute, Swansea University Medical School, Singleton Hospital, Sketty, Swansea SA2 8QA, UK. Tel: +44-1792-285299; Fax: +44-1792-285201. problem is it is $31.50 to get the whole article...are you near medical library to save the money? all the best, Steve p.s. will try to look a bit longer because you wrote URGENT...this is all so hard.. |
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I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates
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SagePatientAdvocates
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Posted: Jul 01 2009 at 9:47pm |
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p.s. just found a recent study...
Breast J. 2009 Jun 9. [Epub ahead of print]Links Predictors of Toxicity and Toxicity Profile of Adjuvant Chemotherapy in Elderly Breast Cancer Patients. Garg P, Rana F, Gupta R, Buzaianu EM, Guthrie TH. Department of Medicine, University of Florida, Jacksonville, Florida. Women older than 70 years have been underrepresented in breast cancer adjuvant chemotherapy trials due to concerns about toxicity, safety and tolerance of chemotherapy. The aim of our study was to assess the tolerance of chemotherapy in older women with breast cancer and determine patterns of toxicity including the impact of age, chemotherapy regimen, functional status and comorbid conditions on this toxicity. We retrospectively reviewed the charts of early stage (stages 1 and 2) breast cancer patients older than 70 years from 1998 to 2004. A total of 62 patients, with mean age of 74.3 years, were identified. Chemotherapy was completed in 89% patients. Overall 79% completed chemotherapy without any significant side-effects, dose reductions, or breaks during chemotherapy. Using logistic regression model increasing age was not associated with early termination of chemotherapy (p = 0.19, OR: 0.868, 95% CI: 0.7-1.076). However, increasing age, lower functional status, and higher comorbidity index scores were associated with reduction in dose and breaks in chemotherapy. None of the patients who received pegfilgrastim prophylactically developed high-grade neutropenia. Our study suggests that adjuvant chemotherapy is safe in elderly patients. Older patients with good functional status and low comorbidity index scores tolerate chemotherapy as well as the younger patients. Prophylactic use of pegfilgrastim may reduce occurrence of severe neutropenia and related toxicity such as febrile neutropenia in the elderly patient. sorry...I have to get some sleep... I think this is a tough project... Can you get to a major NCI Comprehensive Cancer Center that is very active in TNBC clinical trials?...I know probably the last thing in the world you want to do now is travel...but another perspective may be useful? also do your oncologists have any information they can get from the drug companies that indicates how older patients do on the various drugs you are deciding on? e.g is there data presented from their clinical trials they can share with your physicians? all the best, Steve |
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I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates
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Weaver1
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Posted: Jul 02 2009 at 4:52am |
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Steve - I am Bob, Fran's close friend. I want to thank you , personally, and on her behalf, for your quick, considered response. Ye Gads, to stay up until that hour...is above and beyond the call of duty. We will be armed with yours and others' suggestions/references for our meeting with the oncologist, later, today.
Again, thank you so much. Bob and Fran |
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trip2
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Posted: Jul 02 2009 at 5:12am |
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Hello everyone, indeed finding info for older patients is very difficult as most TNBC is diagnosed in younger women although we have several older members here in this forum.
I believe I have something but on the road at the moment and having trouble finding it.
Thank you so much Steve for your help and we would love to hear what you find out later today. Best wishes,
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Stage 2 2003
Stage 1 2007 BRCA 1+ |
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NINASUZIE
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Posted: Jul 02 2009 at 8:42am |
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Fran, Trixey and Bob, I have another friend same age, stage, size who did AC/T and was in excellent health...another "younger" than her age gal! She told me she had little problem with it and completed her treatment with flying colors.
Should BRCA testing be addressed here to decide chemo regime? Steve is the resident sorry to say, "expert" on this issue, and would that change the decision if BRCA gene 1 or 2 positive?
I realize this is a tough decision making time, but take a breath, because days to gain enough information will make better decisions and not effect your chemotherapy effectiveness. Average timeframe after a mastectomy is 4-8 weeks to think of starting chemotherapy due to healing issues anyway. When was your mastectomy date?
Something to consider, Fran. You ARE a very healthy, young robust 71 yr old woman. And how your body and mind respond to this trauma IS something medically to take into consideration. How well do you feel post op vs before that? And what does your oncologist (with the help of the doctor who has known you best, your primary doctor?) say the effect to your general health would be to you with or without Adriamycin?
Retaining your health post op/post chemo and to "bounce back" with both your echo/mugga, feedback from your docs and possibly BRACA testing, are issues that I have seen from my older friends in my support group.
By the way, they all have done well with whatever they/team decided meaning it did help, they have bounced back in their 70s...they speak of having a much harder time with other life issues-death of spouse, life stressors....I am not an expert here at 54 for an active lady of 71, I am sharing what other Breast Cancer Support Group members your age have shared.
You have such a great inner circle of support, know wonder you stay so young
 Take care, |
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Suzie
************** Dx: 1/09 Metaplastic TN IDC/3.5CM/DCIS/1.0;4/09 L mastectomy;6-11/09 Cytoxan/Taxotere X6;BRACA-; Recurrance 11/10 bone mets broke arm;Lung mets;rads X15; chemo/parp tbd 1/11 |
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cg---
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Posted: Jul 02 2009 at 12:43pm |
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Dear Fran, Trixey, Bob,
Welcome to our forum.
I think the deciding factor will be the echocardiogram results whether to add the Adriamycin.
I know of a woman (76) who is in robust health, with no health problems, had a mastectomy and then did the TAC (6 cycles). She had Neupogen/Neulasta support and she had no delays in her treatment or dose reduction because of neutropenia. She actually did better than some younger women undergoing treatment at the same time.
I had the good fortune to marry a gentleman from Sheboygan.
Connie
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alene
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Posted: Jul 02 2009 at 1:31pm |
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Okay I'll way in...(Please note I am not in any way an "expert")
An echocardiagram and a MUGA scan are NOT the same thing. A MUGA scan is more accurate and is REQUIRED before Adriamycin... Someone make sure that it is ordered/completed prior to Fran making a decision. Fran is 71 yrs young and nobody should be taking shortcuts - even if it means an extra trip to the big city.
It is worthy to note...that the stats listed here...are not bad...The tumour is small...this is good...Being node negative - HUGE The tumour grade 3 - not so good
So in my laymen's eyes..You caught this early - while the tumour biopsy showed that it was aggressive in nature (likely to spread)...It had NOT spread into the lymph system. Most studies - show worse outcomes for much larger tumours, that are grade 3 and that have in fact spread into the lymph system.
What is the status of the tumour..did you have a lumpectomy...is the tumour still there? If the tumour is still there...then getting started on chemo soon may be important...however...it the tumour has been removed...
Then.you are NOT in a race. You have time to decide, gather information and weigh your options.
I was told that taxotere had a 16% chance of a Pathological Complete Response - And Adriamycian had a 9% chance. Great odds huh?
I believe the role of adjuvunct therapy is to prevent a recurrance and provide a system wide treatment of your body...just in case some wayward cancer cells are floating around in there. It takes a long time for wayward cancer cells to become tumours..
Hope this tiny bit of info helps
Lots of prayers for Fran
Love
Alene
Edited by alene - Jul 02 2009 at 1:33pm |
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DX 5/21/2008 TN 8cm TAC
Mast 12/08 Extensive Residual Lymphatic Invasion Inop node clavicle 68 Rads Stage IIIc Recur 11/09 Her2+ Surgery 68 RADS 4/10 Biopsy Skin Mets TN 28 RADS Stage IV |
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alene
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Posted: Jul 02 2009 at 2:16pm |
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Okay let me drone on a little bit more...
Believe it or not...supposedly there is one advantage to the tumour still being present at the time of chemo...
In the land of "theory"..You're onc will be able to tell by administering chemo with the tumour present...whether or not the chemo is actually working or not on your flavor of triple negative cancer. (We're all triple negative..but we are not all the same - we're just the group of individuals who aren't positive for estrogen/progesterone/herceptin - We share what we're not...not necessarily what we are) - Am I making any sense?
Anyway....
In the land of theory...you're onc will administer one of your choices...then run cat scans to see whether the tumour is in fact shrinking...This allows oncologists to KNOW whether a particular regimen is actually working rather than waiting till the end of treatment....It gives the oncologist a chance to change to another regimen...sooner..
Now in the land of reality..where I live...
My oncologist used an extra precise test..to see whether the the chemo was working...He had a special "magic ruler"...No kidding...Yeh really... The main reason that we changed..from one chemo to another..was my ability to withstand it's side effects..
For me...Red Devil (aka Adriamycin) was more effective...at least according to the magic ruler. I did not have a pathologically complete response to either regimen in that I had extensive residual lymphatic invasion with active cancer...when all was said and done.
Good news for you...You don't have positive lymph nodes...so....it's just those pesky wayward cells that you need to make sure are gone
Let us know how we can help
Much prayers for you and your family
Alene
Edited by alene - Jul 02 2009 at 2:59pm |
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DX 5/21/2008 TN 8cm TAC
Mast 12/08 Extensive Residual Lymphatic Invasion Inop node clavicle 68 Rads Stage IIIc Recur 11/09 Her2+ Surgery 68 RADS 4/10 Biopsy Skin Mets TN 28 RADS Stage IV |
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Weaver1
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Posted: Jul 02 2009 at 3:42pm |
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DEAr Connie,
Your response and info.-much appreciated! After a long consult w? my Sheboygan Onc I went with my "gut" and decided on the CT-4 treatments spaced 3 weeks apart. I am finally at peace with my decision, but have read all postings and admire all of you understanding your particular situations, as well as others. What irony that your soulmate is from Sheboygan Wi. originally. Fran |
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NINASUZIE
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Posted: Jul 02 2009 at 3:49pm |
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Alene, Fran and Echo vs Mugga way in Gal!
Hi, I have a relevant question here....since I only have "Doctors for Dummies" to read
. You have "extensive residual lymphatic invasion with active cancer" and with my heartfelt "heart thunk" and "go, girl"...please to explain? And how was that discovered/tested, Alene?And I am relieved to also know echo vs mugga as my docs ONLY wanted an echo "that's fine" and said 55% was "just fine". And I said, NO, that is NOT JUST FINE!
So, Fran take some time to digest a bunch of us well meaning "experts"-lol who are quite frankly smart, caring, well versed and experienced. I bless the day I got both the dx and found this website(same day!)...heavens knows I'd be crazy by now (ok, no cracks now). I think cancer makes us all alittle crazy and we're all alittle "cancer crazy"...we KNOW how important this is for you, my dear! Take care,
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Suzie
************** Dx: 1/09 Metaplastic TN IDC/3.5CM/DCIS/1.0;4/09 L mastectomy;6-11/09 Cytoxan/Taxotere X6;BRACA-; Recurrance 11/10 bone mets broke arm;Lung mets;rads X15; chemo/parp tbd 1/11 |
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NINASUZIE
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Posted: Jul 02 2009 at 3:53pm |
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Fran,
Our posts crossed-hate when that happens! Good for your gut decision! And now you know where you can be supported during/after treatment.
Keep us posted and we the same. Hugs,
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Suzie
************** Dx: 1/09 Metaplastic TN IDC/3.5CM/DCIS/1.0;4/09 L mastectomy;6-11/09 Cytoxan/Taxotere X6;BRACA-; Recurrance 11/10 bone mets broke arm;Lung mets;rads X15; chemo/parp tbd 1/11 |
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SagePatientAdvocates
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Posted: Jul 02 2009 at 4:36pm |
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Dear Fran,
I am happy you are at peace and I wanted to let you know that I put Sheybogan in my mapquest so that my ++++++ vibrations do not get lost, along with my prayers for you and your loved ones.. all the best, Steve |
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I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates
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cg---
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Posted: Jul 02 2009 at 5:11pm |
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Dear Fran,
I would not be surprised if you knew some of my husband's family - if you have been into Schwarz Fish Co. you have probably already met some of them.
Once I made my decision I was also at peace and did what had to be done. I was diagnosed in May 2007.
There are lots of helpful suggestions that will make everything so much easier for you.
Please do not hesitate to ask any questions - you will not find a kinder, more supportive group of people.
Connie
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alene
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Posted: Jul 04 2009 at 6:10am |
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Hi Fran -
I'm glad you are at peace with your decision...You're just beginning a long journey...we're here for you...
Suzie:
The info was in my path report from the mastectomy. It took working with my research assistant "Ms. Google"...and finally asking questions of my surgeon etc...to understand what it meant. I WISH there was a Cancer for Dummies book...Man...I feel like I've had to practically enter med school just to get through this thing.
Take care All
and let us know how you're doing Fran
Love and prayers
Alene
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DX 5/21/2008 TN 8cm TAC
Mast 12/08 Extensive Residual Lymphatic Invasion Inop node clavicle 68 Rads Stage IIIc Recur 11/09 Her2+ Surgery 68 RADS 4/10 Biopsy Skin Mets TN 28 RADS Stage IV |
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Weaver1
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Posted: Jul 13 2009 at 7:30pm |
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Dear Connie, Suzie, Steve, and Alene,
Can't thank you all enough for your hearfelt support and advice as I started my first chemo after going w/CT. My reactions so far are probably minimal compared to others, but suffered just the same with stomach problems in spite of meds and now an itchy rash plaguing my upper torso supposedly due to the CT and anti-nausea drugs. Will be on short-term prednisone for relief. Otherwise-not bad so far. Wishing all of you kind thoughts and full recoveries from your journeys thru breast cancer. Fran |
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