TAC VERSUS TC CHEMOTHERAPY?

By bruce2666 Saturday, January 03, 2009

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TAC VERSUS TC CHEMOTHERAPY? My wife had a lumpectomy on Nov 21 to remove a tumor on her left breast [1.7cm] which was lobular carcinoma and the breast surgeon received clear margins around the tumor. However, the pathology report showed 1 of 3 sentinel nodes were positive and on Dec 8 I had an axillary dissection examined 10 nodes which are clear. She has a decision to make and we want opinions please. DIANNE'S HEALTH: Age 59 Excellent health Takes no prescription medicines Weight 125 pounds Estrogen receptor positive HER2 negative Histologic grade 2 Tumor size 1.7 nodes involved 1 sentinel node chemotherapy regimen - third generation regimen recommended BACKGROUND: Dianne went to Genetic Center in Greenwood SC in early Nov 2008 and the result - She was a low risk, less than 5%. On Dec 22 my Oncologist has recommended and I have decided to have chemotherapy. Dr. William J. Edenfield/Cancer Center of Carolinas at Greenville Hospital System in Greenville SC is my Oncologist and has recommended TAC chemotherapy based upon the above information, but has offered that I participate in a clinical trial study for which I am eligible. The clinical trial is in Phase 3. Please give me your opinion. My Oncologist says it is my choice, but if the decision is left to him, he has to go with TAC which is the protocol for me and my cancer at this point. However, Dr. Edenfield has stated that I meet the criteria and am eligible to particpate in a Trial study - Phase 111 trial of adjuvant TC versus TAC in early stage HER2-Negative breast Cancer. It is a concern to me that 1-3% of patients that take TAC have heart damage. Please advise if anyone believes that TC is as effective and safer than TAC. MY QUESTION: If Dianne got a second opinion, Sloan Kettering, MD Anderson, etc. for a medical oncological review for treatment, would she get the same recommendation for treatment using TAC as the FDC recommended treatment or would they also recommend TC as an alternative treatment with the same effetive outcome but without the potential heart damage risk. Thank you...Dianne DIANNE CHAMBERS SIMPSONVILLE, SC EMAIL: bwchambers@charter.net

Comments (24) | Add comment

Phyllis Johnson, Health Guide

1/ 4/09 5:27pm

Since the TC is still in a study, probably no one knows for sure if it will be as effective. However, since they have moved on to Stage III trials, there must be some early stats that show promise. Can you ask the doctors for the studies so far and look at the actual data? These kinds of decisions are very personal. How much additional risk is a patient willing to take for a statistically improved outcome? Only your wife can say what her risk tolerance is--both for the possible spread of her cancer and for the possible side effects. A second opinion may help clarify the risks and benefits for you.

I had Adriamycin (the A in TAC), at age 50 (as well as the other two drugs) and I have had no heart damage, but it is true that some people do. If she gets the TAC, her heart will be closely monitored and the drug can be stopped if she starts showing symptoms of heart trouble. In fact, they will do some tests before starting to make sure her heart is in good shape.

Whatever she decides, I'd recommend that she not look back and second guess herself if anything goes wrong. All anyone can do is make their best guess about what is best at the time and then move forward with hope.

bruce2666

1/ 4/09 9:19pm

Hi Phyllis:

We are going to ask her Oncologist tomorrow about any data from the Trial so far. He told us last week that the results of the advantages/disadvantages can only be measured over time from the outcomes of the 2000 patients in the study.

However, I believe that Dianne, my wife, is coming to the conclusion that TAC is the way she will go, because the TAC is teh approved therapy combination for her.

Dianne is 59 and has no health problems before the breast cancer. Her blood pressure is 110/70, her pulse rate is 60-65, and she was concerned about any possibly of heart damage if the same results would be achieved with the TC as the TAC, but this is not known now. And it will be some time before TC may be shown to be as effective. She could opt for the Trial and if she did not get TAC, she could opt out before the first treatment.

Thanks so much for your input. I hope that you are fully cured and doing well.

kindest regards....Bruce

PJ Hamel, Health Guide

1/ 5/09 12:04pm

Bruce, I had nearly the same diagnosis as your wife, just at an earlier age (47). I did chemo (FEC) and am fine, 7 years later. As Phyllis said, they monitor you VERY closely when you take adriamycin ("A"). It's good to participate in clinical trials if you can, as they advance the research for generations going forward; but it is indeed a very personal, and often difficult, decision to do so. Good luck to her; to you both. And, if you haven't already, you might want to browse our FAQS on TAC chemo. PJH

bruce2666

1/ 9/09 10:15pm

Hi PJ:

Dianne has decided to take the TAC over the TC vs. TAC clinical trial. After so many discussions with different ones, she decided that adriamycin should be a part of her treatment since it has been so effective for many years.

Her Oncologist Dr Edenfield was supportive of her decision and stated to her that he is really happy when patients get involved with understanding and being a part of the treatment plan. Dr Edenfield stated that the Clinical Trial of TAC vs TC, in his opinion at stage 3 of the trial, will probably find that only a subset of women will benefit from adriamycin but that will be 8 - 10 years before that will be known based upon results of the patients data. Dr Edenfield is the primary Investigator for the Cancer Center of the Carolinas for this Clinical Trial of TAC vs TC.

Dianne has MUGA scan next Wed and starts 1st round of TAC next Friday, and she is scheduled for 6 treatments very 21 days.

It is our prayer that she will respond positively to the treatment and that the side effects will be minimal.

Thanks...Bruce

Michelle Willingham

1/ 5/09 2:30pm

Hi Bruce. (Thats my dads name...) I have just read your info and the comments posted here. I must have had a similar diagnosis to PJ as I had FEC treatment aswell. Also my lymph node stauts was 3/27 positive. I then had 12 doses of taxol and 12 months of herceptin. Herceptin has the risk of heart damage aswell and every three months I was sent for a heart scan and my results never changed much from before having Herceptin to finishing it. My last dose was on christmas eve. I am 36 so I know I am a bit younger than your wife. But I am not trying to compare us, I am just meaning to say that whatever treatment they give, they know how much you need to be monitored and will watch the things that they know of that are likely to happen. I think choosing treatment is a personal thing aswell. I think your wife should choose what ever treatment she feels comfortable with after getting all of the information available to her and I wish you both the very best of luck.xxx

bruce2666

1/ 9/09 10:29pm

Hi Michelle:

I am sure that your last dose at Christmas was a good present and a good start to the New Year. You are so young at 36 but as my wife's surgeon told her, its just not fair.

Before Dianne's surgery, we went to the Genetic Center in Greenwood SC and had a counseling session. This session was to asses her genetic risk of a Brac 1 or Brac 2 gene mutation, and she was assessed at less than 5% risk.

Dianne had only 1 postive out of 13 nodes, which was a sentinel node found in her initial surgery. It was odd because after her 1st surgery, the surgeon told me that the 3 sentinel nodes looked fine. However, we found out after the pathology report was issued that the microscope picked up some cancer in 1 node during the post surgery patholology testing of the 3 nodes.

Well, she begins chemo next Friday and we pray for the best outcome.

Wish the best for you in 2009 and beyond, and that you will stay cancer free.

Bruce

Cass

1/ 3/10 8:09pm

I had the very same diagnosis as your wife in June of 09. Had same opportunity for the same trial. Decided to go with the TAC because I did not want to chance that I needed the adriamyacin and did not take it. After going through 8 treatments every 21 days, I can tell you, I hope I never have to do it again and knowing this, I would

not volunteer for any less than they felt sure would take care of the problem. I have 4

radiation treatments to go and will finish Thursday Jan 7, 2010. I am glad your wife is going for the TAC and hopefully, she will never have to go back. Tell her to hang in there and this too shall pass. God bless and best of luck to both of you.

bruce2666

1/ 3/10 10:36pm

My wife decided in Jan 2009 to go TAC and not TC. She also did not want to look back and wished she had used Adriamycin which has been an established treatment for some time.

She finished the TAC chemo and subsequent radiation in late July 2009. She is doing well and has all her energy back but I am still trying to get her weight back up. She lost from 128 to 195 and now around 110.

You cane review her struggle at my blog if you wish. http://whatamazinggrace.blogspot.com/

God bless you with the best of health in 2010.

PJ Hamel, Health Guide

1/ 4/10 6:01am

And God bless both of you, too - PJH

D Brown

7/ 1/10 11:29am

I am currently faced with having to make the decision of going with TAC or TC. I am 47 years old and was diagnosed with lobular breast cancer in my left breast. I had a double mastectomy with reconstruction (the placed, and filled as full as they could, expanders) The removed 16 nodes of which the first 4 had cancer. In addition to all of the above, I am in the middle of a divorce and as vain as it sounds I am extremely concerned about losing my hair. I know that with TC it is possible, but with the added A it is a definite. I know a wig solves the head hair problem, but I can't imagine losing my eyebrows/eye lashes. How do I make this decision? I can't find any documentation that one is better than the other.

Cass

7/ 1/10 11:38am

I am sorry that you are so worried about your hair loss. I took TAC and my hair started falling out second treatment and at that time, my daughter shaved my head for me. It does give you some sense of control when you handle it. That was last September. Finished chemo in November and radiation in January. Hair started growing back before last chemo treatment and now is thicker than ever in my life. I did lose eybrows and lashes but not until chemo was done and only for about 2 weeks. Actually they looked better than ever when they came back also. I would do whatever the oncologist suggests if you are comfortable with them. No matter how bad you think this will be, rest assured that it is not as bad as you perceive it to be. I just finished 1 year check up and I am amzed that it has been a year already. Eveery treatment I would say to myself " this too shall pass" My prayers are with you.

PJ Hamel, Health Guide

7/ 1/10 12:48pm

Hi - Cass' advice is right on. For best results, do what your oncologist tells you, not what you research online; only s/he has all the details about your diagnosis necessary to make the best treatment decisions. And, women experience different degrees of hair loss, especially with eyebrowns/eyelashes; my eyebrows thinned, but I never lost my eyelashes. And it all grows back. Really. You'll be fine... And stay connected here, OK? We can help. PJH

D Brown

7/ 1/10 1:17pm

Thank you. And I will definitely try and keep in touch. Do you know anything about reconstruction and how the chemo will affect that. I had expanders put in at the time of my transplant and am wondering if that has to be put on hold until I'm done with chemo?

D Brown

7/ 1/10 1:19pm

Thank you for the information and the prayers. I am having a very difficult time and trying to stay positive; however, it seems every bit of news is bad news. Keep hoping at some time I'll receive good news. When I had my mastectomy I had expanders put in and they are currently a little over half full. Do you know if I can continue with the reconstruction and then the placement of the actual implants, or will I have to wait until after the chemo?

PJ Hamel, Health Guide

7/ 1/10 5:23pm

I think they'll probably play it by ear. They don't want to risk ANY kind of infection while you're on chemo... and they don't want to stress your already stressed body. If they're just doing fills, rather than exchanging the expanders, they might do that, but I doubt they'd attempt an operation. At any rate, make sure your surgeon and oncologist are keeping in touch with one another, OK? Good luck - PJH

DSteele

7/ 9/10 12:23pm

D Brown

I too have been diagnosed with invasive lobular carcinoma. Have had the double mastectomies and expanders on 5/20/10. Now I have been told I need to start the TAC, then follow with the radiation and hormone therapy. My expanders have not been filled because I had to have additional surgery because my some of my skin died. I am thinking of you. I know how you feel. I am fighting the urge to say no to the chemo. I am 53 and I hurt all over before I found out I had cancer. I will be praying for you.

Dsteele

DSteele

7/ 9/10 12:51pm

One thing - I was curious how you found out you had lobular? Mine never showed up on any imaging. Just got a little beebee type bump and had it biopsied.

Phyllis Johnson, Health Guide

7/ 9/10 6:27pm

I was fifty when I had my chemo, and it wasn't easy. However, I got through it, and 12 years later, I'm glad I did everything possible to prevent a recurrence. These days doctors have lots of new drugs to help manage side effects, especially nausea. If your doctor says that yours is a borderline case for needing chemo, you might want to get a second opinion. However, if you are in the group for whom chemo is definitely indicated, I think you will be happy to know you did everything possible to stay well once you are done with it.

D Brown

7/ 9/10 11:48pm

Danielle,

I decided to go with just the TC. No one could give me a good enough reason to throw in the adriamycin, and with it's possible long term side effects I decided against it. Good luck with your treatment. I'll be praying for you.

Paula from VA

5/14/10 1:50pm

It is truly amazing to me how many women were diagnosed at around the same time frame with exactly the same breast cancer and took the same treatment, TAC. As you have probably figured out, I also was diagnosed in Feb 09 with almost identical cancer, lumpectomy, node affected, the option of TC but opted for TAC. As much as I would have liked to contribute to the study, my personal health won out in the end. I finished chemo (TAC) in Aug 09; radiation in Oct 09, have had baseline mammo (Jan 10). So far, so good. I pray that everyone who contributed to this blog is now cancer free and as healthy as I feel. This may not even be read since it has been so long since last post, but I wanted to share observances.

Paula from VA

5/17/10 9:03pm

It is soooooooo amazing how many of us have been treated for the same and at the same time frame. I also was diagnosed with breast cancer in Jan 09, after surgrey in Feb, I started my chemo treatments, TAC in March until June 25th 09, then Rad until Oct 09. All test have come back clear since finishing my treatments and I am sooooooooooooo blessed for that. The only side effect from all of it has been severe Neuropathey in my feet, which my Dr's are working hard to find a fix for that. They have started me on Neurontin, up 600mg a day right now, with hopes it will help repair the nerve damange done by the Taxotere drug. Other than the damange done by the Tax I'm very blessed that almost a year out and I am cancer free. I guess it is with all of us that have been through cancer, there is always a little fear of that next report or test done by our Dr's. But there is nothing to fear but fear itself, and I FEAR NO EVIL FOR THE LORD IS WITH ME.

God Bless you all, PJ

PJ Hamel, Health Guide

5/17/10 9:32pm

Thanks for the report here - and be well, PJ (from another PJ!) PJH