CMF vs. AC

[epgnyc]

I was diagnosed with breast cancer, 1.8 cm. , node negative, grade 3, HER2/neu negative, ER/PR negative (I'm 54 & post menopausal). My oncologist recommends 8 treatments of CMF for 6 mos. rather than the more toxic AC, specifically because of my age, having no node involvement and being HER2/neu negative. If those factors had been different, he said he would have wanted me to take AC. He said AC has only a slightly lower recurrence rate (about 1-2%) than CMF and in my case it wasn't worth the increased toxicity (I also have MVP, a heart condition). What are your recommendations?

[CCF-RN,MSN-JS]

Dear epgnyc, Both of these regimens as an adjuvant treatment in breast cancer are acceptable.  An anthracycline containing regimen (adriamycin, the A in AC) shows a small but statistically significant improvement in survival compared to nonanthracycline-containing regimens (such as CMF).  However, there is a risk of cardiac toxicity with cumulative doses of anthracylines, although, there is no evidence of excessive cardiac toxicity in women without significant pre-existing heart disease with anthracyclines at the cumulative doses used in standard treatment regimens.

So decisions on what adjuvant regimen is used need to take into consideration the potential survival benefits versus specific concern about additional toxicity for the individual.  In your case particularly because of your pre-existing heart condition the decision regarding adjuvant treatment might lean toward the non-anthracycline containing regimen.

[lizziecee]

I don't understand the replies to this question - I had 6 rounds of FEC which I was told (in England) was the latest chemotherapy. I had been taking methotrexate (the M in CMF?) for 3 years prior to diagnosis of invasive breast cancer for intractable Crohn's disease and when I could get no sensible answers from my Oncologist here I e-mailed the Mayo, MD Anderson in Houston and the only decent reply I got was from you - saying I had perhaps become resistant to methotrexate, which I was (although my gastro now says I was not absorbing it)because my psoriasis was getting worse and the methotrexate was not keeping the Crohn's under control. My Oncologist actually told me that if I continued to take methotrexate whilst having FEC that I would die from septicaemia, so I stopped the methotrexate and had to had decadron during chemo. I am in a nightmare situation now with Crohn's, but clear of Cancer. Why don't they use methotrexate anymore for breast cancer here? You are so far ahead of treatment than we are in England. Some doctors here act like God and when I posed these questions to my first Oncologist I was asked: "Do you want to continue this consulation?" I dissolved in tears and only saw him once again before I transferred to a resident type doctor, who was much more sympathetic to my "empirical problems" as my gastro put it. I wish I had known then what I know now and would have come to you for more help. Thank you anyway for what a few sentences did for me - it gave me the courage to challenge this arrogant, rude oncologist.