Chemo Questions, Early Stage

If considered a Working stage I or stage 2, had a lumpectomy, clean margins 2nd time in, report shows
"Grade 2/3".   ER+ PR+, HER2- and a 26 on the Oncodx recurrence test.  4 cycles of Adriamycin & cytoxan, every 2 weeks recommended.  It seems to make a lot of sense for precautionary purposes.  Already went through 1 treatment.  
First question, Does it make sense to continue to ensure killing any possible cancer cells that may exist with this diagnosis?
2nd, does it make sense to get a 2nd opinion after having 1 treatment, even if only for peace of mind.
3rd, does this sound like the best path to take or seem excessive?
4th, should 4 treatments of AC be a concern related to heart toxicity now or later?
5th, why do they use Adriamycin and not epirubicin or something else?
and 6 what does Grade 2/3 mean?
Thanks.

[bluebutterfly2222]

I'm not clear on why you would have decided to undergo chemo, actually start it, and then are now considering stopping it?

I am also not clear on why your actual stage has not yet been determined?

Do you have some doubts about your oncologist's treatment of you, leading you to think you need a second opinion, "if only for peace of mind?"

Without knowing the answers to these questions, I'm not sure how helpful I can be, but I'll give it a try...

1. Since you have already started chemo, it probably does make sense to complete it (unless you have had some terrible reaction), for several reasons:

a. Unfortunately, there is no information about the best treatment of a breast cancer patient who has an intermediate Recurrence Score. There is an ongoing clinical trial known as the TAILORx trial in which persons with an intermediate Recurrence Scores are place on either chemotherapy or hormone therapy on a random basis to determine the outcome and thus appropriate treatment of this group of breast cancer patients.

However, as you no doubt aware, your OncotypeDX score fell in the higher end of  the intermediate range. You probably decided on chemo as a precaution, based on that and the fact  that  a high Recurrence Score indicates a greater chance of the breast cancer returning, so the patient may benefit from adjuvant systemic therapy, including chemotherapy.

b. Having already had one cycle, side effects such as hair loss have likely already been triggered, so stopping now would probably not not protect you from that.

c. Chemo cycles are timed to try to interfere with the growth of cancer cells at their most vulnerable stage, so to be effective in trying to destroy them all, several cycles are required. Stopping after just one cycle wouldn't provide you with much protection.

2. I would suggest you first try discussing all your doubts, concerns, and questions, including the ones you listed above (3., 4., and 5.) regarding cardiac toxicity, why s/he selected this particular protocol, etc., with your current oncologist.  If for some reason that doesn't go well, then you could certainly seek a second opinion.

6. Grade  2 means moderately aggressive and Grade 3 means  more aggressive or highly aggressive (indicating a type of cancer that is more likely to spread quickly and recur).

Please post again, adding to this same thread, to let us know how that discussion went with your onco, what you decided, and how things are going for you.

Best wishes...

[suzela]

Thanks so much for the thorough reply and listening, means a lot!  I believe it comes down to making a personal choice and that's hard to deal with when thing happens quickly and I'm not the expert.  I do not necessarily doubt the oncologist's diagnosis, recommendation, or ability at all. They are the best or one of them.  

I think your statement is what keeps me second guessing since it appears no one truly knows......no information about the best treatment of a breast cancer patient who has an intermediate Recurrence Score.  Darn it!!!

It's not as though they say OK you have cancer and need this to try to destroy it or else.  For me it's precautionary and data that's not as fact based as we'd like.  We did discuss the heart effects, max dosage, etc.  Doc said they'd have prescribed taxotere and not AC but my heart tests were fine.  I'm not clear why AC and not epirubicin, whats the difference. Are 4 cycles a lot?  I went forward with the mindset that I must not take a chance.  I did have some side effects and the doc said was common...pains, also had a zombie like feeling almost 2 days but they've subsided.  I think it comes down to fear, having to trust the doc that the benefits outweigh the risks (they believe they do after reviewing my case).  

I recognize I'm fortunate to be early stage but when we see the #s and the percentage of how many people in my shoes really benefit, it's something, which is why I'm doing it, but a relatively small #.  I was at peace that 4 cycles wasnt much and I dont want to chance it since the score's a 26....simple as that but then I read on the internet and that may have got me going on all this.  Thank you.

[bluebutterfly2222]

You are welcome!

I understand  the fear and worries you are dealing with! It is difficult enough to hear a BC dx, but then immediately on top of that you have to go through all kinds of tests, and make lots of decisions about treatments you previously knew little or nothing about...

Even though no one knows for sure about the benefit of chemo for intermediate range scores, I'm the cautious type and generally follow the "Better safe than sorry!" philosophy, but it is a very personal, individual decision, and yours alone to make,,,

No, 4 cycles of AC is not a lot.  

Adriamycin sounds scary, but the more serious side effects are rare. Two "people" very close to me--one human and one canine  :-)--went through it without any lasting effects, and I haven't noticed any terrible results from it posted in this forum in the well-
over-a-year period I've been a member.

Epirubicin is an alternative, but I doubt it's a better choice, or I'm sure your onco would have recommended it. It also has a lifetime max, due to possible cardiac problems, and carries "a slight risk of luekemia." Here is a link to a discription of it:

http://www.chemocare.com/bio/epirubicin.asp

(You can check out any chemo drug on that site.)

Keep in mind that this large community of BC survivors and supporters is here to help you in an way it can, be it just listening, emotional support, sharing of experiences, or providing information.

Hang in there,
bluebutterfly