Chemo options

Hello

I've got a question about chemo.
I've (38yr) been diagnosed in march and already had surgery.
My GYN now says that I should have CEF (FEC) chemo, but I haven't been to the oncologist, yet so I don't know exactly what chemo I'll be getting. My diagnosis is:
pt1 n0 m0 1,2 cm, G2. E+ (90%) P+ (90%) HERneu negative KI-67 = 8%. Which means the prognosis is pretty good, I guess and that I have a low risk or getting bc again
My question is, what would be the standard chemo for my kind of tumor? I live in Germany and I believe that treatment in the states is advanced and better than ours. I really, really want to avoid this type of chemo, and do CMF instead. Any suggestions?

Thanks
Jen

[Cleveland Clinic]

Dear jen:  The decision of whether to do chemotherapy and what drugs to use depends on many factors including the size of the tumor, whether there are lymph nodes involved, and the health of the patient, to name several.  In general, the decision is made based on a risk versus benefit ratio.  This may differ by physician and to the person for whom the chemotherapy is recommended.  CEF is not commonly used in the US.  The most common regimen in the US is AC. AC and CEF regimens have never been directly compared but each has been compared to the old standard 'CMF' regimen in well designed clinical trials. In brief, the three-month AC regimen was equal in effectiveness to the six-month CMF regimen. CEF, also a 6-month regimen, was somewhat more effective than CMF but was also associated with more toxicity. The other way to improve upon the efficacy of standard 4 cycles of AC chemotherapy is with the addition of 4 cycles of paclitaxel chemotherapy. The sequential use of AC followed by paclitaxel may be even more effective if given on an every 2-week schedule (which takes 4 months) rather than an every 3-week schedule (which takes 6 months).  More recently, a study has suggested that a combination of docetaxel and cyclophosphamide, given for 4 cycles, may also represent an improvement over the AC combination. As you can see, there are a variety of regimens and we have listed only a few.  The person best equipped to have this discussion with you is the oncologist who will know your situation and be able to discuss risks versus benefits in terms that can help you to decide whether and what chemotherapy is appropriate for you.  As we learn more about the biology of breast cancer, there appear to be some individuals with strongy hormone sensitive tumors who are best treated with hormonal therapy and may not require chemotherapy.  Newer prognostic tests such as the Oncotype DX assay may be helpful in sorting out who those individuals are.

[Avidhiker]

Of course, you are free to research your treatment options, but only your oncologist can recommend the correct chemo regimen for you.  Get a second opinion if you want as well BUT DON'T WAIT TOO LONG.  DO THE CHEMO AS SOON AS POSSIBLE.  The window between surgery and chemo is only 12 weeks.

[jenjen68]

Hi Avidhiker

Thanks. I know that it's my choice, but I just would like to find out what the 'standard' treatment is in the states. I personally think that FEC is a little 'harsh' for my kind of diagnosis.

Jen

[Avidhiker]

Since I am not a physician, I really can't tell you what the "standard" is, but it appears that most breast cancer patients here receive Adriamycin and Cytoxan (AC) and then Taxol or Taxotere.  I was T2N0M0 (2.4 cm size) and that is what I received.

Since you are HER2-, you are not a candidate for Herceptin, the targeted monoclonal antibody.

Your hormone receptors are high, so you will also likely be treated with an anti-estrogen such as Tamoxifen or Arimidex (post menopausal).

Good luck!

[jenjen68]

Dear Forum-RN-RF

Thank you for your answer. I did list my factor and was hoping that you could tell me what the BEST option would me in my case.

Thanks
Jen

[jenjen68]

Dear Avidhiker

Thank you for your answer. I've been reading about AC, but I didn't even know that it was a 'common' chemo. It's all so confusing. Of course, I want what's best but mot when the risks outweigh the side effects.

Good luck to you, too.

Jen

[Jak5]

I had FEC x 3 and Taxotere X 3, but my cancer was 2cm with 3 nodes positive also grade 3. My onc said that we will do aggressive treatment also because of my age (37). I think FEC is tough on your heart.
Good luck

[lizziecee]

Hi Jen,
I live in England and FEC was commonly used when I was dx in 2003.
My tumour was invasive ductal, 2 cm, and I had 4/18 lymph nodes affected. Also had associated DCIS, both cribriform and comedo which were excised along with the tumour,under the Wide Local Excision.  I had 6 x FEC and had no heart problems. Adriamycin is not commonly used in England because it is hard on the heart, so I think Jak may have confused the two different chemo regimes. I believe Taxol and Taxotere are now being used widely in the UK. We don't pay for chemo drugs or treatment in the UK, so the different costs of various chemos do not really come into play.

Your Oncologist is really the best person to advise you which chemo to have, as he has all the details.
Hope you soon get it sorted out.
Liz.

[greenstein]

As a physician I would recommend checkin out
http://www.cancerdocchitown.blogspot.com