Chemotherapy dose decision ?

Respected Doctor,

My mother was diagnosed with stage two breast cancer in the left breast. She had a surgery on August 10, 2007 to remove the left breast. 4/23 Lymph nodes [in the armpit] were found positive. Details of my mother's health are as follows –  

Age : 49
ERPR status: Positive
Postmeanopause [since 9 months]
Surgical margins: negative
No Sugar
Mild Blood Pressure
No heart trouble
she was operated last year for stones in gall bladder

following Chemotherapy regiment is selected for her

3 cycles of FEC followed by 3 cycles of Docetexal

but doctrs are not agreeing on the doses of epirubicin & docetexal.

One opinion is for 80mg/m2 of epirubicin & docetexal on the grounds that it is sufficient in preventive settings.

Second opinon is for 100mg/m2 of epirubicin & docetexal on the grounds that this case does not fall into preventive settings category.

Could you please tell us what constitute preventive setting? does this case fall under preventive setting?

What is the suggested dose in this case ?




Yours sincerely

Amit Purohit

[Cleveland Clinic]

Dear Amit Purohit,  Prevention would refer to treatment in a situation where there was a risk of disease and a treatment was given in order to prevent the disease from occurring.  Treatment after surgery for breast cancer would be called adjuvant therapy.  Adjuvant therapy is treatment given after surgery to try to prevent or minimize the growth of microscopic deposits of tumor cells that might grow into a recurrent tumor. There are several differing chemotherapy regimens/schedules that may be used as adjuvant treatment of breast cancer.  Determination of the regimen as well as the dosage for the individual patient may vary according to specifics of the situation such as stage of cancer, tumor characteristics (size of tumor, grade of tumor, Her2 status, ER/PR status) the individual’s overall health.   These specifics regarding dosage and regimen would best be discussed with the medical oncologist who will be treating the patient..

[amit.purohit]

Thank you for the prompt response. Now I understand that this case does not fall under the preventive setting because cancer is already diagnosed and surgery done.

I also understand that a medical oncologists opinion should be the final call for the doses. But oncologists are differing on the dose quantity. They agreed on the regimen & schedule but they differ on the dose [80 mg/m2 Vs 100 mg/m2].

Could you please give a neutral opinion for the dose [3 FEC + 3 Docetexal] based on following information -

Stage of cancer : 2
Size of tumor: 3.5 X 3 cm
Grade of tumor: 2
MRBB Score: 2+2+2 = 6
Metastatic tumor shows features of well differentiated duct carcinoma
ER/PR Status: Positive
4/23 Lymph nodes positive

Overall Health: Good [Please refer details in the last post]

Thanks & Regards
Amit