Hormone therapy and no Chemo?

[Franciscus]

My wife had her mastectomy recently. Turns out it was a Grade 2 and 2.7 cm tumor; one positive node; ER/PR positive; HER 2 negative; all other tests negative (bone scan; PET CT). Other pathology looks good. The onco feels that chemo is necessary, but that we can choose between AC+T or CMF+Aromatase inhibitors (no sure which one). We will probably choose CMF+Aromatase inhibitors due to the relatively lesser side effects.

Two questions:

1. Does it make sense to use CMF+Aromatase inhibitors rather than AC+T?

2. Can we avoid the CMF and just use hormonal therapy by (e.g.) surgically removing the ovaries? Is this a sensible option?

Thanks,

Francis

[CCF-RN,MSN-rf]

Dear Francis:  Chemotherapy is recommended for breast cancer when the disease has some factors which may increase the risk of the disease returning.  Large tumors, and positive lymph nodes are examples of two such factors.  The drugs chosen will depend on a number of factors, including the person's specific disease and the health of the patient.  AC+T is a more aggressive approach.  Hormone therapy (whether it is tamoxifen or an aromatase inhibitor) would likely be recommended regardless of the chemotherapy choice, due to the tumor being ER/PR+.  In other words, your wife would still be recommended to receive treatment with an aromatase inhibitor if she received AC+T.  Removing ovaries will not affect whether or not chemotherapy should be done but might affect hormone therapy choices.  In determining the best approach for your wife, you should discuss options with her oncologist in terms of trials and statistics.  Another option is to seek a second oncology opinion, preferably with a breast cancer specialist.

[Franciscus]

Thank you for the replies to my post. It seems the onc feels that my wife's case does not need AC+T and she can use CMF because she had a mastectomy (less chance of local recurrrence)and all the other tests look good, except for the one positive node. We will get a second opinion from a breast cancer specialist.

[sparkle246]

I am not a doctor, but I did just finish treatment for a 1.3cm, grade 3, node negative, er+, stage 1 cancer.  My treatment was, AC every two weeks, then T (taxol) every two weeks.  It's called dose dense.  I will now have radiation and then finish up with Aromatase Inhibitors (sp?) for 5 years.  I am happy I was offered this type of treatment, because I know it is very aggressive and that is what I wanted.  It wasn't comfortable for the 4 months I was in treatment, but it wasn't as bad as I thought.  

Hope this helps.