IIIa breast cancer treatment

My 40 yo sister-in-law was recently diagnosed with IDC stage IIIa with tumor size 1.4 cm and 4 of 8 nodes pos, ER+(97), PR+(14), Ki-67 25, & HER2/nue neg. She has had a simple mastectomy w/ axillary node dissection (complicated by severed long thoracic nerve) and a prophylactic mastectomy with reconstuction bilat. (incl. tissue expander placement). Her only other medical problem is immunotactoid glomerulopathy (ITG) which is stable with a CrCl of 65 and proteinuria of about 1 gram. Her planned treatment is AC q2w x 4 followed by T q2w x 4 then radiotherapy and Tamoxifen. Is this approach state of the art or is there a better approach or is there an equally good approch that has less potential deletarious side effects? Can liposomal doxorubicin be used in this country? Should it be used?

[Cleveland Clinic]

Dear bossyrossy:  AC-T is one of several standard regimens used in the US as first line adjuvant chemotherapy for breast cancer.  The exact choice of drugs would be based on the individual disease characteristics as well as physician preference.  Any drug regimen would be considered in the context of the patient’s health and expected risk versus benefit profile.  Liposomal doxorubicin is FDA approved and used in the US.  However, it is approved for platinum resistant ovarian cancer, AIDS related Kaposi’s sarcoma after failed chemotherapy, and Multiple Myeloma in combination with bortezemab.  It is not currently approved for any breast cancer indication. It is frequently prescribed off label for the treatment of Stage IV breast cancer, but it would not typically be prescribed as a replacement for known effective therapy in the adjuvant setting.  Further, liposomal doxorubicin has a similar toxicity profile to doxorubicin.  Ultimately, the oncologist would be the expert best equipped to select the most appropriate regimen for your sister based on her situation.