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Is FEC chemotherapy the right choice for...
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Is FEC chemotherapy the right choice for...

Dear knowledgable community,

I have been advised from my oncologist that the right course of chemptherapy action for breast cancer is FEC. If my vital organs are already cancerous, is this still the most appropriate form of chemotherapy to be choosing?

This question, comes from my mother, who has fought breast cancer for 9 years, with 3 failures from the specialists to pick up and act on the spread of this cancer. 5 surgeries, and 2 sessions of radiotherapy later, the cancer has now spread into her liver and she has extensive fluid in her lungs, with breath incredibly limited. There is a lack of consultancy available to get second or third opinions, within our current community, and so we are again putting faith in the medical system which has failed for 9 years. She is now 12 days into her first course of FEC, which is knocking her hard, and she is questioning that with the research she has undertaken and understands that FEC is the form of chemo used for breast cancer in specific, but is it the appropriate choice if vital organs are affected also?
If you have any information, thoughts, first hand knowledge, or have links for further reading I would be sooooo grateful.
Many thanks in advance,
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Having helped your mother survive breast cancer for 9 long years, is it not a bit unfair that the medical system now stands accused of "failing" her?
Cancer is still incurable in advanced stages, although our knowledge of the basic biology is rapidly increasing, and also leading to better treatment modalities and increased patient survival in a wide variety of cancers.
FEC is a reasonable option for your mother. Taxanes have also been tried, but toxicity/tolerability may be an issue with yur mother as she has advanced disease.
If her ER/PR/HER2 Neu status is known, she can be put on additional medications.
Hi.  Since your mother has breast cancer which has spread to her liver, this is classified as Stage 4 disease.  Your question is if the FEC regimen is still appropriate for someone with stage 4 disease ("if vital organs are affected also").  You're also probably wondering if FEC is not only appropriate, but the BEST choice for chemotherapy, given your mother's circumstances.

First of all, I would like to clarify that the FEC regimen is commonly used not only when breast cancer is confined to the breast and nearby lymph nodes, but also when it has spread to other vital organs like the liver, lungs, or bone.  However, saying that FEC is useful in treating metastatic or Stage 4 disease does not automatically make it the appropriate choice for your mother's case.

Choosing the best chemotherapy regimen for a patient with metastatic disease like your mother is a complex process. It involves having to weigh in a lot of factors.  I've listed some of the more important ones below:

1. The type of cancer your mother has.  By cancer type, I’m referring to the histology, tumor grade, hormone receptor (ER/PR) status, HER-2 receptor status, etc.  Certain drugs become more appropriate given a certain configuration of tumor characteristics.  For example, for ER positive and HER-2 positive tumors, an anthracycline based regimen like FEC combined with trastuzumab may be a good choice.

2. Your mother’s functional capacity and presence of other chronic illnesses.  Functional capacity measures how strong your mother’s body is, and her ability to withstand the rigors of chemotherapy.  If your mother has poor functional capacity, or has a lot of other chronic illnesses such as heart disease, it may be better to choose a regimen which has a milder side effect profile.

3. The treatment goals.  For stage 4 disease, it is already difficult to cure the person of the cancer.  In this setting, the treatment goals usually consist of prolonging survival, controlling the symptoms and complications arising from the cancer, or making the patient more comfortable and assuring quality of life. The choice of chemotherapy regimen (or whether to give chemotherapy at all) will depend on the goals that have been set before the start of treatment.  These goals have to be agreed upon at the onset by the doctor and the patient, so that treatment can proceed smoothly.

If you have doubts about the kind of treatment your mother is currently receiving, my suggestion is for you to sit down with her doctors to talk things out.  I’m sure they’ll be more than willing to accommodate you.

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