Need chemotherapy regimen advice soon

[ajayarmani]

Hello Doctors -

I am writing on behalf of my mother, 61 yrs, who has been diagnosed with triple negative BC (background below). She has already been administered 3 cycles of CEF.
Here are the details (Same cycle is to be repeated every three weeks for 6 cycles in a similar way) :
Inj Cyclophosphamide   850 mg I.V. on day 1
Inj Epirubicin                150 mg in 1 NS over 1 hour on day 1
Inj 5-Flurouracil             850 mg I.V. on day 1

After the 3 CEF cycles, the oncologist is recommending  3 cycles of Paclitaxel (290 mg) and Carboplatin (450 mg)". Each cycle of 3 weeks interval.
My question is
1. Is the oncologists recommendation agreeable - wrt efficacy ? wrt toxicity ?
2. Would u recommend weekly paclitaxel+carboplatin instead (instead of 3 week cycles) ? again, wrt efficacy ? wrt toxicity ?
3. what about 3 cycles of just docetaxel by itself ?
4. Can docetaxel be combined with carboplatin ?

I would really really appreciate any advice. Thanks in advance. Meanwhile, Here is some background on her case:
  Underwent Right Modified Radical Mastectomy on Dec 5, 2007
  Diagnosed with 3.8 cm size malignant tumor IDC Grade 3
  Tumor is close to deep margin but free (0.2 cm away)
  Nodal Metastases to 1 level I node out of 28.
  ER - PR - CerbB2 negative  (Triple Negative)    Cutoff >10%
  Additionally, ki67 testing revealed a MIB1 index of 10%

Thanks,
AJ

[lizziecee]

Hi - sorry to hear of your Mum's diagnosis. I was 58 yrs when dx Jan 2003 with a stage 2, grade 2, IDC tumour with associated DCIS, comedo and cribriform, and 4/18 lymph nodes positive. I was ER+, HER2-, PR not done.  I had 6 cycles of FEC, then 25 rads, Been on Arimidex since and doing well, even though I am on weekly chemo (methotrexate for Crohn's).

My dx is a little different to your Mum's and this could be the reason why her Oncologist is advising a different chemo regime after the FEC. The fact that she is triple negative means she cannot have hormonal treatment such as Arimidex or Tamoxifen, and hence the difference in her chemo treatment to mine. I would ask her Oncologist for a fuller explanation as he is the one with all the facts.

When we first get breast cancer, we naively believe it is a single disease, whereas it is not. There are many different kinds of breast cancer, viz; ductal, lobular, inflammatory and even Paget's disease. I believe the Oncologists are the only ones who understand bc in depth, and the hormonal status indeed plays a big part in a patient's individual adjuvant treatment plan.

I do wish you Mum well  - she is lucky to have such a wonderful caring daughter.

Liz.

[SadButHopeful]

My diagnosis in 2004 very similar to your Mothers.  Very agressive chemo, radiation and surgery in my case.  I teetered with the decision to do the chemo.  I can only
suggest you get very definate, and possibly in writing, answers regarding
"chemo brain" and the real issues involved.  I pray for your Mother and your family.

[Cleveland Clinic]

Dear AJ: There are several accepted treatments for breast cancer chemotherapy.  The decision of which one is generally made by the oncologist based on the literature and experience.  There is not necessarily an absolute right or wrong.  You should discuss with the oncologist the rationale for his/her recommendation and pose these questions to him/her.  If you are concerned about the regimen, your mother should seek a second opinion that would include the pathology review and examination, so that an accurate opinion could be given.  We cannot comment on specific treatments for individual cases.