Risk of recurrence vs risk of cardiac or liver damage from AC.

[ljohnsonfl]

I am a 44 year old woman (premenopausal, though chemo is putting me through early menopause). I was diagnosed with invasive ductal carcinoma breast cancer and underwent a mastectomy in Oct 2002. A 3.5 x 2.3 x 2.7 cm tumor with clear margins was removed. No nodes were involved,
pathological stage T2 N0 M0. My ER and PR were both positive. Her2/neu was 0.0. Histological grade 1. Nottingham combined score 5.

I received different recommendations from two different physicians. The first advised that I undergo 6 cycles of AC adjuvant therapy and tamoxiphene following. The second physician indicated that 4 cycles of AC would be adequate followed by tamoxiphene. I understand that with AC therapy there is a risk
of cardiac and liver damage. What are the advantages and disadvantages of 6 AC cycles versus 4 AC cycles relative to both my chances of recurrence and the risk of developing cardiac and/or liver problems. Considering my age, 44, does 6 cycles vs. 4 cycles reduce my chances of the recurrence and thus out weigh the risk factor of developing cardiac or liver problems?

Thank you
Linda K Johnson

[CCF-RN,MSN-JS]

Dear Linda, It is possible that the total dose of chemotherapy is the same whether given in the 6 doses or the 4 doses.  The risk of cardiac damage increases after a certain lifetime maximum dose of adriamycin and risk increases when cumulative doses are greater than 550mg/m2.  Transient elevations in blood tests that are used to monitor liver function (bilirubin and liver enzymes) occur in less than 1% of patients recieving adriamycin (these usually would return to normal once treatment stopped).  Liver toxicity is seen with high-doses of cyclophosphamide, and is rare in the doses given for adjuvant treatment.

[ljohnsonfl]

Thank you for your response. I will ask my doctor what my cummulative dosage is.