Selection of Chemotherapic Regimen

My sister-in-law age 65 (F) post-menopausal,DM(++), had been recently (25th July,2002)undergone mastectomy of her right breast with axillary node dissection. Her tumour was 4 cm in greatest dimension with skin fixation at the upper outer quadrant, HPR- IDC Grade-III, no lymphovascular embolization, ER-Negative, PR-positive (score-9), all 6-dissected nodes were un-involved. Medical Oncologist advised Chemotherapy of CEF(Cyclophoshphamide+Epirubicin+5-Flu) Regimen, 6-cycles at 21 days interval, plus tamoxifen for 5-years. Irradiation after completion of chemotherapy.

A second opinion taken from another Professional Medical Oncologist in my City advised Taxotere in adjuvant setting with Adriamycin. We are confused as my Medical Oncologist says that CEF is the standard drug & Taxotere is still under trial and too toxic to be advised considering the age of my sister-in-law. We have to decide fast,as you know. Please advise us your best considering latest development of choice of Chemotherapic Regimens.

[CCF-RN,MSN-rf]

Dear Afroza:  In general, taxotere is second line therapy unless it is part of a clinical trial.

[annied]

Question: I thought that if you had a mastectomy you did not require radiation. If the breast has been removed, then was is radiation area?
Also, I thought Adriamicin & Cytoxan were the preferred chemo for first time breast cancer.

[annied]

re: Fear of Taxotere toxicity:

I just finished Taxotere chemo June 25, 2002. (I had recurrent breast cancer dx'd January 2002. First breast cancer: diagnosed January '97, stage III, with chemo of Adriamicin/Cytoxan).

I disagree with that oncologist who said "Taxotere's too toxic". It's a whole lot easier than Adriamicin & Cytoxan. I had 12 Taxotere treatments- once per week, every Thursday afternoon, & was back at work next morning. Would have some diarrhea on weekends, but no nausea. Back at work on Monday. Some fatigue, diarrhea, hair loss, nail/fingertip pain & now starting to lose some nails, some fingertip pain (pain in fingertips each time around 3rd day after treatment, pain would go away after about 3 days). Nails will come back, though.

My worst complaint was that food tasted funny. But food now tastes good again. my fingers don't hurt anymore, tho my one thumb-tip has slight sensation loss. I can see some stubble on my head - must be new hair getting ready to sprout.

[Afroza]

Dear annied,

    The answer of CCF-RN, MSN-RF dated 12th July, 02, that, " In general, taxotere is second line therapy unless it is part of a clinical trial", seems to stand in your case as it appears that  you received therapy with Taxotere in an adjuvant setting in case of a recurrence, as I understood. Kindly confirm.

    Adriamycin was not the point. However, it was good to know that Taxotere did not give you much trouble with side-effects, it is understood that, the side-effects of Chemotherapeutic Drugs vary from person to person and to particular clinical/pathological  situations of an individual.