Different chemo regimes


Since joining thses forums I can see that there are many variations of chemo regimes and cycle duration. I am curious about how oncologists determine what we have, dose strengths and number of cycles.

The most usual regime seem to be FEC or FEC-T for 6 cycles.

I am on FEC but for just 4 cycles (no idea why only 4 apart from onc saying that is more than sufficient for me… I am having 18 herceptin as well)

Suspect one of the key factors is whether we are neo-adjuvant or adjuvant.

Just know there are some very experienced and knowledgable ladies out there who can help to satisfy my curiosity.

Much love
Pixie xx

Hi Pixie

I wouldn’t call myself knowledgeable or experienced but anyway…

I am on pre-surgery 6 x FEC-T for inflammatory breast cancer which has spread to lymph nodes, but no bone/liver/lung mets found on latest scan. I am also to have Herceptin but was negative for hormone receptors. I am 46 and this is my first time with cancer and I am otherwise in good health.

I was told this was to reduce the risk of the cancer spreading beyond my lymph nodes. Also to hopefully reduce the size of the cancer as mine is currently only just operable but the op would be difficult.

I think they take into account your age, height and weight, general health and whether you have any other health issues like diabetes, heart, liver, kidney etc problems when they decide the type and dose of treatment. Also the extent of the cancer.

Hope the rest of your treatment goes OK, sorry to hear you had problems but loved your Debenhams post!

Squeakymouse xx

Hi Pixie

My BC is triple negative, ductile invasive, 5cm, grade 3, nodes supposedly clear. However I’m on neo adjuvant FEC-T (3 x FEC plus 3 x Docetaxel) which, according to the treatment notes I was given, is normally used for ‘node positive early BC’.

I don’t know how they work out the regimens. Recently I met another person with TNBC, same type, size and grade, and she was given a mastectomy straight away followed by a different type of chemo (can’t remember which one). However, she’s younger and fitter than me, so perhaps that’s why there’s a difference in treatment. Being triple negative there’s no follow-up drug treatment possible after radiotherapy as tamoxifen and herceptin aren’t relevant to this type.

I asked my consultant oncologist about this, and she said that chemotherapy regimes are, as far as possible, personalised to each individual. My BC is node-negative, grade 3, ER/PR +3, HER-, and she recommended adjuvant 3 x FEC and 3 x TAX, as taxane (or a 3rd generation regime) vastly improved my personal survival/recurrence at 10 years. Decision still to be made about whether endocrine therapy will be of benefit. She said that her decisions are based on recent research, statistics and she uses a combination of online tools and vast experience to make an informed, joint decision with each patient. She also ensures that the potential benefits outweigh any risks, so treatment also considers general health and results of additional health checks e.g. ECG. I had WLE and will have 15 x radiotherapy, as again my surgeon said that for me survival rate was the same as a mastectomy. So…probably not an answer to your question Pixie…just that everyone is as individual as their BC diagnosis and hopefully receives tailored treatment.

Hi Pixie

Sarah12’s comment of ‘node positive early BC’ probably sums my BC up. I’m on FEC-T (3 of each). Found my own lump in December, had biopsy and dx in January, lumpectomy to remove 10mm tumour in Feb and 4 nodes removed. One had trace of cancer cells. Surgeon said historically they would have gone on to do lymph clearance but there was no point as chemo would clear any cancer cells and clearance would be an unnecesary step. Oh and I was ER+/HERneg. My onc used various computer programmes to determine my risk factors of developing further cancers and said the chemo would give me the best chance of non-recurrence over 10 years. My FEC-T is therefore adjuvant, not neo-adjuvant.

After the six blasts of chemo I have 25 session of radiography to look forward to (why some people have 15, some 20, some 25 or more is another mystery). Rads will be followed by 5 years of hormone therapy - not tamoxifen because I am post menopausal (63), but another drug. Can’t recall the name right now.

I hope you get lots more postings on this subject as it’s a very interesting exercise.

Love, margieteexx

Thank you to everyone who is responding… it really is fascinating.
My beastie was diagnosed as a stage T1c, Grade 2, 13mm, Nodes Clear, 8/8 ER + and HER +.
My treatment, after WLE and SNB, is 4 x FEC; 20 X Rads; 18 x herceptin; 5 years letrozole (its what you will get margie, one of the aromatase inhibitors)
Onc tells me this gives me excellent chance of being cured - no reccurences.
Hope he’s right 'cos it feel like a long old haul but at least it got me a portacth so cannula free zone here :slight_smile:
Much love Pixie xxx

Hello ladies

I’m a march chemo person. No 5 beckoning on 23rd may.

I had 35mm lump, stage 2, then surgery to remove and a therapeutic mammoplasty ( which looks great but leaves the dilemma of having lop sided boobs and do I put myself through more surgery to balance just for cosmetic reasons?). Surgery Jan 16th, then the awful waiting.

Chemo of Fec75 started on 1st March for 6 lots. No lymph nodes affected, so assumed that’s why fec75, but who knows. Luckily near the end and even gave radio mapping appointment through for 13th July that should start that week or so later for 18 sessions. Then as pre menopausal Tamoxifen for 5 years which I’ve already been on pre surgery, so know what to expect.

So strange how two people can sound the same but then be treated differently. Maybe it’s just how different trusts work, or the different opinions of oncologists.

Carolyn xxx

Hi Pixie

Just checked out which hormone therapy I’ll be on - as you say, it will be an aromatase inhibitor, but the one I’ve been earmarked for is Arimidex which is an anastrozole. Heavens, the knowledge we are all picking up in such a short time is unbelievable. Just such a pig there’s a need to find out … next step is to find out what the difference is between anastrozole and letrozole!!! Both I gather have basically the same chemical structure - just found a clinical research paper on the comparison and the abstract concludes with the suggestion that lestrozole may be slightly moe effective than anastrozole. When the time comes, I’ll ask my medical team.

Didn’t mention in previous posting that my tumour was stage 1, grade 2.

love, margieteexx


I am an April bunny and am having 6 FEC-T. I had a 4cm lump in my lymph node with 1 other node affected & traces in 2 nodes (out of 22). I had a mastectomy & ANC on 28thMarch and no cancer was found in my breast.

My node was er+ 6/8 and is assumed to be grade 3 because of the way it has behaved. Cases like mine are quite unusual but according to my ONC not rare enough to get me fame & fortune.

My ONC says she chose FEC-T to help prevent recurrence as it is the best available treatment for young & fit. I am really interested in the science behind the choice so my poor ONC will be interrogated next time I see her.

I am borderline for rads, will take tamoxifen for 5 years and will be requesting a risk reducing mastectomy on my right breast due to the sneaky nature of my cancer. I had self examined since 20’s & had clear mammograms from 44 and only found my underarm lump by accident

I am also having 6 FEC-T. This seems to be the most common regime at the moment, from what I can tell. I was IDC, grade 2, 43mm tumour, 2 nodes, 7/8 ER+, HER2+. I started chemo in April, two down, about to have my third.
Pixie - I imagine you are down for four instead of six sessions because of clear nodes, and smallish tumour. But the HER2+ means chemo is necessary as Herceptin works best administered with chemo.
I wonder if the different types get different regimes, like invasive lobular carcinoma has different drugs to invasive ductal carcinoma? Or maybe they base it more on grade and stage? I don’t know.

Mine is IDC 3.5cm on mammogram (MRI was only done day before first chemo and should get results in wednesday when I go for my second). My treatment is neo-adjuvant 6 x Fec-t (3 x Fec100 followed by 3 x taxotere). Underarm looked sus on ultrasound but FNA was clear, they’ll do the sentinel mode biopsy with mastectomy after chemo, then rads and hormone therapy. My tumour is weird looking apparently, very haemorrhagic with giant cells. No official grade since pathology was done only on core biopsies (insufficient material for grading apparently). Er 8/8 HER - and I am in early forties. Fit. Have had bad asthma all my life too but it is fairly well controlled, but from what I can gather asthma makes lung spread more likely.

I was 29 when diagnosed at beginning of this year. I have ILC, 55mm tumour, Grade 3 and in 1/26 nodes. I am ER+ and HER2- I am having 6 x TAC (strongest drugs apparantly), assuming rads but will discuss after chemo and 5 years of Tamoxifen and Zoladex. I have already had a mastectomy and immediate DIEP recon in which tumour was removed with clear margins. I have been told that everything will be thrown at me because I am young and the ILC is aggressive but not really been given much more info to be honest. I would be interested to see what you manage to find out from all of this.
Keep those bunny ears up straight.
Natalie xxx

HI girls,
Thank you for posting. Have my first appt with oncologist tomorrow so feeling very apprehensive about chemo. My diagnosis is very similar to Namar82 but I am older 48, not many post on ILC so glad to find you. 65mm tumour ER+ PR+ AND HER2 - but advised to have delayed reconstruction. Will find out more tomorrow, I was dx in Feb and after 3 biopsies, mri, many scans,wle and then mx feeling so overwhelmed. So much to take in about chemo and effects, not sure how I am going to cope and keep the family going too. Also told that will have everything thrown at me too. Interesting thread on chemo tips but so may comments to scan thru would be good to narrow tips down to ones regarding Ilc.
good luck everyone.

Hello ladies

Am encouraged to see I am not the only curious one in terms of the different chemos.

On Monday i went to have bloods done and asked the chemo nurse, she was more forthcoming than onc who tells me “don’t worry about it, you are having the best chemo for you”. Not sure he understands difference between worry (which I am not) and fascinated (which I am) :slight_smile:

Chemo nurse told me the starting point at my hospial is the type of cancer. I have IDC so the chemo of choice is FEC.

If there are positive nodes, it is FEC 100 plus Tax, 6 cycles.

If there are negative nodes but grade 3, it is FEC 100 for 6 cycles.

If like me, it is negative nodes and stage 1 or 2, it is FEC 75. 6cycles for HER2- and 4 cycles for HER2+ followed by 18 herceptin.

She said ILBC is usually straight Tax.

But I bet it differs at other hospitals… We should compile a chemo index LOL

Pixie xx

Thought I would throw mine into the mix, just as it seems different to a lot. I was diagnosed in Nov 2010 with IDC, large lump 4.5cm, no nodes, ER+, PR+ and HER2+. I had chemo to shrink, WLE, radiotherapy and Herceptin. I had 4 x AC and 4 x Paclitaxol chemo, given 2 weeks apart, so 16 weeks in total. When I started the Paclitaxol I also started the 18 Herceptin. I then had WLE and sentinal node biopsy followed by radiotherapy, all the while having Herceptin throughout. I finished Herceptin in February this year. At the same time my husband’s secretary was having treatment with similar diagnosis (her lump slightly smaller) but she had FEC regime every 3 weeks, at the same private hospital in London with same onc. We were told that because I was younger and fitter I was having a stronger more concentrated regime as my body could cope better. Don’t know how true that was, but all I know is it was hell for me. She worked during her 3rd week, I didn’t work at all through chemo.

Fascinating that your chemo nurses are so well informed Pixie…all mine seem to do is administer the chemo based on what comes down from pharmacy according to the prescription sheet. It is a large, mixed chemo unit so perhaps less specialised? One lady next to me yesterday had a similar diagnosis to me, but smaller lump and younger, so only FEC x 6 and the lady the other side had a very different diagnosis but the same chemo as me 3 x FEC and 3 x TAX. Chemo nurse was surprised I had Filgrastim injections for TAX - I had them for FEC…as other lady didn’t, but I am working and she is not, so maybe that’s the difference as my WBC and Neuts have always been good! I saw a different Onc on Mon and he said that when prescribing chemo they take into account size of tumour, grade, stage, age etc., so very personalised - concurs with my consultant which is reassuring! Maybe you should start an index?! Suspect it will be complex though…

This is very interesting.
I’m her2+ Grade 3 don’t know the other bits but am having 4 x EC 4 xTax and 18 Herceptin with the herceptin starting at the same time as the Tax. I had WLE and SNB Early March, no node involvement lump was 9mm. Am really beginning to think need to ask ONC why I’m having 8 lots when ‘norm’ seems to be 6 for most people. But am bit of a wuss about knowing any really bad things.