Is 6 x FEC good enough ?

I appologise if this seems a daft question but it is really concerning me. I read alot of the posts on this site and it seems that most peole are having 3 x FEC and then 3 x tax. I wasn’t given the option of tax yet i have read that it is the gold standard in treatment. I am now worried that 6 x Fec is not going to be good enough. Should i get an appointment with my oncologist and push to have Tax ? I originally thought you only got tax if you had a certain number of nodes involved, but many ladies seem to have it with clear nodes, my nodes are clear - is it a question of cost?
Melx

I had one node involved and I still had 6 FEC. I believe there are other considerations, but I don’t know what all of them are. The only time Tax was even mentioned to me was when I saw a different Onc. He asked whether I was FEC or FEC/Tax and said something like ‘Well you don’t want Tax if you don’t need it.’

You are entitled to ask why you are having the regimen you are, but I don’t think you need to assume that you are getting something lesser just because it’s not the same as someone else. There may be other factors.

I am having 6 FEC, too.

My understanding is that Tax is normally offered to those that have early node positive BC. These are the NICE guidelines:

nice.org.uk/nicemedia/live/11594/33575/33575.pdf

I had a 2.5cm grade 3 tumour with 0/1 nodes affected. Hence, I am on 6 FEC treatment plan. I was like you for awhile but I pulled the internet apart until I found the evidence that showed the difference in outcome between 3FEC & 3TAX and 6FEC for my kind of cancer was 1%. As they were using round numbers that could be 0.5% rounded. The decision on whether to go with just FEC or FEC + TAX isn’t just based on the nodality of the cancer but the grade and size, too.

The way I look at it is should I ever develop a node positive cancer they can always pull the Tax out of the bag.

My dx was Grade 3 with no node involvement and I was bunged on 4 FEC and 4 TAX by one of the country’s leading oncs. Heck of a set of treatments and no idea if it’s better than 6 FEC or 3+3 or not, but it seems to be very variable what they recommend.

Ann x

Ann,
One of the other factors taken into consideration is age. Forgot to mention that. The younger you are the more aggressively they treat it. Also, hormone satus is important in deciding what regimen to go with. As I understand it TN breast cancer is also treated very aggressively. But I agree there is variation.

48 soon. Not very young really…

Ann, You are still young and I bet you are still pre-menopausal.

My sister developed BC at age 41, it was small and picked up on a mammogram. She had WLE, rads and tamoxifen. Never given any other option. 5 years later (2006) she developed a second ER+ tumour in the other breast. This time they treated it very aggressively; chemo, rads, and ovarian ablation. She is still doing OK today, almost 5 years on from the second DX.

I’ve just had 6 fec. My tumour was 3.2cm. I’m pre menopausal but the grand age of 51 so i was coming to menopause time anyway. I think it depends on a load of variables but i dont think fec x 6 is a second class option at all.

xx

I had 6xFEC before my op because they thought there was no node involvement and it was just to shrink the tumour. However when they did the op they found cells present in 3 nodes and some tissue surrounding the tumour so now I’m having 4x TAX. Not great as there has been a 6 month break between FEC & TAX and I was just getting my hair back!

I had 6xFEC before my op because they thought there was no node involvement and it was just to shrink the tumour. However when they did the op they found cells present in 3 nodes and some tissue surrounding the tumour so now I’m having 4x TAX. Not great as there has been a 6 month break between FEC & TAX and I was just getting my hair back!

sorry I posted that twice. Laptop is playing up tonight or it could be chemo brain!

The site’s been a bit “odd” for the last few days, so I suspect it’s not you at all, Buzzy.

You can check for yourself the differences between just fec or fec plus tax in respect of your personal dx by playing with the figures and data on adjuvant on line. From memory, fec is first generation chemo and taxanes are second generation. But beware, you have to feel strong enough to go there as it can be scary. You could ask your consultant why s/he decided 6 tax and get them to run the figures through with both options you could ask for a second opinion on your treatment plan, loads of ladies here have. If you want to, maybe set up a thread asking for their experiences. Either way, i think you need questions answering by your team/specialist breast oncologists about your case. Its imperative to have confidence in your treatment and now is the time to act if you dont have it. You need to feel settled with the plan to move forwards beyond your dx and reclaim your life.

I was 36, no nodes, grade 3, weakly er positive, 17mm tumour. Nice guidelines said no taxanes. My onc decided to give me 3 fec 3 tax chemo. I asked him why. He said he wanted to hit it aggressively as he thought the cancer might act more like a tnbc. Also my age was part of his decision to choose taxotere.

Vickie

I’m IDC with extensive node tumours - will need full clearance eventually. I’m having neo-adjuvant chemo.

I was going to have 6 EC but then it got changed to 8 EC then I turned out to need Herceptin and it doesn’t play nicely with EC so I got swapped to 3 EC and 5 Tax with Her.

They seem to keep juggling the recipe around. There are SO many different recipes - loads of us seem to have FEC instead of just EC but that doesn’t make theirs better than mine or vice versa. Everyone’s BC is different.

vicki

fec is 2nd gen and tax is 3rd… anything with epi in is second gen… cmf is first gen but epi-cmf is second gen.

i was 37 with grade 1 and no nodes with first cancer… no chemo then 40 with 2cm grade 3 TNBC still no nodes but extensive lymphatic invasion and got epi-cmf.

i asked for tax but was told ’ the cost to you personally is too high’… i think what he meant to say was the cost to his budget was too high… mind you hes also the guy that told me having a gene test was a waste of time as i wouldnt have a mutation… hmmmm wonder where this brca 2 came from then!!

would love to know how they decide but there is no national policy and much of it is down to oncologists personal choice and which research paper hes read most recently.

Lx

Re: Adjuvant on-line, I have always wondered how up to date their statistics are. For example, do they take account of targeted therapies such as Herceptin or are their stats based on the treatment outcomes from several years ago? I have played around with cancer maths (Ladies - DO NOT go there unless you are very, very confident that you can cope with what you find - the results can be disturbing) and know that there stats are several years old now from reading the small print.

Vickie, My tumour stats are almost identical to yours except that I am 56 and my tumour was bigger at 2.5cm. Mine was also weakly ER+ (3/8) but I am on FECx6 and will have aromotase inhibitors after rads as my onc said he treats weakly positive as positive on the presumption that some of the tumour cells will respond. Interesting yours treats it more like a TN. Do you know what your ER score was?

Ninja, Totally agree - everyone’s BC is different. We may be getting the best possible and most up to date chemo/treatment for our cancer and it is still possible that our cancer will not respond. I mentioned my sister before who had an ER+ tumour at 41 and was put on Tamoxifen. She developed a new primary that was also ER+ while on the drug. Something was stopping the Tamoxifen from working. Her Drs. can not explain why this happened so they removed her ovaries to get rid of the ER at the source.

Lulu, Did you get gene tested while you were having treatment? I was told I had to wait until treatment was finished. I am really pressing for it because my sister had bilateral disease, my aunt (father’s sister) has had it and my father’s mother’s sister died from it. My father died at 37 from a sarcoma and his younger brother the year before from leukaemia. We also have a history of thyroid cancer and prostate cancer on that side of the family. My GP told me (before my sister was DX with bilateral disease) that my risk was not high because the cancer history was on my father’s side of the family, and only maternal history was relevant. With two daughters, I want to know if I have one of the recognised gene mutations and if not at least get someone to acknowledge that they are at high risk so that they are offered regular screening earlier than the government guidelines dictate.

I too was told twice by my GP a few years ago that I didn’t need to worry because the cancer history was on my dad’s side. I hope the general medical profession are more well informed now! I have in fact inherited a faulty BRCA1 gene from my father. Jolly well hope 6 x FEC is good enough cos that’s what I’ve had and no more treatment now as BC was triple negative [upside no medication side effects either]. BB

Hi,
My diagnosis was similar to Vicki’s - except I’m much older - 58, 11mm tumour, no nodes, weakly ER+, but also vascular invasion. I had 3 FEC and 3 Tax. I think it was the vi which made my onc go for the Tax.
Seems there are lots of things to weigh up before they decide - not least onc’s preference etc as Lulu said.

Regarding inheritance, I understood that total DNA was in every cell, so you can inherit stuff from father’s side a- not to mention men can get BC too.

Cherry Orchard - with your family history I’m not surprised you would like some testing. Every single blood relative of mine has died from a heart attack or stroke - at an early on my father’s side. He was 41, his father and brothers, late 50s or early 60s. I was quite sure that’s what I was heading for.

Stella

Lulu: “much of it is down to oncologists personal choice and which research paper hes read most recently”

  • or hopefully, WROTE most recently…

Dancing Girl: “I understood that total DNA was in every cell”

Yes. At the time of conception, the egg and sperm divide in a process called mitosis.
Mitosis produces two daughter cells with the same genetic make-up as the parent cell. Chromosomes are copied so that each daughter cell receives a copy of every chromosome.
That’s why they can take a painless scrape from the mucous membrane in your cheek for a DNA test.

What is not yet understood (or wasn’t when I studied human biology) is why some of the embryonic cells go off and differentiate to form (say) a kidney, others a heart and so on.

HTH

I had 6 FEC, and asked why I wasn’t given 3 FEC and 3 Tax. The advice I received was that although there is evidence which suggests combination chemotherapy produces a survival advantage over single agent chemo, that evidence only applies to patients receiving one cycle of chemotherapy. For patients who receive/or are likely to receive more than one cycle of chemotherapy, there is evidence that sequential single agent chemotherapy has a better survival advantage than combination chemotherapy. In other words, if someone is likely to require more than one cycle of chemo, there appears to be a survival advantage in having single agent chemo’s sequentially rather than together.
From what you say, I presume that this is likely to be your only cycle of chemo, and that you’re probably having it as an insurance policy, so maybe you should ask why they are not giving you combined chemo.