Hi everyone, I could use some advice. I was offered the option of doing 6 cycles of TC chemo instead of 4. This was suggested because I had a local recurrence after my first diagnosis in March 2023 (lumpectomy, 4 cycles of EC chemo, and radiotherapy). I wanted to give myself the best shot at avoiding another recurrence or metastasis, but there isn’t much evidence or trials showing that 6 cycles are more effective than 4.
My oncologist couldn’t give a strong recommendation either way, leaving the choice up to me. On one hand, I want to do everything I can to prevent a recurrence, but on the other, I worry about whether 6 cycles might be over-treatment and lead to long-term side effects.
Has anyone else faced a similar decision or have any insights that could help? I’d really appreciate hearing your thoughts
I’m not sure if your are ER+ or TNB or something else. Also, the size of your tumor and if there was more than one, etc. I would think each of these factors would come into play. Can you get a 2nd opinion? I would want my MO to have a strong recommendation. Sounds like they want to leave it in your hands and that sort of bothers me. It is ultimately your choice, but it helps when they can guide you.
I’m sorry for your recurrence. I too am in the same place, but for me it’s been over 13 years. It seems that not a lot has changed in the different treatments. I did TCx4 back then. Mostly because my Oncotype test was a 22 and I had 2 micromets in my lymph nodes and I was 46 with young kids. All these factored in. I am now 60 and I am only taking Anastrozole, but that may change after surgery
I was the opposite as in I asked if TC x 4 over EC x 4 / T x 4 would be ok to do & my oncologist agreed as:
I was hormone + her 2 -
Although one node came back with macromets (3mm) I had NO LVI/ECE
My ki67 was 5%
Grade 2
Maybe dig a bit more into the pathology of the reoccurrence ? That may help with your input
Also remember - we as patients would not be given a choice unless they felt it was safe for us to do so (a lovely nurse told me this when I had to decide btw a full node clearance or radio on it after chemo)
Thank you. That’s actually good advice. My initial cancer was ER+PR+HER2 low. My recurrence ER+PR- and HER2-. So it changed from Luminal A to B. Grade continues to be 3. I had 2 different oncologists’ opinions - same hospital. I don’t think there are many trials with local/ regional recurrences. I’m going tomorrow for my 4th cycle. Not sure yet if it will my last.
Thank you. My first diagnosis was ER+ PR+ HER2 low. Grade 3. 32mm no lymph node involved. Despite EC chemo + radio + tamoxifen it returned in less than a year and was also found in a lymph node. I asked 2 opinions within the same hospital. Both said 4 cycles is the protocol, if your body tolerates and there are not many side effects, we can add 2 more cycles.
The only thing I’d say is that they always weigh up the risks to you versus benefits of the treatment .
They’ll only suggest it if they think you can tolerate it x
I’m glad you had a chance to get 2 opinions. Since your tumor was hormonal, I was under the impression that Tamoxifen for pre-menopausal and Anastrozole for postmenopausal would have kept the tumor from coming back. Are you now post-menopausal due to the chemo? That is my only “looking back” regret. I couldn’t take Tamoxifen all those years ago, but my doctor was cool with the fact I had surgery, chemo and rads. He didn’t offer me any AI meds at that time since I don’t think they knew as much then as they do now.
If there isn’t much evidence that 6 is better than 4, perhaps look to the areas where there is more evidence. Wishing you the best and a speedy recovery.
Thank you for your message:heart: I’m not expecting advice - I know how complex cancer is and only my team have access to all the details. I’m posting for messages like yours to expose me to different ways of analysing this situation or patients that had 6 cycles and don’t mind sharing their experience. My worry was that although I was hormonal positive ER8 PR7 and I was on Tamoxifen since Sep 2023, I had a recurrence diagnosis in July 2024. Oncologist stopped Tamoxifen as it was not working for me. My recurrence is now ER7+ and PR - so my my team will change me to Letrozole after chemo treatment but as I’m “less hormonal positive” i wonder if it will work this time around.
to expose me to different ways of analysing this situation or patients that had 6 cycles and don’t mind sharing their experience. My worry was that although I was hormonal positive ER8 PR7 and I was on Tamoxifen since Sep 2023, I had a recurrence diagnosis in July 2024. Oncologist stopped Tamoxifen as it was not working for me. My recurrence is now ER7+ and PR - so my my team will change me to Letrozole after chemo treatment but as I’m “less hormonal positive” i wonder if it will work this time around.