Which regimen - how does an onc decide?

Hi

I’ll be starting chemotherapy in 2/3 weeks.

I’ve been trying to find out how the oncologist decides which drugs to use, but other than finding lots of patronising patient-based references to the doctor tailoring the treatment to your special needs, I can’t find which drugs suit which type of cancer or individual.

Has anyone had it explained to them why they’re having FEC or Tax or CMF or a combination or whatever? I’d just like to understand a bit more about it. Anyone found a good online reference?

thanks all

Jane

I think it may well be in the NICE guidelines. Here’s a web address I found if you don’t mind digging around a bit in it until you find the relevant bit …

nice.org.uk/guidance/index.jsp?action=byID&o=12

OOps - my link doesn’t seem to work. Try typing NICE breast cancer into search engine.

Hi
There was a thread on this a while back. But my recollection is no one could really work it out. Obviously there is some reference to grade and node involvement but some people with seemingly similar histologies were given different chemos. Hope you find some answers. When I asked my onc why I was having 3xfec and 3x tax he said because of my age (38). Nothing to do with nodes or grades or size of tumour. Dx

Different oncs have different practices, i was given 3 fec 3 tax but was told other oncs would equally have given me 6 fec. I was told usually give 3 fec 3 tax if there is node involvment or tumour was triple negative, but only if the patient seems like they could cope with the taxotere. I had 17mm tumour, weakly er positive, no evidence of node or vascular involvment, pr and her negative. My onc gave me fec plus tax as he thought i could deal with it at my age (36) and because he thought the cancer may act more like a triple negative tumour as it was only weakly er positive, so gave me that treatment. There are no right and wrong answers apparently and practice varies

Hope that helps,

Vickie

thanks girls - NICE was useful re specifics of certain drugs and led me somewhere else which stated fecx3 and taxx3 is significantly better for premenopausal women with node+ or metastatic cancer, halting progress of existing disease by an extra 6 months over less aggressive drugs.

Unfortunately I can’t have the tax cos I’m pregnant.

I was told by the oncology nurse that FEC is “bogstandard” chemo - simple and effective. Tax is a more expensive drug and works on cells in a different way. FEC attacks the DNA, Tax attacks the outer skeleton of the cell.
A lot of fuss is made about tumour grade but according to my onc it is nowhere near as important as staging.
Your regimen all depends on individual pre-treatment prognosis and the whim of the onc I suppose. Tax does seem to be more “hardcore” and appears to be used more commonly used when there are more than a couple of nodes involved.

I am sorry to hear that you are having to go through all of this whilst pregnant Jane72. Best of luck to you.

I had a bit of a shock this morning when the oncologist suggested an unexpected regimen: 4 cycles of AC, deliver baby, have a week to recover, then 4 cycles of Tax! Jeez.

I asked if 8 was really necessary and it seems that’s mostly to do with timing as there’s no statistical benefit - can’t have Tax while pregnant and they don’t want to leave too big a gap between treatments or wait to start, so I can’t have 3 and 3. So I have agreed to 4 AC and at least 1 Tax following delivery - any more and I think postnatal depression is just around the corner. He said that most of the benefit comes from the 1st exposure to a new drug.

I start next week. Finding it hard to take in. Two weeks on from op and still no pathology but surgeon said he was ‘confident’ there was cancer in most/all of the nodes. Lovely.

Has anyone else had 4 and 4 cycles?

Hi Jane so sorry that you are having to go through all this on top of being pregnant…:frowning: {{{hugs}}} I had IBC so had to have 4xac and 4xtax before my mastectomy… i had been warned if the path results were poor i would have had more chemo after the mastectomy but luckily they were good… Sheesh they are not giving you much recovery time! I take it they are hoping to induce the birth as you would have to have healing time after a section…

Everyone’s experience of chemo is different but for me ac made me tired and feel sick (although only physically sick a couple of times…) so quiet similar to early pregancy in some ways…

Hope they get back to you soon with the pathology results.

Theresa x

Hi Jane
Sorry can’t help, just wanted to send you love and support, hope someone will come along with some answers for you.
I am having 3 FEC and 3 TAX l had a lot of lymph nodes involved, just hoping all this chemo is doing it’s job!

Your photo is beautiful! how old will your little one be when the baby is born? and more to the point when are they going to induce the baby?

The waiting for test results is the worst thing, well no everything is the worst thing!! but we all hate the waiting, are they going to ring you with the results, or do you need to go back.
You must be exhausted, all this and pregnant, and a little one running round, keeping you on your toes!
Hope you have lots of family and friends to help after the baby is born, you want to grab every little bit of help offered
Take Care
Lots of Hugs
Sandra xxx

Hi Jane

I once asked my onc why some people 4 and 4. He said there were lots of reasons but one was that for health reasons they were being given a lower dose in each chemo but more doses. I suppose this kind of makes sense while you are pregnant or recovering from childbirth.

I am sure they are taking the very best care of you and your baby. Debx

Hi Jane

Really sorry to hear you have this to manage while being pregnant.
Yes, I had 4 and 4 spread over 6 months.
I had 4 x AC (which I think is very similar to FEC) then 4 x TAX prior to mx. Quite a few women at my hospital had the same regimen- I was told in my case that 4x4 was standard. At the time I was given the impression that age (36), size of tumour and the fact that they knew there was nodal involvement were significant in their drug choice. Reading on here it appears that this combination for chemo is pretty widespread.

Very best to you, hope you get the rsults thro soon.

C xxx

I had 4 and 4 for my triple neg tumour.I think it was because at 63 I was getting on a bit to tolerate taxotere and I did find it very hard.

I had 3 x FEC and 3xTax - had only one node involved but was Grade 3 & Stage 3.

The onc didn’t suggest it would be worse than FEC (which it certainly was) …or that I might not tolerate it at my advanced age (66)
The Tax was fairy horrible- but I think it is for most people isn’t it- and several people told me it was the “gold standard” chemo drug.

Hi jane72
So so sorry you’re going through this…
I had 4 AC & 4 Taxotere before surgery 4 years ago, E- tumour.
Last oct started treatment for new primary opposite breast E+ this time. Had 6 AC after surgery. (No tax – phew!)
BUT had liposomal doxorubicin, MYOCET because it is less damaging.
‘The liposome allows the doxorubicin to remain in the body longer so that a greater amount of chemotherapy is delivered to the cancer cells, while having fewer side effects on healthy tissue.’
Quote from Macmillan factsheet.
The side effects of this AC were much less severe for me.
Not sure if this would be suitable for you but may be worth talking to your onc?
Sending you hugs & every good wish going.
jkx

Hi Jane72,

I too had 4 x FEC & 4 x Tax, that was three years ago. I understood at the time that I was given tax due to node involvement, and that it was the gold standard treatment (also being 44).

During my treatment the hospital changed its standard to 3 x FEC & 3 x Tax - tho’ I continued on the 4 & 4 as I was already on that regime. I was told at the time that the overall dosage would remain the same on the new regime, so that each cycle would have a stronger dose in it to make up for the reduced number of cycles.

Thank you all so much for your replies.

roadrunner - I will definitely ask the onc about dosage, it’s something we forgot to ask yesterday but thought of as soon as we got home. I just can’t see me having 4 cycles of tax. When I asked about statistical benefits I was told there aren’t any, but 4xAC and 4xtax is standard.

I do feel these regimens are rather arbitrary and given in order to translate each of us into a convenient statistic. I feel very much I’m an individual and I will stop when the disbenefits start to outweigh the benefits.

Jane,

Sorry to hear you are having to go through this either side of having a baby - my children are teenagers, so much easier to deal with. Yes 4 & 4 is a long haul - even without a new baby - and there were certainly times when I felt I couldn’t do it again, but I did, and now I am very glad that I have had everything thrown at this cancer. Three years on I am OK, and if it were to come back at least I know that I did everything to stop it, and I won’t have any regrets (which is why I am still persevering with tamoxifen despite the never ending hot flushes).

Best wishes
xx

Hi, I was told that I would be having 4xFEC and 4x TAX - the TAX because of node involvement and the quantity because i’m having chemo prior to surgery. I’ve found it very doable, i’ve only got 1 TAX left, but my children are older ( 8,10 and 12).

All the best with treatment and for the birth of your new baby.

Michele

Hi Jane72

Its bad enough being dx with bc but to be pregnant as well is up there in the ‘best of times/worst of times’.

Anyway, we are similar in that we were dx whilst pregnant although this is where my story differs as I was 30 weeks pregnant when I discovered the lump. I had my surgery within 3 days of dx and then my onc/surgeon both agreed that it would be best to induce baby at 35 weeks with the hope that a c-section be avoided so that I could start chemo. I find it interesting that your onc says they don’t want too big a gap between treatments. My onc had given me a 9 week window from surgery to start chemo which would have gone up to 12 weeks had I had a c-section. 12 weeks was the maximum time he said that he could delay treatment. Baby was induced at 37 weeks and I started chemo 2 weeks later = 9 weeks from surgery.

The chemo I had was 3 x FEC and 3 x TAX. The reason for the TAX was my age, I was HER-2+ and I had a cluster of cells (micromets) in the sentinel node therefore he said he was going to treat me with TAX and err on the side of caution and treat me as node positive. He obviously had all my pathology results at the time he was giving me my treatment plan but you say you haven’t had your pathology results through yet - I wonder whether your treatment may change again depending on the pathology.

I actually found the TAX a lot easier to deal with than the FEC but I know some people have a really tough time on TAX.

I hope your treatment goes as well and side effect free as it possibly can for you and your baby. Take care. Love xxx