Please kindly help choose chemotherapy and location

[Sangbang]

Dear community,

I am diagnosed with BC stage 3a, multiple lymph nodes positive, T2N2M0, ER/PR -ve, HER2 +ve, 36 years old, no history on maternal side, no sisters, potential history on paternal grandmother side, no heart disease history, 2 young kids, healthy.

Underwent lumpectomy and axillary clearance. Going to the next stage in the process - I am confused between the different chemotherapy options - primarily TCH (dr. Radheshyam, HCG, bangalore) vs. ACT-H (recommended by Dr vineet gupta, sakra, bangalore). Based on my research, the heart related issue seems to be one problem with ACT-H and also the side effects seem potentially more profound. This doctor recommends AC every 2 weeks for 4 cycles and Paclitaxel every week for 12 weeks with Herceptin every 3 weeks. The Paclitaxel seems very aggressive and not sure about it.

However, the fact that Herceptin can be started right away with TCH routine seems to be logically making sense, but there is a few percentage points difference in recurrence between the two...

- Can you please provide any other good (cost is not concern) medical oncologist recommendation in Bangalore?

- Can you share your opinion of TCH vs ACT-H regimen?

Your timely inputs will be beneficial...

Thanks so much,

Sang

[sumeet_shah Administrator]

Both are appropriate chemotherapy regimens. And not possible to recommend one over the other. It is individual choice of a Medical Oncologist. Since you are 36 and fit and young, the chances of heart issues related to chemo would be much less; I do not mean to ignore cardiac toxicity, but given your age, I would not take that point as a sole deciding factor.

My suggestion is, talk to both of them in detail and take a call. See, with whom are you more comfortable and who answers you promptly and is likely to respond quickly in case chemo related problems arise and accordingly select. As for the two chemo regimens, both are good.

[Sangbang in reply to sumeet_shah]

Thank you very much Dr for your prompt response ... your service towards the community is laudable.. i have a quick follow up question - it seems that not only is my cancer is invasive but also shows a high ki67 of 60% so we are super worried...

I had no inkling of tumor and literally woke up with it and within 2 weeks felt pain in the arm...

Therefore as we have seen Herceptin to be effective in recurrence risk reduction .. does it then make sense to start with it right away with TCH or it doesn't matter if it comes into the regimen after 8 weeks as with the ACTH regimen...

Again thank you very very much!!

[sumeet_shah Administrator in reply to Sangbang]

Most women with breast cancer will have a high Ki67. Don't let it bother you. It is mainly done to help An Oncologist assess risk profile and to decide drugs. Just undergo standard treatment and you will be fine.

[roxboxfox RadiationOncologist]

Both the Oncologists have suggested a Third Generation Regimen

Both are accepted Standard of Care

There has never been a comparison between the 2 chemo regimens, so u would never know which one is the superior .

TCH would be my preferred option as it's an anthracyclines free regimen and as you have noticed Hercwptin is started early

[trpl]

Dear take courage , you will be alright after sometime once you finish the treatment. I also tread this path before you at 39 , now 40. I stay at Whitefield, Bangalore. You can call me on this number 9901063930. Whether l can be of some help in time of need