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"Grey Zone" Adjuvant vs Neoadjuvant/ AC-PACL (DD) + TRAS vs PACL + TRAS
10 Posts

I am at the stage of having to make a final decision on the treatment options presented to me. Here is my story. If you can provide any perspective that will stop me from losing my mind in the process, that would be great! (I am at the stage of reading clinical research publications and doing the math on the concentrations of the drugs… Yikes!)

I am 63 years old and was diagnosed at the end of Dec 2022 with IDC, stage 1 (1.5 cm), grade 2, ER+, PR+, HER-2 + , no indication of lymph node spread at this point as per imaging. I have been told I am in the “grey zone” in terms of choosing an Adjuvant versus NeoAdjuvant treatment regime and also choosing between an aggressive chemo AC-PACL(DD)+TRAS over 18 weeks or a more mild regime PACLitaxel-Tras . I believe the doctors feel the neoadjuvant and aggressive chemo are best long term solution so good sense tells me that I should go that route, but the aggressive chemo scares me not only in terms of possible side effects, but the secondary cancers (i.e. leukemia). Also I feel like a sitting duck with a cancer that grows rapidly (HER2+) and not having the cancer removed first. With all the tests and appointments and the initial tumour found Nov 3 it will have been 3 months by the time I start treatment.

11 Replies
Cynthia Mac
4217 Posts
Tagging Runner Girl‍ , cancertakesflight‍ , JustJan‍ and Essjay‍ .

Defender‍ , one or more of these ladies will hopefully be able to offer information that will help you through this.
1905 Posts

@Defender welcome. I found the anxiety around choosing treatment options at times overwhelming and daunting so know you’re not alone in that. I had triple negative IDC, stage 1 so a different type of breast cancer than you have. I actually decline chemo for my breast cancer but was diagnosed with ovarian cancer just a few weeks after that so ended up having chemo anyway. My chemo regime was different so I can’t comment on the types you mention. My understanding on using adjuvent chemo is based on tumour size but can also be very patient specific based on your set of circumstances. Typically, if the tumour is over 2 cm they like to do chemo first to shrink the tumour to have a better surgical outcome. For me, psychologically, I would want to have the tumour removed first and then have chemo to clean up any cancer cells that may be floating around.

I don’t think there is right or wrong choice and you are doing the right thing by gathering information. I’m confident that you will make the right decision that works best for you.

2153 Posts

@Defender welcome…

I had my chemotherapy for triple negative (another aggressive cancer) after surgery but the general protocol for triple negative is to have chemo before surgery. The reason for this is that through scans they can see if the cancer is responding to the chemo while you still have the tumour. If they remove the tumour they are just hoping any residual cells in your body have been mopped up.

I too was stage 1, and at 49 at diagnosis I knew I needed to hit this hard to give me the best chance of a long and healthy life. I took the dose dense AC Paclitaxel option. They checked my heart out first and it was in good shape.

It was hard, but not as bad as I expected.

I hear you on the risks from the chemo - lymphoma, leukaemia - these are pretty scary possibilities. And as cancer patients we are at a higher chance of another different cancer. And that’s before we even mention secondary breast cancer…ore the chance of a recurrence. We cannot escape the risks and that brings fear all.the.time.

I looked at it as there being risks from all of the treatments and I would defer to the treatment my oncologist recommended to give me the best chance. so here’s my plan - to live my life as well as I can for as long as I can - eat well, exercise, do things I enjoy, see family and friends and try and enjoy life. It’s the best I can do!

10 Posts

@Runner Girl
Thank you so much for sharing your journey. It means so much more hearing this from someone who has gone through it. I am at the point where I need to accept things the way they are, focus on the current situation and stop trying to predict/control the future. Thank you!

10 Posts

Thank you so much for sharing your journey. I believe I will need to adapt your plan as well “to live my life as well as I can for as long as I can”. That is a plan I can share with my family and friends. Thank you!

10 Posts

Thank you for sharing your journey and perspective. I suppose I am going through the various stages of actions taken following diagnosis. It is great to have the insight and support of others who have been there. Thank you!

10 Posts

@Cynthia Mac
Thank you so much. They were all very helpful!

@Defender It's great that you have options although it may not feel like that when it comes to making decisions. I was diagnosed with breast cancer in 2011 so the drugs available to me may be somewhat different but our cancers are also different. I had both invasive (IDC) and non-invasive (DCIS). I also had cancer in 2 of 22 lymphnodes that they removed during surgery. I had a mastectomy because my DCIS had spread too far. I had surgery, chemo, and radiation followed by Tamoxifen.

I can totally understand your concerns about what could happen, but as others have said, I chose to deal with the here and now. I figured if I didn't do what I needed to do to rid my current cancer I wouldn't have to worry about any future cancer.

It's a personal choice. You have to do what feels right for you.

As for waiting, I don't know if it makes you feel any better to know that I didn't start treatment until about 3 or 4 months after experiencing symptoms.

Hang in there. You seem to be approaching things calmly and clearly. Keep asking those questions and once you've made your decision try not to second guess yourself.

Thanks @Cynthia Mac for the tag.


348 Posts

@Defender welcome to the club. I am glad to hear you are doing research because treatment protocols are changing and some have lower rate of recurrence. I did surgery, ACTT (chemo every 3 weeks), radiation in that order. Newer protocols do chemo first to ensure the tumor is responding. A new protocol is also weekly taxol which has a lower rate of recurrence than ACTT.

Ask you oncologist for the data. They should provide it. I didn't look tossed here you are but BCCANCER is moving to weekly Taxol for 3-4 months (can't recall exactly) with herceptin every 3 weeks for 1 year. BCCANCER protocols are also on their website so you can see them.

Mine did return in my liver in aug 2019. I did weekly taxol for 4.5 months with herceptin and pertuzumab every 3 weeks for life. It knocked the Cancer back and I have been stable ever since. Not Cancer free but not growing and not shrinking. I walk the dog, hunt, work full time, live my life.

This diagnosis is not the end of your life. Whatever protocol you choose will work. And if it does return there are good drugs to keep us alive and LIVING a long time. This is just a pot hole in the road of life. You might have a flat, you might have a dented rim (i have a dented boob) but you can heal and repair and live.

Reach out any time.

10 Posts

Thank you for sharing. Your note on weekly PACL makes me think that is the option they show in Schedule 2 of the patient information I received on the AC-PACL(DD) +TRAS chemo, so I think it is offered in Ontario as well now, and I will definitely do some reading on that. The oncologist did not discuss the different schedule options with me yet. I was looking at the schedules and thought the 16 week definitely was preferred to the 20 week, but now I understand where the 20 week fits. Thanks!

10 Posts

@Runner Girl
Hi, How large were your tumours if I can ask?

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