Wednesday, February 23, 2011

T before C except before A or is it A before T...?

The current treatment for TNBC is abbreviated as such:
4xT DD
A=Adriamycin aka doxorubicin aka Red Devil
C=Cytoxan aka cyclophosphamide
T=Taxol aka Paclitaxel Taxotere is sometimes substituted as it is usually more tolerated
DD=dose dense meaning every 2 weeks though sometimes the T is spread out in 12 weekly administrations

Almost always, the Adriamycin regimen is administered before the Taxol (although occasionally at the same time).
Does it matter which order?
A recent meta-analysis says yes. ( a meta-analysis pools many studies together with the advantage of having much more participants. A disadvantage of this is not all the variables are held constant) It turns out that in some places T was given before A. The study looked at the records of 3000 BC patients over a 10 year period in which half were given T then AC and the other half AC then T. Presumably the participants in each group were equal in terms of tumor grade, size, node status, etc..a rather big assumption. Also it must be noted that for my TNBC friends, the results weren't examined or at least reported for successes regarding cancer subtypes.

The results: 5 year relapse-free rate for TA vs AT: 88.8% vs 79.5%
10 year relapse-free rate for TA vs AT: 83.9 vs 65.6%

The clear winner: TA with the much better numbers

The authors had no explanation why it would be better. So now that some light has been shed, are oncologists switching the order? It doesn't seem so. I wish I had this study in hand when I visited my oncologist last week to hear her opinion. There is some buzz on the TNBC website with newly diagnosed patients seeing these better numbers marching into their oncologists' offices demanding the better order and getting pushback. Change comes slowly.

As for the side effects on the patients: T and A (love those initials..along with the drug sometimes used: 5-FU)
have different miseries the patient must endure. In general, patients seem to hate A the most though the side effects of T sometimes last for years afterwards (neuropathy being the main one). Adriamycin can cause heart failure and leukemia though at smaller rates than Taxol causes neuropathy.

A record low here in Tundraland..minus 6F though it will warm up almost 40 degrees today. Although I had diligently cleared out the driveway 2 days ago, the plows put up a wall overnight. I thought with some momentum, I could drive through it. Wrong..very wrong. Once I finally was freed, things were clear and I found a flattened down spot outside the Y so I could run around and around.


Teri Bernstein said... are so artistic and so eloquent...I forget that you are also ever-the-scientist. It must be frustrating that even thought you know how to get information, and even though you can UNDERSTAND the information you is not always available on a timely basis.

On another note: it looks like I threaded the needle and visited Michigan during the only decent week of weather this winter! Spring will come...

Holly said...

ugh...i don't like those stats one bit!


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