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Have BRCA 1 mutated triple negative breast cancer. Prescribed taxotere and cytoxan. Chances of recurrence

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Oncologist, Radiation
Practicing since : 2007
Answered : 526 Questions
I have stage 2 1lymp positive grade3 triple negative breast cancer right,dcis left breast and i was diagnosed in 2009 with brca1. My oncologist has me on 6 cycles of taxotere and cytoxan. I am afraid of recurrence because I am not getting adrymiacin(the red devil). Will it increase my chnaces of recurrence due to not having it?
Posted Mon, 1 Apr 2013 in Cancer
Answered by Dr. Dipanjan Majumder 14 hours later
Thanks for posting your query.

You have BRCA 1 mutated triple negative breast cancer (TNBC). This disease entity currently has got special importance due to its special biological behaviour.

The TNBC tumour shows considerable overlap with BRCA1 mutated tumours in 75%-85% cases. Data on adjuvant chemotherapy in TNBC are limited and retrospective in nature.

In GEICAM 9805 study Docetaxel, Doxorubicin, Cyclophosphamide chemotherapy has shown better results.

St Gallen consensus also supported use of cyclophosphamide in adjuvant setting.

Another attractive option in BRCA mutated tumour is use of Cisplatin because BRCA 1 mutated tumour cannot repair DNA damage (double stranded break repair).

PARP inhibitor Olaparib has also been tried in this scenario, but no recommendation is there for this novel approach.

Anyway, standard chemotherapy with docetaxel (T), cyclophosphamide (C) has got proven efficacy. Doxorubicin (A) has role in adjuvant setting also but many time doxorubicin cannot be given in presence of cardiological comorbidity.

In adjuvant setting TC chemotherapy is better than AC in both disease free survival and overall survival. So TC chemotherapy can also be selected as adjuvant chemotherapy.

Hope I have answered your queries; keep me posted for further follow up.
Above answer was peer-reviewed by
Follow-up: Have BRCA 1 mutated triple negative breast cancer. Prescribed taxotere and cytoxan. Chances of recurrence 1 hour later
My oncologist said she would only give me platinum based if I was stage 4 my heart is in good shape so it sounds like the TAC is still better over just TC
Answered by Dr. Dipanjan Majumder 5 hours later
Thanks for follow up.

In recent years doxorubicin (Anthracyclin) induced cardiotoxicity is re-evaluated.
This is now a burning issue especially after introduction of Taxane (Docetaxel).

I am hereby mentioning some data on cardiac toxicity of doxorubicin-

-Incidence of chronic heart failure is about 3.0% for patients receiving a cumulative doxorubicin dose of 400 mg/m2. The incidence increased to 7.5% at a 550 mg/m2 dose and 18.0% at a 700 mg/m2 dose.

For these reasons presently the randomized trial is going on comparing TAC vs. TC.
The results will be mature after 5-10 years.

Another approach for testing anthracyclin sensitivity is testing for topo II over expression but it has been told that presence or absence of topo activity has not been clearly linked with either the usefulness or lack of usefulness of anthracyclines in a conclusive way.

Anyway the decision depends on your oncologist. Treatment of breast cancer in adjuvant setting has got some dilemma especially in your case. Specific recommendations are still awaiting. As TC is equally good chemotherapy so there is nothing to worry right now. Please follow your oncologist's advice.
Above answer was peer-reviewed by
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