Am I the only one doing this ?

Hey @2MC I have done 4 x AC and have now had 8 of the 12 taxol. However I was chatting to my onc only the other day and he said some doctors do taxol first and then AC. He said that there was no difference in the overall outcome. It seems to be more about the doctor’s preference. I hope that helps. 

Thanks @Mazbeth
i guess I’ll just have to ask my oncologist why?
I really feel alone at this because I don’t know if it’s going to make A/C harder on an already run down body from chemotherapy 
anyway thanks for responding 
and all the best with the rest of you treatments also 

Perhaps some oncologists are of the opinion that if the AC is done first, followed by the 12 Paclitaxol, that some patients may feel burnt out by around 8 - 10 of the Taxol and decline to finish the course...even if no major side effects, but "Just sooo over it"" type reaction. They may feel that if the (majority opinion) easier taxol is finished, then the relatively smaller number of 4 AC might have a greater completion rate. If the patient starts flagging, it may be easier to nudge them across the line with only 4 treatments. At the end of the day, its main course, then pudding. The same kilojoules are consumed if the chocolate mousse is eaten before the roast beef.

@AllyJay
an interesting way of looking at it And I appreciate your response 
did you do it this way or know of someone who did?
im just asking because it would be nice to talk to someone about their experience 

Hi there 2MC.  I'm afraid I'm one of the AC first then Taxol group. I had not heard before your post of doing it the other way around, but perhaps there is something in the way each drug regime works, that suits your particular cancer's growth and multiplication pattern that called for this change in sequence. I strongly suppose it boils down to the oncologists preference, but I would ask for a detailed explanation, if only to put us all out of the misery of wondering why.

FYI - quite complex to read and as A/C first remains more common (not just in Australia as far as I can tell) I don’t know what the further outcomes of the study have been, given it’s been  over a decade since the actual study. 

Article on taxol before a/c from the MD Anderson study.  
Chemotherapy Sequence Affects Early Breast Cancer Outcomes Elsevier Global Medical News. 2011 Jan 7, B Jancin 

SAN ANTONIO (EGMN) — The sequence in which paclitaxel and anthracyclines are given for treatment of early breast cancer makes a big difference in long-term outcomes.

That's the conclusion reached in what is believed to be the largest-ever retrospective study of the clinical impact of the sequencing of taxanes and anthracyclines. The study involved 3,010 early breast cancer patients who were treated during 1994-2009 and entered into the prospective online database at the University of Texas M.D. Anderson Cancer Center, Houston.

The clear winner was paclitaxel, followed by anthracycline-based therapy with 5-fluorouracil, doxorubicin (Adriamycin), and cyclophosphamide or 5-fluorouracil, epirubicin, and cyclophosphamide, Dr. Ricardo H. Alvarez reported at the San Antonio Breast Cancer Symposium.

Starting with paclitaxel rather than an anthracycline-first regimen led to better long-term results in the settings of adjuvant chemotherapy and primary systemic (or neoadjuvant) therapy.

The adjuvant chemotherapy analysis included 1,596 women, three-quarters of whom received paclitaxel followed by anthracyclines. The 5-year relapse-free survival rate with this regimen was 88.8%, compared with 79.5% when anthracyclines were followed by paclitaxel. The 10-year relapse-free survival rates were 81.8% and 73.5%, respectively.

Five-year overall survival was 93.1% with paclitaxel followed by anthracyclines, compared with 83.2% for the reverse. The 10-year overall survival rates were 83.9% and 65.6%, respectively.

In a multivariate analysis that was stratified for potential confounders, including age, clinical stage, hormone receptor status, tumor grade, and era of diagnosis, the anthracyclines-first sequence was associated with a 67% increased risk of relapse (P less than .0001) and a 2.5-fold greater risk of mortality (P = .001), according to Dr. Alvarez, a medical oncologist at M.D. Anderson.

Among 1,414 patients who underwent neoadjuvant therapy, the 5-year relapse-free survival rate was 79.0% with the paclitaxel-first regimen vs. 61.2% with the anthracyclines-first regimen. Ten-year relapse-free survival occurred in 61.7% and 50.5%, respectively, of these patients.

Overall survival was 84.2% and 66.2% at 5 and 10 years, respectively, in patients who received paclitaxel followed by anthracyclines, compared with 71.3% and 53.4% in those who got anthracyclines first.

In a multivariate analysis, the anthracyclines-followed-by-paclitaxel sequence of neoadjuvant chemotherapy was associated with an adjusted 49% higher risk of relapse (P = .01) and a nonsignificant 28% increase in risk of all-cause mortality (P = .17), compared with the paclitaxel-first strategy.

The mechanism that accounts for the increased efficacy of taxane-first regimens for treatment of breast cancer is unclear, according to Dr. Alvarez

Well, according to that study, paclitaxel first is the clear winner in terms of survival, so why are the majority of us having the AC first? Something to discuss with my oncologist. 

I suspect it’s not that simple - the article does not cover at all (so don’t know what the study showed) side effects! So while the incidence of cancer recurrence looks to be significantly reduced, we don’t know what other effects (on the heart, for example) may have been experienced. You can’t have both chemotherapy regimens together, as the body can’t take it. As my peripheral neuropathy impact looks to be permanent, I consider side effects important. I don’t regret treatment with hindsight, but it may well have affected my acceptance of treatment if I had been told it was highly likely beforehand! We are mostly pretty easily startled about these things when we start on this caper! I also wonder about the last para - almost a throw away line, but surely critical?