I recently saw a 35year old post lumpectomy with 1cm TN, gr 3, N0 disease. I proceeded with TC x 4 but am always torn with these tumors 1-2cm. Generally I opt for TC less than 1 and AC-T over 1cm for TN. After reviewing Plan B and success C, now I’m wondering if for these 1-2cm, should I be pushing more for TC x 6 so as to not have any inferior DFS?
I use the same selection criteria as you for anthracycline or not in T1b vs. T1c TN, especially in older patients. I am not aware of any direct comparisons of TC x4 to TC x6. I also agree that Plan B and Success C are well conducted trials which are underdiscussed in the US. The Oxford overview did demonstrate a proportional benefit for anthras but some of this was due to increased duration. In this 35 yo which is an independent risk factor for worse prognosis, at 1 cm I would use TC x6. For a young patient with >1-2 cm I would use dd AC-T.