I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates
Steve, Thanks for making the links hot; it might be helpful if you can lay out the steps to make the links hot in the posting so everyone knows how to in the future. Otherwise, one can always copy and paste the link into the browser. The UofM has already told the new patients that the docs operate as a team and that we should not try to get a second opinion from another doc within the system.
o.k. I will try...I agree that I would like everyone to know how to do it...it is just from past experience I think it is easier if I explain to someone when we are both in front of a computer..
Maybe you could call me in a couple of hours if my explanation doesn’t work now and I can expalin it to you and then you can tell folks..
There is a little icon to the right of the W icon about the word Size above...if you click on it it says insert hyperlink...
so what I do is highlight the link I want to post..place the cursor where I want the link to appear on the post and then hit command C...then click on the hyperlink icon...then hit command V to put the link in the hyperlink (a little box will pop up on your screen called Hyperlink Properties) and then hit o.k. and the link will appear on the post “hot.”
hope it works and I hope everyone does it as needed in their posts...I always try to post a link when I am mentioning a study so that folks can read about it and not rely on my words to interpret it but rather see what the study says.
thanks again for posting..
all the best,
Steve
I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates
Collection of review articles on TNBC disease, diagnosis, treatment
Hi everyone,
I am uploading the links to some of the articles I have come
across that you might find useful.I
think Judy, Donna and others have pointed to some of the articles already but I
thought it might be useful to put them here as well … sometimes it has been hard
to locate the threads.
At the comprehensive cancer center where I am a patient, the
educational center will give hard copies of papers that a patient
requests.Because of copyright reasons,
they do not give out electronic copies.
Triple negative breast cancer, Foulkes et al. N. Engl. J.
Med. 363:1938
(cautionary note: success in phase II trials may not translate to similar
success in phase III)
Recommendations from an
International Consensus Conference on the Current Status and Future of
Neoadjuvant Systemic Therapy in Primary Breast Cancer, Kaufmann et al. Ann.
Surg. Oncol. ePub 12/23/11
4-2-12 Breast cancer virtue issue from the Oncologist (free)
http://epub.theoncologist.com/issue/49427 Not all on TNBC, some relevant in a general way, some are basic science articles
will search the PubMedCentral (PMC) open access library of medical literature maintained at the National Library of Medicine for publications about TNBC. All of the articles in this repository are freely available for anyone to download.
Dr. Lisa Carey, who helped to define TNBC as a clinical syndrome, has a recent review accessible by PMC
One more thing about the podcasts, if you select the IBCC4 series (drop down menu) -- you will see 2 other podcasts that are of interest; one by Hudis and one by Pegram that you may find of interest as well.
Cross Cancer Institute and University of Alberta, Edmonton, Alberta, Canada.
bassam.abdulkarim@mcgill.ca
Comment in
J Clin Oncol. 2011 Jul 20;29(21):2841-3.
PURPOSE: To evaluate the risk of locoregional recurrence (LRR) associated with locoregional treatment of women with primary breast cancer tumors negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (triple-negative breast cancer [TNBC]).
PATIENTS AND METHODS: Patients diagnosed with TNBC were identified from a cancer registry in a single institution (n=768). LRR-free survival was estimated using Kaplan-Meier analysis. The Cox proportional hazards regression model was used to determine risk of LRR on the basis of locoregional management: breast-conserving therapy (BCT; ie, lumpectomy and adjuvant radiation therapy [RT]) and modified radical mastectomy (MRM) in the TNBC population and T1-2N0 subgroup.
RESULTS: At a median follow-up of 7.2 years, 77 patients (10%) with TNBC developed LRR. Five-year LRR-free survival was 94%, 85%, and 87% in the BCT, MRM, and MRM + RT groups, respectively (P < .001). In multivariate analysis, MRM (compared with BCT), lymphovascular invasion and lymph node positivity were associated with increased LRR. Conversely, adjuvant chemotherapy was associated with decreased risk of LRR. For patients with T1-2N0 tumors, 5-year LRR-free survival was 96% and 90% in the BCT and MRM groups, respectively (P = .027), and MRM was the only independent prognostic factor associated with increased LRR compared with BCT (hazard ratio, 2.53; 95% CI, 1.12 to 5.75; P = .0264).
CONCLUSION: Women with T1-2N0 TNBC treated with MRM without RT have a significant increased risk of LRR compared with those treated with BCT. Prospective studies are warranted to investigate the benefit of adjuvant RT after MRM in TNBC.
Locoregional recurrence in patients with triple-negative breast cancer:
preliminary results of a single institution study.
Dragun AE, Pan J, Rai SN, Kruse B, Jain D.
Department of Radiation Oncology, James Graham Brown Cancer Center, University of
Louisville, Louisville, KY 40202, USA. aedrag01@louisville.edu
PURPOSE: To examine the impact of radiotherapy on breast cancer patients with triple-negative (ER-, PR-, HER2/neu-) disease.
MATERIALS AND METHODS: A prospectively collected database of 152 triple negative breast cancer patients was initiated in 2004. A total of 77 patients who had all phases of their therapy (surgery, chemotherapy, and radiotherapy) at our institution with a minimum of 2-months follow-up are included. Patients with all types of surgery (lumpectomy or mastectomy), chemotherapy (neoadjuvant or adjuvant), and radiotherapy (tangents only or comprehensive nodal irradiation) are included. Patients received radiotherapy in the setting of breast-conservation and in the postmastectomy setting for ‚â•5 cm primary tumors and/or ‚â•4 positive lymph nodes. Patients were divided into 2 groups for statistical analysis, based on whether they received radiotherapy or not.
RESULTS: In the cohort, 53 (69%) received radiotherapy, 24 (31%) received no radiotherapy. The median follow-up was 23.2 months (range, 2.0-63.1). In the alive patients, the median follow-up time was 25.6 (range, 2.0-63.1) months. Patients who received radiotherapy were significantly more likely to be of a higher AJCC stage (P < 0.001) than patients who did not receive radiotherapy. Of the patients who received radiotherapy, 33 (61.1%) did so for breast conservation. For the entire group, 1- and 3-year overall survivals are 90.9% and 86.3%, respectively. The 3-year actuarial locoregional relapse-free survival probability for patients who received radiation was higher than those who did not receive radiation (79.6% vs. 57.9%, P = 0.049).
CONCLUSIONS: Despite significantly lower AJCC stage, patients with triple-negative breast cancer who do not undergo radiotherapy have a significantly higher risk of locoregional recurrence.
Adjuvant chemotherapy and radiotherapy in triple-negative breast carcinoma: a prospective randomized controlled multi-center trial
Wang J, Shi M, Ling R, Xia Y, Luo S, Fu X, Xiao F, Li J, Long X, Wang J, Hou Z, Chen Y, Zhou B, Xu M
Department of Radiation Oncology, Fourth Military Medical University, Xi'an, China.
BACKGROUND AND PURPOSE: Triple-negative breast cancer (TNBC) presents a high risk breast cancer that lacks the benefit from hormone treatment, chemotherapy is the main strategy even though it exists in poor prognosis. Use of adjuvant radiation therapy, which significantly decreases breast cancer mortality, has not been well described among poor TNBC women. The aim of this study was to evaluate whether the combination of chemotherapy and radiotherapy could significantly increase survival outcomes in TNBC women after mastectomy.
PATIENTS AND METHODS: A prospective randomized controlled multi-center study was performed between February 2001 and February 2006 and comprised 681 women with triple-negative stage I-II breast cancer received mastectomy, of them, 315 cases received systemic chemotherapy alone, 366 patients received radiation after the course of chemotherapy. Recurrence-free survival (RFS) and overall survival (OS) were estimated. Simultaneously local and systemic toxicity were observed.
RESULTS: After a median follow-up of 86.5 months, five-year RFS rates were 88.3% and 74.6% for adjuvant chemotherapy plus radiation and adjuvant chemotherapy alone, respectively, with significant difference between the two groups (HR 0.77 [95% CI 0.72, 0.98]; P=0.02). Five-year OS significantly improved in adjuvant chemotherapy plus radiation group compared with chemotherapy alone (90.4% and 78.7%) (HR 0.79 [95% CI 0.74, 0.97]; P=0.03). No severe toxicity was reported.
CONCLUSIONS: Patients received standard adjuvant chemotherapy plus radiation therapy was more effective than chemotherapy alone in women with triple-negative early-stage breast cancer after mastectomy.
1. Ann Surg Oncol. 2011 Oct;18(10):2858-65. Epub 2011 Mar 26.
The negative effect of triple-negative breast cancer on outcome after
breast-conserving therapy.
Zaky SS, Lund M, May KA, Godette KD, Beitler JJ, Holmes LR, O'Regan RM, Yu ES, Yu
DS, Landry JC.
Department of Radiation Oncology, Emory University Winship Cancer Center,
Atlanta, GA, USA.
PURPOSE: To evaluate disease failure patterns and overall survival (OS) of women with triple-negative (TN) breast cancer who underwent breast-conserving therapy (BCT) and to understand the relationship of TN tumors with other prognostic factors.
PATIENTS AND METHODS: The Surveillance, Epidemiology, and End Results (SEER) registry identified 562 women diagnosed and/or treated with unilateral invasive breast cancer during 2003-2004 at three Emory hospitals. After medical record review, 193 eligible women, with all tumor types, received BCT. Primary endpoints (local, regional, and distant recurrences) and secondary endpoint (OS) were evaluated using chi-square tests and Cox proportional hazards models.
RESULTS: Of the 193 women, 33 (17.1%) had TN tumors and 160 (82.9%) had non-TN tumors. Patient characteristics were similar between the two tumor types; however, tumor grade and use of chemotherapy and hormones differed between the two groups. Median follow-up was 3.4 years; 22 patients had recurrence (12.2%), and 12 died (6.2%). Patients with TN tumors had higher local (12% versus 4% for non-TN) and distant recurrences (15% versus 4% for non-TN) rates (p = 0.01). On multivariate survival analyses, TN status [hazard ratio (HR) 1.8, 95% confidence interval (CI) 1.13-2.93] and African American (AA) race (HR 1.9, 95%CI 1.2-3.07) were independent predictors of inferior OS.
CONCLUSIONS: Patients with TN breast cancer showed significant increases in local and distant metastatic recurrence rates after BCT, and TN status and AA race were independent negative predictors of survival. For the future, identification of these high risk features may bring personalized medicine closer to reality.
Note in this paper, 30/33 of patients with TNBC had RT.
2. Crit. Rev. Oncol. Hematol. 2011, in press
Boutrus R, Taghian AG, on behalf of AROME
Radiation Oncology Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Abstract Patients with node negative and large primary tumors ≥5cm comprise a rare entity of breast cancer patients for which clear management guidelines are not available. Data about the rates of loco-regional failures (LRF) in this patient population are scarce and reporting widely varying observations. Post Mastectomy Radiation Therapy (PMRT) for this group of patients is controversial. In this review we examined the available literature discussing the LRF rates in this clinical setting and the value of adding PMRT in their management.
Quoting paper:
"In a subset analysis of 1078 patients who were enrolled in the Danish 82b&c [4] and [5] studies, Kyndi et al. [17] investigated the relationship between the biologic subtype and prognosis of patients with high-risk breast cancer (node positive and/or tumor > 5 cm and/or invasion of tumor in to skin or pectoralis fascia) treated with mastectomy with or without PMRT, sixty patients had N0 disease. Having a triple-negative or a receptor negative/Her-2 positive (Rec-/Her-2+) tumor was significantly associated with increased LRF (p = 0.01, 0.009 respectively).
Despite having the highest LRF rate, Rec-/HER-2+ tumors did not show a significant reduction of LRF after PMRT (p = 0.2). Furthermore, the reduction in the LRF rate after PMRT was significantly smaller for patients with triple negative or Rec-/Her-2+ disease when compared with Rec+/Her-2+ patients which could be explained by the increased radioresistance among patients with Rec- tumors. A conclusion could be made that patients with Rec+/HER-2- would likely benefit from PMRT, however, the higher than usual LRF rates observed among patients not receiving PMRT make these results not amenable to generalization."
(this paper looked only at patients with mastectomy who had
undergone post mastectomy RT.Even in
this group, TNBC patients had the highest loco-regional recurrence rate of
11.8% and suggested that TNBC patients may be radio-resistant).
I had the radical mastectomy, radiation and chemo as soon as I was diagnosed, and I still had recurrence - first time on the mastectomy surgery line, and the second time - nodes on my mediastinal and behind my right pectoral muscle (right breast is where my cancer started). Not to put a damper on anyone's parade.....I took all possible measures in the beginning, but still had recurrence. I'm fighting it now with the clinical trial parp inhibitor. I've had success so far - but the chemo regimen is really kicking my blood counts to the curb. I will have to stop the gemcitibine for my next treatment ( #12) due to my plts dropping so low this past week. So I will continue with only carboplatin + parp inhibitor (iniparib) for cycle 12. Then, the next scan is done after that to make sure it is still working. Last scan showed only the right pectoral node was still there. The others are gone. So that is helping me feel good about this treatment, and the fact that I still have my hair....that is also helping me feel good! Sounds silly, but I like having my hair and getting treatment that shows positive results! Good luck to you Lee.....I hope you get rid of your cancer the first time - for GOOD!
It is important to realize that many of the available studies on TNBC are retrospective in nature and relatively fewer in number due to TNBC being a recently recognized disease entity. Additionally the studies describe behavior of a population of women and in many instances other variables have not been accounted for. It is difficult to translate statistics to individuals.
TNBC is heterogeneous and defined by exclusion of only 3 markers. We need personalized medicine to tailor your (my) treatment to your (my) disease. Medical treatment for TNBC is in flux as more of what is known in the basic sciences and from clinical trials get incorporated into the standard of care. Unfortunately that could take a while.
One of the most impressive things about this site is the intelligence and generosity of the participants. Many women, like yourself, on the eve of chemotherapy treatment would not be sharing the considerable knowledge they have garnered over the last month.
Yet, here you are helping our community with your informative links on various important topics. I applaud you and am genuinely moved by your efforts.
I have seen others here post encouraging/informative messages shortly before or after surgery, on the eve of chemo, during chemo, pre, during, and after radiation therapy. And of course, often, the spirit continues at other difficult times, as well. There is such a lovely spirit of helping and supporting others here. That is one of the reasons I love this forum.
I hope your treatments go well and wish you a pCR.
You have been, are and shall be in my prayers,
Steve
I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates
Steve, I am touched by your comments and the help you have given so generously to myself and everyone else on this forum. I want to give back what I can, while I can, to the women and men using this forum. Many have already contributed so much with their time and thoughtfulness, importantly sharing their experiences and their knowledge. I will continue to post information that I come across that I think will benefit our community. Lee
Thanks for these links, and the article on second opinions.
I signed up to an oncology website that asks doctors to evaluate pictures of slides and photos of people with various symptoms. It then gives three or four treatment and diagnosis options, and asks the doctors to vote on the options.
I was amazed to see the widely varying opinions of the disease depicted. We were glad we had sought multiple opinions.
I hope your SLND goes well, and your nodes are clear!
Best regards, Wade
Wife DX 5/2011@52 2.5x3.1cm;6/2011 DD A/C 4x,Abraxane 4x; Lumpectomy, SN biopsy 10/2011; 10/27/2011 NED; Rads start 11-22-2011, Rads fin 1-11-2012; 10-2013 NED; 07-18-2014 NED; November 2018 NED
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