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Question about Chemo

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sweetpickle View Drop Down
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    Posted: Dec 19 2012 at 6:57pm
Hello everyone, I have a question about Chemo options as I am now a little confused as to what is being offered to me.  During my meeting with my Onc. last week we discussed doing A/C with taxol afterward and that I would need a port.  I then went for a 2nd opinion to a surgeon in a bigger town who thinks that he can do a lumpectomy after chemo and then I can do rads.  My previous surgeon wanted to go straight mas. and then chemo, I wasn't comfortable with him at all.

When I came back to discuss this with the Onc. she now says that I should do Taxotere/Cytoxin and that I won't need a port.  She doesn't want to use the adrimycin(sp?) because it can cause heart problems down the road.  What I don't understand is why this was never mentioned at our previous consult?  The surgeon said that I could do TAC or dose dense treatment which is the A/C followed by Taxol.  He never mentioned Taxotere.

I really like the surgeon and he has a lot of experience with TNBC.  My onc. is really nice and I like her but I'm now questioning the switch.  I'm so confused as to what road I'm suppose to take and it is overwhelming trying to learn what all these drugs are and how they work so that I can choose what's right for me.

Anyone have a similar experience?  Thank you.

P.S.  Still waiting for BRCA test results, if positive then I will choose double mast., not sure how that would change the chemo regime.
11/13/12 DX TNBC, BRCA 1+ Grade 3, 4.3cm tumor, susp. node under arm, 4 A/C biweekly & 4 Taxol biweekly
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Dec 19 2012 at 7:53pm
Sweetpickle,

Sorry for all the confusing opinions you are being given.  Can you refresh my memory about the size of your tumor?  Wasn't it thought to be Stage 2?  Do they think any nodes involved?  It sounds like they are now recommending neoadjuvant chemo before surgery.  Neoadjuvant will allow you to know if the chemo is working or not.  If it doesn't respond, they can then switch chemos before surgery.

There's been some discussion and controversary about whether Adriamyicin benefits TN or not.  I really don't know the answer as I still see many women getting A/C plus T.  Taxotere/Cytoxin was/is commonly given to smaller tumors, Stage 1, no nodes, when I was diagnosed.  It was the chemo I had and I didn't have a port.  

Donna
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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sweetpickle View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote sweetpickle Quote  Post ReplyReply Direct Link To This Post Posted: Dec 19 2012 at 8:02pm
My tumor is 4.3cm right now, no node involvement as far as they can tell. Im ok with TC treatment, from what Ive read so far.  Im just confused by the switch and why she didnt mention this before.

Edited to add, Im clinical stage 2A


Edited by sweetpickle - Dec 19 2012 at 8:07pm
11/13/12 DX TNBC, BRCA 1+ Grade 3, 4.3cm tumor, susp. node under arm, 4 A/C biweekly & 4 Taxol biweekly
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Post Options Post Options   Thanks (0) Thanks(0)   Quote mainsailset Quote  Post ReplyReply Direct Link To This Post Posted: Dec 19 2012 at 8:20pm
Just a reminder out of the blue that the MD Anderson study showed Taxol first in the protocol has seen more success than Taxol 2nd.
dx 7/08 TN 14x6.5x5.5 cm tumor

3 Lymph nodes involved, Taxol/Sunitab+AC, 5/09 dbl masectomy, path 2mm tumor removed, lymphs all clear, RAD 32 finished 9/11/09. 9/28 CT clear 10/18/10 CT clear
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Carlads Quote  Post ReplyReply Direct Link To This Post Posted: Dec 20 2012 at 12:06pm
Sweetpickle,
I can totally relate with you.  When I met with my Oncologist before surgery he said I would be doing dose dense A/C  followed with Taxotere. 
 
After surgery it changed due to the fact that I have some positive hormone receptors.  So it changed to just T/C . However, he did tell me about the heart issues at our first Consult.  My clinical stage was I after surgery it was II.  I had a 2.5cm tumor, sentinel node had mirco 1mm (tiny) but they did a Auxiliary node disection and took 22 nodes all negative. 
 
I really like my Oncologist but like you, I am little confused. I have a class Wed on Chemo so I will certainly ask a lot of questions.
 
Prayers are with you,
Carla
 
 
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sweetpickle View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote sweetpickle Quote  Post ReplyReply Direct Link To This Post Posted: Dec 20 2012 at 6:00pm
Thanks Carla!  Smile
11/13/12 DX TNBC, BRCA 1+ Grade 3, 4.3cm tumor, susp. node under arm, 4 A/C biweekly & 4 Taxol biweekly
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Post Options Post Options   Thanks (0) Thanks(0)   Quote dmwolf Quote  Post ReplyReply Direct Link To This Post Posted: Dec 20 2012 at 6:26pm
Hi, Sweetpickle.  4.3cm is big enough that you probably want to bring in the big guns.  I wouldn't skip the Adriamycin with a tumor that size unless I had heart problems.  In your shoes, I would 1) do neoadjuvant chemotherapy (chemo first, then surgery), 2) do dose dense AC followed by T or T followed by AC (may be better, according to retrospective metanalyses), 3) do either lumpectomy and rads OR mastectomy - it doesn't really matter to outcome so you may as well keep your breast unless you are a BRCA mutation carrier.

Good luck deciding!  One of the main reasons to do chemo first (neoadjuvant) is that you can see whether the chemo is working, and if not change course.  If you have surgery first you'll have no way of knowing whether your treatment is effective.

Best,
Denise

DX 2/08@43 stg II IDC; gr2,0 nodes. Neoadj chemo, first ACx2 (fail) then CarboTaxotereX6(better). Lump, Rads done 11/08; Clodronate. False alarm queen: PetCT lung & TM marker. NED. PBM w/recon 9/10.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote sweetpickle Quote  Post ReplyReply Direct Link To This Post Posted: Dec 20 2012 at 7:17pm
Thank you Denise!  I have been trolling every article I can find regarding chemo regimes and what you have outlined seems to be the predominate advise for TNBC.  I should find out my BRCA results tomorrow which will help me decide between Lump. or Mas.

It's frustrating to have to go in to my Dr. and contradict what she feels is the best way to go.  I will do it because my life is on the line but geez why do we have to fight so hard with Dr.'s when just dealing with cancer is enough in and of itself?

Thank you all for you support, advise, and concern!  I'm so very grateful to have found this site!
11/13/12 DX TNBC, BRCA 1+ Grade 3, 4.3cm tumor, susp. node under arm, 4 A/C biweekly & 4 Taxol biweekly
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lee21 Quote  Post ReplyReply Direct Link To This Post Posted: Dec 20 2012 at 9:30pm

I agree with what Denise wrote.  Standard of care for high risk BC is either sequential DD AC-T (DD T or 12 weekly Taxol) or TAC (Taxotere, Adriamycin, Cytoxan given concurrently) x 6.  In the adjuvant setting for operable node positive BC, NSABP B-38 trial results indicate there is no difference in survival between the 2 regimens although the spectrum of side effects were different.  Because of the underlying biological heterogeneity, not all TNBC will respond similarly.  Attempts have been made to identify which subgroups might benefit from anthracyclines (adriamycin or epirubicin) but biomarkers to date have not had sufficient predictive power to allow routine clinical use.  As we have seen here on this forum, some members have responded to anthracyclines while others have not (in the neoadjuvant setting). 

 

There are a number of questions that should be addressed with your oncologist upfront in the case of neoadjuvant chemotherapy.  First, how would tumor response be measured (physical exam vs imaging studies) and at what frequency (after how many cycles)? Second, what will be the plan if the tumor doesn’t respond or progresses?  Unfortunately, there are no guidelines regarding this situation.  Possibilities are to go straight to surgery (followed by adjuvant chemo) or to change regimen.  Some believe that if a tumor is chemo-resistant, it is likely to be resistant to other standard chemo regimen but we just don’t know. Third, when should sentinel node biopsy be performed (before or after chemotherapy)? Again, no standard approach there either.  The advantage of having SNB before chemo is that if you are node negative, there will not be any need for subsequent complete axillary dissection.  On the other hand, SNB after chemo might provide a better understanding of tumor response to chemo.

 

See my previous posts on this topic:

http://forum.tnbcfoundation.org/newly-diagnosed-support_topic4924_page6.html

 

There is a nationally recognized TNBC expert at UNC (Lisa Carey) and I think if there is any question, a second opinion is always helpful.

12/9/11 @59,IDC,grade3, TNBC,3cm(MRI),SLNB0,stage IIA, BRCA1 variant
1/30/12 DD AC-T, 6/7/12 Lumpectomy, ypT1b(0.8 cm), 7/9/12 Rads x 30
11/9/12, clinical trial cisplatin/rucaparib, cisplatin-only arm
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Natalie Quote  Post ReplyReply Direct Link To This Post Posted: Jan 10 2013 at 11:25pm
Hi my go to people.
I have a question for yas, not about me.
A friend of mine has a son who is 15 years old and so sad to say diagnosed with Hodgkins Lymphoma a month ago. He is now on his second round of 6 different chemos at once for the next 6-8 months. 

He is getting slammed with so many side effects, his family is doing an amazing job trying to keep up with everything and still soo many questions are coming up for them as this unfolds. I am getting the feeling that there is a lack of communication to them as far as the things to help support him during these treatments. Round two and he already had his wbc counts tank, started losing hair almost immediately, mouth sores, nueropothy and bone pain and so on. This poor kid Cry

As we all know kids express themselves in so many ways, and Chris has the gauges in his ears, nose piercing, lip piercing & eye brow I think. I stopped by the house this evening and I really feel like I was able to connect to Chris on everything he is feeling and helped Mom & he feel better and a bit easier with the side effects thus far. His doctors are riding he & mom over the piercings during chemo treatments being potentially dangerous for infection. 
I don't believe I upset mom too much when i felt to side with Chris on this one. This 15 year old boy is going through so much right now that he just shouldn't be. Mom did say she kind of feels the same way. I suggested she ask the doctors to support this request by showing the documentation to support the claim.

Now I am sure that there are a lot of us out there that have had body piercings when diagnosed and treated. Me? I am a no frills plain jane, with only ears pierced but don't where earrings any more really.

Have any of you experienced or seen such write-ups on this subject? I Googled and I see nothing. So I say let Chris maintain this part of himself when all else is being rattled right now.

This foundation is my go to, an=d everyone here has been such a help to me. 

Natalie


TNBC stage1 size 1.8, grade3 no nodes 4/11 Lumpectomy 5/11 4cycles DD A/C 4cycles DD Taxol. Double Mastectomy 12/11 BRCA all neg
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Post Options Post Options   Thanks (0) Thanks(0)   Quote majjers Quote  Post ReplyReply Direct Link To This Post Posted: Jan 17 2013 at 1:54pm
Natalie,
I sure wouldn't want to put the poor boy in any further danger but I agree that he should be alllowed to express himself - in a healthy way, for his own good while he's doing these tough treatments. Delaying a piercing isn't going to hurt and the consequences of one gone bad is far worse. I think I would make him wait, and make sure he has a counselor or support group to talk to in the mean time while also making sure to alleviate those SE as much as possible.  Just my two-cents.
 
Traci
dx 5/25/07, Stage 2A,TNGr3
DD 4 AC,4 Taxol
32 rads
BRCA 1&2 (-)
7/11 mets to lung; Too many lines of chemo to list! The saga continues but only GOD numbers my days!
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beck View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote beck Quote  Post ReplyReply Direct Link To This Post Posted: Jan 17 2013 at 2:11pm
anyone here that didnt do taxal, i didnt stating to wonder if doc knew what he was doing
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Post Options Post Options   Thanks (0) Thanks(0)   Quote deelee02 Quote  Post ReplyReply Direct Link To This Post Posted: Feb 03 2013 at 3:53pm
Hi - I posted "My mother too." I should have posted in this forum. If I can figure out how to move it I will.
 My 81 year old mother with Alzheimers just started AC to T on Jan. 25. She now has diarrhea. Wondering if this will get worse as treatments go on.  Did otc med help? we're you able to control it. she lives with my father in  a nice "Assisted Living With Memory Help" secetion of retirement community. They actually had it cleaned up by the time I got there.
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