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ddspain View Drop Down
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    Posted: Apr 14 2013 at 6:38pm
Wink
So Does anyone know if 3X- breast cancer has a default protocol chemo treatment ?
Ive had only one meeting with the oncologist and I think that was what he was telling me.
I kind of blanked out a little when he hit me with the triple negative. It came as a big surprise.

I am just learning....
But I know I will be starting soon. Was hoping to gather some knowledge before I start.

Thanks !
D
right mastectomy 3-20-13.
1.5 cm
grade 3 tumor
nodes clear
awaiting chemo
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arabella View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote arabella Quote  Post ReplyReply Direct Link To This Post Posted: Apr 14 2013 at 9:48pm
Hi ddspain!

I'm not sure if there is a default protocol....I'm not sure what all they  look at to figure out what you as an individual will be given.    Wish we were tested according to TNBC subtype and that they did in fact know which worked best on what subtype and all.  Hopefully one day that will be the way it is.

My diagnosis is similar to yours....1.1 cm, clean margins, stage 1 (mine was graded 1 as well but I've questioned the grade 1 because that seems so inconsistent with TNBC, but oncs (I consulted with 3) didn't let that phase them) and my nodes were negative.  

Anyway, the chemo that was suggested was Taxotere and Cytoxan, one onc said 4 rounds, but then my present onc said 4 rounds and 2 more for insurance so to speak as that is what M.D. Anderson's protocol was at present for me.

Hope this helps you a little and the very best of luck to you!

Kaye
Dx TNBC 1/2013; age 63; 1.1 cm; Stage 1, Grade 1(?); lumpectomy clear margins; ALND -; severe SEs to first TC and treatment stopped; radsX25; BRCA -
Recur 6/2015 Mastectomy
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Grateful for today Quote  Post ReplyReply Direct Link To This Post Posted: Apr 14 2013 at 10:30pm
ddspain,

Lee posted some good info on chemo for TNBC on thread:
    http://forum.tnbcfoundation.org/taxol-treatment_topic11073_post112355.html?KW=#112355

Originally posted by Lee21 Lee21 wrote:

There is not a single standard of care treatment protocol, more likely it is institution-dependent. There are basically 3 "standard" treatment regimens for TNBC (MD Anderson has its own regimen and I've never been able to get a rational explanation for why they do things the way they do).
1) DD AC -> DD Taxol (every 2 weeks x 4 cycles each)
2) DD AC -> weekly Taxol x 12 weeks
3) TAC (Taxotere, A, C every 3 weeks x 4 cycles)

In terms of head on comparison of benefits re: Taxol
1) CALGB 9741 study -- Taxol every 3 weeks vs Taxol every 2 weeks. Taxol every 2 weeks is better in terms of disease free survival and overall survival.
2) ECOG study reported in the NEJM 2008 -- Taxol every 3 weeks vs weekly Taxol.  Weekly Taxol is better.

No comparison of weekly vs every 2 week Taxol to my knowledge.

In terms of toxicities, comparisons between weekly Taxol vs every 3 week Taxol:
weekly Taxol better in terms of myelosuppression (bone marrow toxicity) but worse in terms of neurotoxicity.

In my opinion, it is better to stick with the regimen that the hospital is most familiar with, since there are no data comparing weekly to every 2 week Taxol.  I was given Neulasta throughout my DD AC-T. I had some numbness in my fingers and toes that progressed throughout treatment, then got better when treatment was completed.  But then I received cisplatin and the neuropathy got worse.  Nothing so bad that it interferes with anything I do, just something I know is there.

12 weekly Taxol vs 2 week Taxol means 8 more infusions.  If you don't have a port, it will be a challenge.

In terms of who gets severe neuropathy, most likely it is dependent on your genetic makeup.  For example, they have found certain polymorphisms in beta-tubulin III to predispose to severe toxicities. It is an active field of investigation since in some patients, neurotoxicity is dose limiting.




There is the matter of anthracycline (Adriamycin or Epirubicin) in TNBC chemo protocols.
Others may post a clearer picture of this situation. My understanding is that some oncologists
feel there are A FEW situations where the anthracycline can be avoided. In that case, one
sees the protocols such as Arabella referred to: TC (Taxotere and Cytoxan).

THIS IS GENERAL INFORMATION.   YOUR CHEMO PLAN IS THE ONE RECOMMENDED BY
YOUR ONCOLOGIST AND DISCUSSED WITH YOU.   Basically, one might consider asking the oncologist:
what are ALL my chemo options with the pros and cons of each option.

Another thing to keep in mind.
Although it may seem that one's situation is similar to another person's,
due to some pathology factors and/or due to some personal (health) factors, each person
might have a different chemo plan with each plan being the best for each.

Am assuming you will be having another visit with the oncologist before you start chemo.
If not, would ask for one so you have an opportunity to get more information and ask your
questions.
In addition to the questions you have, you might want to consider asking:
       What are all my chemo protocol options?
           What are the pros and cons of each option?
       How many cases of TNBC do you treat each year?

Some members have gotten 2nd opinions/consults on their chemo treatment plan by oncologists
       who are experts in TNBC/who have much experience with TNBC. Some times the recommendations
       are the same....giving one added confidence in one's chemo plan. Some times different chemo
       protocols are recommended in which case one can sort out the pros and cons of each protocol
       with each oncologist.
General info:
One can check if there is a NCCN (National Comprehensive Cancer Network) Cancer Center      
    https://www.nccn.org/members/network.asp       
    in one's area.
One can check if there is a NCI (National Cancer Institute) Cancer Center in one's area.
     For appointments at a NCI Center, ask for the TNBC oncologist.
     http://www.cancer.gov/researchandfunding/extramural/cancercenters      
     http://www.cancer.gov/researchandfunding/extramural/cancercenters/find-a-cancer-center


With caring and positive thoughts,
Grateful for today..........Judy

       
       


Edited by Grateful for today - Apr 15 2013 at 12:52am
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ddspain View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote ddspain Quote  Post ReplyReply Direct Link To This Post Posted: Apr 15 2013 at 10:09am
Thanks so much.
Excellent info.
My next appt with onc is Thursday and I am sure her will cover alot of this .
I just wanted to become familiar with the terms and general knowledge beforehand so I can "follow" what he is saying.
I believe he was talking taxol weekly twelve weeks...and then something else for 4 weeks every other week.
What is DD AC  and A and C  ?


I appreciate your time !
D.

right mastectomy 3-20-13.
1.5 cm
grade 3 tumor
nodes clear
awaiting chemo
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Post Options Post Options   Thanks (0) Thanks(0)   Quote debB Quote  Post ReplyReply Direct Link To This Post Posted: Apr 15 2013 at 10:42am
Hi D!

I am in Illinois also, welcome!

The DD is dose dense, A is Adriamycin (the anthracycline) and C is Cytoxin. The most common chemo regimen that we see is 4 cycles of AC and either 12 weekly or 4 DD Taxol. That being said, like Judy mentioned, sometimes tumor size or other health issues will dictate changes. The Adriamycin is the hardest, with potential heart side effects. The Taxol has neuropathy side effects. Some places do derivatives of these same drugs or will skip one of them based on your own circumstances. There is some discussion about 1.5cm being the cut line for treatment, but that also varies by oncologist.

There are lots of threads to read with great info. So much info it can make your head swim! Don't hesitate to ask questions!

Deb
Dx 4/29/11, 46 yrs old, 3.9 cm tumor, Stg 2 Grade 3 chemo 4 rounds DD AC, 12 weekly taxol, finish. Lumpectomy, 2mm residual tumor. 37 rounds rads completed. Cisplatin/PARP trial
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Post Options Post Options   Thanks (0) Thanks(0)   Quote ddspain Quote  Post ReplyReply Direct Link To This Post Posted: Apr 15 2013 at 11:32am
I see !
Well that is exactly what my oncologist has said.
Ac every other week 4x and Taxol every week 12 times.


It is alot to digest.

Thnaks !!
right mastectomy 3-20-13.
1.5 cm
grade 3 tumor
nodes clear
awaiting chemo
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Post Options Post Options   Thanks (0) Thanks(0)   Quote ddspain Quote  Post ReplyReply Direct Link To This Post Posted: Apr 15 2013 at 11:34am
What do you mean by 1.5cm being the cut line ?
right mastectomy 3-20-13.
1.5 cm
grade 3 tumor
nodes clear
awaiting chemo
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ddspain View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote ddspain Quote  Post ReplyReply Direct Link To This Post Posted: Apr 15 2013 at 11:39am
Hi Deb ......
I lived in Peoria all my life and just recently moved to Bloomington.
Where are you ?
right mastectomy 3-20-13.
1.5 cm
grade 3 tumor
nodes clear
awaiting chemo
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ddspain View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote ddspain Quote  Post ReplyReply Direct Link To This Post Posted: Apr 15 2013 at 11:40am
How did you get in to the trial ?
right mastectomy 3-20-13.
1.5 cm
grade 3 tumor
nodes clear
awaiting chemo
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MarissaK View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote MarissaK Quote  Post ReplyReply Direct Link To This Post Posted: Apr 15 2013 at 12:12pm
Good morning, D. I was just following your thread and see that Deb is offline. You had asked her about "the cut line". I think she was trying to convey that depending on the size of your tumor and other variables, the regimen of drugs you are put on can/may be tailored differently than the more standard DD, aggressive treatments she had talked to you about. A tumor between 2-5 cm is stage 2 (either 2A or 2B depending on no lymph nodes vs a few...). With a 1.5 cm tumor and no nodes you are in stage 1A (up to 2 cm & no nodes). All TNBC is typically treated with some form of chemo, it's just a matter of what treatment plan your doctors feel are right for you.

Hope this helps...And I apologize in advance if Deb responds to you meaning something entirely different!!
DX 5/18/12 at age 34. Stage IIIC IDC TNBC, grade 3, 3 cm (multiregional nodal involvement). DD ACT complete 9/5/12. BMX 10/15/12, ALND: 0/12 nodes. pCR. Rads x 25 + 3 boosts completed 2/6/13. BRCA neg
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Post Options Post Options   Thanks (0) Thanks(0)   Quote JulieKCA2013 Quote  Post ReplyReply Direct Link To This Post Posted: Apr 15 2013 at 12:23pm
Ask your doctor if there are any trials going on that you can be in.  I know I just was diagnosed and if I had done chemotherapy after surgery there was a trial that involved herceptin that I could get into.  But since my plan was chemo before surgery I was not eligible.  

-Julie
Dx 3-7-13 TNBC, 5cm pT2N1M0
3-19-13 ACx4, 5-14-13 Taxolx4
7-17-13 BMX ypT1N2M0(.9mm) 4/24 nodes.
10-8-13 completed Rads x 30
12-3-13 completed Eribulin Trial
10-18-13, 3-19-14 Bone/Ct Scan Clear
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Post Options Post Options   Thanks (0) Thanks(0)   Quote ddspain Quote  Post ReplyReply Direct Link To This Post Posted: Apr 15 2013 at 12:25pm
How are you doing on the chemo ?
right mastectomy 3-20-13.
1.5 cm
grade 3 tumor
nodes clear
awaiting chemo
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Post Options Post Options   Thanks (0) Thanks(0)   Quote debB Quote  Post ReplyReply Direct Link To This Post Posted: Apr 15 2013 at 2:00pm
Hi Ladies,

Marissa, that is exactly what I meant. There have been some ladies here recently talking about getting more/less chemo with a 1.5 cm tumor, which luckily is still small!

D- I am in the Champaign area, so not too far from you! The trial that I was in was for women who had chemo first but had residual disease. If you check www.clinicaltrials.gov it has the listing of ALL trials out there. Narrow your search by breast cancer or even TNBC. If you think you might want to go that way, then look through the trials and if there are some that interest you then bring them to the attention of your oncologist. It sounds like what they told you about chemo is what we see as the most common protocol. With TN, we don't have other options, so chemo is the main thing we have to beat this bad boy back!

Good luck- and keep reading!
Deb

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Dx 4/29/11, 46 yrs old, 3.9 cm tumor, Stg 2 Grade 3 chemo 4 rounds DD AC, 12 weekly taxol, finish. Lumpectomy, 2mm residual tumor. 37 rounds rads completed. Cisplatin/PARP trial
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