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Neoadjuvant Chemotherapy vs. Adjuvant Chemotherapy

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archanapc View Drop Down
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    Posted: Aug 29 2018 at 2:03am
Hi all,

My name is Archana and I am 32 years old. I was diagnosed with stage II TNBC on August 8th, 2018. I did a barrage of tests i.e. 3D mammogram, ultrasound, biopsy, MRI, lymph node biopsy and genetic screening. The results of those tests were as follows: TNBC, tumor size 2.4cm, the lymph node biopsy was benign, genetic screening of 8 gene panel resulted in negative results for BRCA1/BRCA2 gene mutation, plus I have no family history of breast or ovarian cancer on both my dad and mom's side.
I had my treatment consultation appointment today and my breast surgeon as well as chemo oncologist suggested the following plan of action: lumpectomy with sentinel node biopsy, followed by adjuvant chemotherapy (4 rounds of AC, 12 rounds of Taxol), followed by 20 rounds of radiation. 
They said due to my tumor size there was no surgical benefits of doing neoadjuvant chemotherapy before surgery. But I think if they remove the tumor before doing chemo, how will I know if chemo is effective on my cancer cells. They said they see no benefits in survival or surgical response for neoadjuvant chemotherapy for me but they can start chemo first if I want to. I am so confused and need to tell them of my decision by this Thursday. Please help me Confused
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srb32281 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote srb32281 Quote  Post ReplyReply Direct Link To This Post Posted: Aug 29 2018 at 10:09am
Hi!! My mom did neoadjuvant chemotherapy that was because it was determined to see if she would do a lumpectomy or mastectomy after chemo--she already decided to do a mastectomy when chemo started.  Plus she had LN involved--so also to reduce the amount of LN to be removed as well.  I'm glad she had neoadjuvant purely because she was able to know if the chemo worked with destroying the cancer cells.  I do work in a medical oncology and my boss (also her doctor) stated if you have a pCR (pathological complete response) you will lower you chances of recurrent disease.  Plus TNBC being highly aggressive responses much better to chemo than someone who is ER positive.  

Her surgery was a month ago and her breast mass and skin showed no signs of cancer or residual.  She did have two LN positive with 6 being taken out but showed signs of treatment effect.  My boss said its usually 50% to have a pcr with LN involvement because you hope chemo can destroy it all. To me and my two cents and if I were going through this, I would want to know if cancer worked and that is kind of the only way to truly know.  Plus if you do the lumpectomy after chemo, they may not have to take away so much tissue and your margins could be better.  I know here if someone has a big tumor they usually do chemo first then surgery.  I only know of one patient here who was TNBC which chemo did not work her tumor kept growing but she ended up taking xeloda and that shrunk her tumor.  

It's a hard choice and you want the best possible option for you to beat this awful disease. But you need to do what you feel is best for you and what you need. Another option is if you have residual cancer after chemo and surgery, you can do radiation then be put on Xeloda for 6-8  months since TNBC have no other options to them like hormone receptor positive patients do. Good luck and I know you will make the right decision since you will chose what is best for you!
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LakeGirl66 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote LakeGirl66 Quote  Post ReplyReply Direct Link To This Post Posted: Aug 29 2018 at 11:23pm
Hi Archana-
I also had tnbc stage 2, diagnosed Oct. 2015. I was node negative, negative for BRAC mutations as well. I had neoadjuvant chemo. I had 4 rounds AC, 12 rounds Taxol, then, BMX. I achieved pCR. If I would have had adjuvant chemo, I would not have known that the chemo actually worked. When I had my surgery, my dr could find no evidence of cancer. Having neoadjuvant chemo helped give me peace of mind.

Edited by LakeGirl66 - Aug 29 2018 at 11:33pm
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