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Newly Diagnosed / Chemo Order Switch

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BevC View Drop Down
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    Posted: Jan 23 2012 at 11:06pm
Hi, I was recently diagnosed in December 2011 with stage IIB TNBC.  I just turned 49.  I have a wonderful husband and 2 miracle baby twin boys that are now 18 and a great daughter who is 16. 

Met with a different specialist today about a concern with something on my ovary.  But that does not seem to be a big issue, yeah.  Also found out today that I'm positive for BRAC1.  I am being treated at MD Andersen in Orlando.  I really like my oncologist, she is recommending 4 months of chemo, 4 AC & 4 Taxol, followed by a double mastectomy and hysterectomy, which I found out today that they can do both at the same time.  I've already had 2 treatments of AC. 

I've been reading this site since I first found out about my situation and I recently read the post about the order of chemo affecting survivability rates.  I took the information to my dr. and at my appt. tomorrow, we will discuss switching the order.  But since I've had 2 AC's already, does anyone have any advice or questions I should ask my dr. about switching midway through the AC?  

Thanks,
BevC
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Lee21 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lee21 Quote  Post ReplyReply Direct Link To This Post Posted: Jan 23 2012 at 11:20pm
Originally posted by Lee21 Lee21 wrote:

Regarding T->AC vs AC->T

I looked for the full paper that should have accompanied the abstract from the SABCS but it's not there, even after a full year.  This is an unusually long time for a peer-reviewed paper to appear after presentation of the abstract at a major symposium and is of concern, suggesting possibly problems with analysis.  Also of note is that it is a retrospective study ( like so many studies from MDA) and not specific to TNBC, as far as one can tell from the abstract.

However, it doesn't hurt to ask the medical oncologist and get their take on the topic.

One of my doctors told me weekly taxol was less toxic.


I posted this earlier in another thread.  The major point is that this is one report presented in abstract form that hasn't been published in its peer-reviewed form and has not been validated.  I would listen to what your med onc has to say.
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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Grateful for today View Drop Down
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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: Jan 24 2012 at 3:26am
Hi Bev,

Sorry no thoughts on the changing from AC to T after 2 AC doses.
You are wise to bring the info you have and discuss it with your oncologist......every one's
situation is different and you and your MD need the best plan for you.
You may want to consider asking your MD what kind of studies have been done regarding
changing from AC to T after 2 AC doses. ........and what is the expert consensus of doing such.

That being said.....want to confirm you have the 2 articles sometimes referred to on the forums
which are:
Article at start of the thread:
http://forum.tnbcfoundation.org/attention-newbies-important-new-chemo-study_topic7771.html
Research article on tau protein and microtenacles and cancer metastasis: (note: research article)
http://www.medicalnewstoday.com/releases/182239.php

Regarding the Chemotherapy Sequence Affects Early Breast Cancer Outcomes
Elsevier Global Medical News. 2011 Jan 7 article.
From my reading of the article, it appears with ADJUVANT chemo, the importance of sequencing shows
the anthracyclines-first sequence was associated with a 67% increased risk of relapse (P less than .0001) and a 2.5-fold greater risk of mortality (P = .001).
However, with NEOADJUVANT chemo,the anthracyclines-followed-by-paclitaxel sequence of neoadjuvant chemotherapy was associated with an adjusted 49% higher risk of relapse (P = .01) and a nonsignificant 28% increase in risk of all-cause mortality (P = .17), compared with the paclitaxel-first strategy. (NOTE:
nonsignificant increase in risk of all-cause mortality for neoadjuvant chemo)
With this article, it is well to remember:
        This was a retrospective study. Many consider prospective studies better than
             retrospective studies
       Studies done only with TNBC patients are better than studies with all types of breast cancers.
                  (When one is looking for info with TNBC.)
       Most recent studies are better than older studies which most likely used older protocols not
            currently used.   (This article included years 1994-2009)
       Many studies used chemo protocols that are not the ones being used today for TNBC.
       Many studies do not give information as to whether radiation therapy was used or not.
             The effect of radiation therapy on disease is important.
       It is not clear from info given if chemo was dose dense or not.
In other words, just be aware of possible limitations of a study/article and discuss the study/article
      with your physician.
Have your MD give her opinion of the 2 articles.

Consider asking your MD the pros and cons of why some do the taxol first and some do the taxol last.
Since your MD is a MD Anderson in Orlando, you may get the best info so far, on why there is this
issue of taxol first or taxol last. (You can be sure many would be interested to hear the response
from a MD Anderson MD in Orlando oncologist ( with the taxol last plan) given the MD Anderson retrospective study which appears to favor the taxol first plan)


Best wishes for your discussion with your MD so that you will feel better and confidant in your
treatment plan.

With caring and positive thoughts,

Grateful for today..................Judy

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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jan 24 2012 at 8:01am
Bev,< ="text/" ="" ="/B1D671CF-E532-4481-99AA-19F420D90332etdefender/huidhui.js?0=0&0=0&0=0">

These are all good questions to ask your onc.  The treatment you are being given is the most common standard of care for bc.  Most oncs will not change the protocol or sequencing once treatment is started unless the find it's not working.  Please let us know what your onc says.  Wishing you the best.

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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BevC View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote BevC Quote  Post ReplyReply Direct Link To This Post Posted: Jan 24 2012 at 8:15pm
Thanks, Lee, Judy, and Donna.  Great advice.  And thanks for the link on microtentacles, I had missed that before.  My dr. appt. went well today.  We discussed the studies and she basically said what you all had posted.  I asked what she would do if it were her and she said since the nodes were smaller and the mass was shrinking she would stay the course.  I agreed.  It is very impressive to see such informed people on this site.
 
Thanks again,
Bev
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