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Positive nodes after chemo - what now?

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Ditrona View Drop Down
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    Posted: Jan 08 2019 at 10:46am
Hello everyone!
 
My sister-in-law was diagnosed with TNBC in June. At the time of MRI the tumor was 8 cm and several positive nodes. Her Ki-67 is 95%, so very agressive. She is on a trial, had 10 weeks with Olaparib (which shrunk her tumor to 2 cm) and then continued with cyclophosphamide for 16 weeks (high dose every 2 week). The tumor shrunk even more down to 1,1 cm. However, something happened, and at the last MRI before surgery they found a new tumor with a bridge over from the old one. At surgery they found several positive nodes. 10 nodes were removed, at least 3-5 was positive. This doesn't sound very promising and I'm wondering if any of you know if there is any chemo that have shown promising results in the adjuvant setting?
 
She is brca-negative.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote rstar Quote  Post ReplyReply Direct Link To This Post Posted: Jan 08 2019 at 11:16am
Hi Ditrona,

Do you know which trial was your sister on? Is it the PARTNER trial? was she only receiving Olaparib or a combination with other drugs too?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Ditrona Quote  Post ReplyReply Direct Link To This Post Posted: Jan 08 2019 at 11:45am
Itís called Petremac, a Norwegian study. She was receiving only Olaparib, then the chemo after. The study uses gene tests to figure out which treatment is the best. 


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Post Options Post Options   Thanks (0) Thanks(0)   Quote rstar Quote  Post ReplyReply Direct Link To This Post Posted: Jan 08 2019 at 12:10pm
Well, she wasn't really having the standard of care but still got a very good response from mainly dna damaging agents tho that seemed to be shifted at some point, so how about a chemotherapy from the Taxane family or Xeloda which is lately given post surgery?

Edited by rstar - Jan 08 2019 at 12:36pm
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Ditrona View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Ditrona Quote  Post ReplyReply Direct Link To This Post Posted: Jan 08 2019 at 1:37pm
I think I read from another post here, that xeloda only had an effect for the non-basale like types? She has basal-like..

But Iíll search more on Taxane:-)
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Post Options Post Options   Thanks (0) Thanks(0)   Quote rstar Quote  Post ReplyReply Direct Link To This Post Posted: Jan 08 2019 at 2:23pm
Another member here had stated that there was a difference in dosage between the trials so we don't really know for sure, but being basal is probably the main reason as to why she had responded to Olaparib without having the brca mutation. Based on my experience with my mom (also being basal), Xeloda did absolutely nothing to her tumors.

Edited by rstar - Jan 08 2019 at 2:32pm
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Kellyless Quote  Post ReplyReply Direct Link To This Post Posted: Jan 08 2019 at 11:39pm
Taxol kicked my very aggressive basal tumors butts twice. The second time I did just Carboplatin and Taxol and got a complete response. If she does a Taxane, she should do Taxol over Taxotere. My tumor this time was actually like two tumors side by side and connected. Made them miss it on mammogram and ultrasound, it took an MRI with contrast to see it. Once they knew what it was they could find it with ultrasound. Breast MRIs should be used more, especially with dense breasts, cystic issues or scar tissue from lumpectomy and radiation. 

Edited by Kellyless - Jan 08 2019 at 11:40pm
IDC, 2.2 cm, Stage IIb,lumpectomy 1/30/09 ACx4,Tx4 36 rads
6/1/16 Local recurrence same breast, same spot 1.8cm Carb.4x every 3 wks, Taxol 12x once wk. Dbl Mast. PCR!! Reconstruction fail, NED!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Ditrona Quote  Post ReplyReply Direct Link To This Post Posted: Jan 10 2019 at 2:23pm
The backbone of this study is PT53 mutation. About 80% of TNBC have this mutation, and their results have been great for those 80%. She didnít have this mutation, but very similar characteristics. 

My brother now wants her back on Olaparib. She really responded so well on this drug, so hopefully it will still have an effect:-)
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Ditrona Quote  Post ReplyReply Direct Link To This Post Posted: Jan 10 2019 at 2:27pm
Iím glad to hear:-) She also had two tumors, connected side by side, not to begin with though. 

Taxol and Carboplatin - Iíll keep that in mind, in case the Olaparib fails.
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