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Study on Recurrence in TNBC

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123Donna View Drop Down
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    Posted: Jan 16 2015 at 10:40am
Analysis of pattern, time and risk factors influencing recurrence in triple-negative breast cancer patients

The aim of the study was to assess the rate, pattern, and time of recurrence in patients with triple-negative breast cancer (TNBC) and to evaluate factors influencing recurrence and overall survival in this group of patients. Out of 2,534 consecutive breast cancer patients diagnosed between January 2005 and December 2006, 228 (9 %) were TNBC (ER/PR/HER2-negative). The clinicopathological characteristics were determined using descriptive statistics. The overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan–Meier method. The univariate and multivariate analyses were developed to identify factors influencing recurrence and survival in TNBC patients. After 6 years of observation, metastatic disease occurred in 35 % of all TNBC patients: 15 % in the brain, 14 % in the lungs, 11 % in the bones, 8 % in the liver, and 14 % had locoregional relapse. The highest risk of recurrence was during the first 3 years after primary treatment, and then, during the next 2 years of observation, it did not change. 6-year DFS and OS were 68 and 62 %, respectively. Factors influencing recurrence were tumor size and systemic adjuvant chemotherapy, while factors influencing overall survival were tumor size, nodal status, adjuvant/neoadjuvant treatment, and metastases in the brain, liver, and bones. Characteristic pattern of recurrence in time was revealed. The tumor size was responsible for recurrence despite lack of involvement of lymph nodes. Aggressive adjuvant/neoadjuvant treatment ordered in all clinical stages of TNBC (including N0) was factor responsible for avoiding local and distant relapse and prolonging overall survival.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586394/


Graph:  Risk of recurrence in different sites in triple-negative breast cancer patients






Edited by 123Donna - Jan 16 2015 at 10:41am
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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Post Options Post Options   Thanks (0) Thanks(0)   Quote KristyLee Quote  Post ReplyReply Direct Link To This Post Posted: Jan 16 2015 at 11:18am
Thanks, Donna.  I'm still in chemo, but I'm already fixated on recurrence risk.  

One thing that I was thinking about yesterday.  My tumor has a very high KI-67, like 70%.  I wonder if that makes it more likely that any recurrence would happen sooner, since it's so fast growing.  Do the rouge cancer cells that would cause mets lie dormant, or do they immediately start dividing?  

I guess I only wonder because it would be comforting to feel like recurrence risk was peaking earlier than the usual 3 year mark, and I'd be "out of the woods" a little earlier.  :)

I'll ask my onc the next time I see her, but maybe someone has thoughts on this.
Dx 09/14 Stage 2 TNBC, Grade 3, 3cm, no nodes. BRCA1+ Neoadjuvant treatment: 4 AC/T, 12 Taxol, 4 Carboplatin. BMX Diep Flap Hyster 3/5/15. Path report PCR, no radiation advised.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jan 16 2015 at 12:03pm
KristyLee,

This is just my personal opinion but I don't hold much relevance in the KI-67 number.  Anything over 20% is considered high and most TNBC is high.  I thought having a 48% KI-67 number my chance of recurrence would be lower.  I ended up with a recurrence anyway.  I've seen many women that have had very high KI-67 numbers never recur.  

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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Post Options Post Options   Thanks (0) Thanks(0)   Quote joni31 Quote  Post ReplyReply Direct Link To This Post Posted: Feb 09 2015 at 7:50pm
I have a question on this...what do they consider a large tumor? Lots of articles talk about tumor size being so important but never give an actual size. Some small tumors get more "attention" then larger ones. Some women get mastectomies for small dcis tumors. I don't understand what they base decisions on when they talk about size. Does anyone know?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote TriplePositiveGirl Quote  Post ReplyReply Direct Link To This Post Posted: Feb 17 2015 at 1:16pm
Donna,

If you look at the chart, the risk of metastasis/recurrence in the bones goes UP after 5/6 years, while all other metastases/recurrence sites level off to practically nothing in the patients they studied. That's interesting. I wonder what that means?? Could this include blood cancers also (like what happened to Robin Roberts)? 

Joni - I think anything under 2cm is considered stage 1 - at least that is what my oncologist had said. 

Lisa

Diagnosed Jan 2010; Stage IIa, grade 2, 3.2cm in rt. breast, no nodes and BRCA-. 4 cycles Carbo/Gemzar 3/10; Lump 6/10; 2 cycles carbo/gem after surgery 8/10; 35 Rads finished 12/1/10. NED.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Feb 18 2015 at 8:33pm
Lisa,

I wonder too why the graph for bone mets goes up after years 5/6.  There's a new clinical trial that may help answer that question.  

LDE225 in Treating Patients With Stage II-III Estrogen Receptor- and HER2-Negative Breast Cancer

This randomized phase II trial studies the effects of erismodegib (LDE225) on disseminated tumor cells (DTCs) in patients with stage III-III estrogen receptor (ER)-negative and human epidermal growth factor receptor 2 (HER2)-negative breast cancer. The presence of DTCs after completing treatment for breast cancer may be linked to recurrence of the disease. LDE225 may eliminate DTCs in bone marrow and reduce the risk of recurrence.


Originally posted by wwjdJanice wwjdJanice wrote:

My breast oncologist at Washington University is working on this clinical trial: LDE225 in Treating Patients With Stage II-III Estrogen Receptor- and HER2-Negative Breast Cancer.  I was not a candidate for trial because I had recurrence and one of prereqs is no recurrence incidents.  From a lay person's understanding the way she explained it to me was like this:

 
1.  This clinical trial thinks cancer cells might hide out in bone marrow that most non-lethal chemo regimens cannot kill because most chemo administered is not at the lethal levels that kills cells in the bone marrow itself (note:  I'm not a doctor so don't hold me to this but I think if you get bone marrow &/or stem cell transplant they set out to kill all cells even cells in bone marrow and then they reseed your cells from scratch somehow in the bone marrow)
 
2.  This trial will take a sample of your bone marrow to evaluate Disseminating Tumor Cell (DTC) presence, then treat you in such a way to train your immunity system to see the DTCs as some sort of allergy with the hope your immunity system will attack/rid your bone marrow of the DTCs.  After x-months they take another sample of your bone marrow to evaluate DTC


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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Post Options Post Options   Thanks (0) Thanks(0)   Quote denise07 Quote  Post ReplyReply Direct Link To This Post Posted: Feb 20 2015 at 10:58pm
Interesting but confusing I thought bone mets were more rare with tnbc it is more likely to spread to organs first.Should we have our doctors check this take a sample of our bone marrow? maybe I sound silly but rather be safe then sorry this was never mentioned to me ah another thing to worry about.
Thank You,
Denise
DX Idc 10/07,st2,gr3,2/6 lymphnodes
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Any One?
DX Idc 10/07,st2,gr3,2/6 lymphnodes
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Post Options Post Options   Thanks (0) Thanks(0)   Quote stream Quote  Post ReplyReply Direct Link To This Post Posted: Mar 08 2015 at 10:34am
Quote Some small tumors get more "attention" then larger ones. Some women get mastectomies for small dcis tumors. I don't understand what they base decisions on when they talk about size. Does anyone know?


Sizes (T1 to T4) and gradings (G1 to G4) matter.

My personal opinion: the point about "size" is that a huge tumor have (perhaps) larger hypoxic regions (regions with less oxigen/blood-supply). Hypoxia boost something called EMT (=loss of cell-cell-adhesion=>metastasis). Anyway - it seems just to be a statistical observation that huge tumors are a reason for

Grading is about differentiation.... something about EMT as well imho (EMT-> ephitelial to mesenchymal transition). Higher Gradings, lesser differentiated, more likely for spreading or/and agressiveness.


Just personal opinion.



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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jan 25 2019 at 6:15pm

Triple-negative breast cancer: Recurrence and survival rates

A review from 2018, published in the British Journal of Cancer , analyzed data from people with triple-negative breast cancer. The results indicated that if someone survived for 5 years following treatment of the disease, there was a low probability of it recurring in the next 10 years.

Doctors believe that certain factors affect recurrence rates of triple-negative as well as other types of breast cancer.

Some factors that may increase the likelihood of recurrence include:

  • larger tumors
  • initial diagnosis when a person is 35 years old or younger
  • lumpectomy without radiation
  • involvement of the lymph nodes

According to specialists, the highest risk of recurrence typically occurs in the first few years following treatment. After 5 years, the risk of recurrence reduces.

People who have triple-negative breast cancer are also more likely to develop metastasis. Metastasis refers to a secondary cancer forming in a different part of the body.

One study, published in the Journal of Clinical Oncology, determined that metastasis was most likely to appear in the brain and lung. The researchers also concluded that survival rates are better when metastasis occurs in the bones.

According to BreastCancer.org, triple-negative breast cancer accounts for 10–20 percent of all breast cancers.

The organization also states that 1 out of every 8 women in the United States will develop invasive breast cancer at some point.

Doctors base survival rates on the percentage of people who are still alive at least 5 years after they received a diagnosis.

However, survival rates have some limitations:

  • Doctors base the rates on a 5-year time gap, so women who have received recent diagnoses may have a higher survival rate because of advancements in treatment.
  • They do not take recurrence, metastasis, or substages of cancer into account.
  • Individual factors, such as age and overall health, play a role in how long a person may survive.

Doctors calculate survival rates according to the stage of the cancer when the person received the diagnosis.

The American Cancer Society report the following 5-year survival rates for breast cancer:

  • stage 0 to 1 — near 100 percent survival rate
  • stage 2 — about 93 percent survival rate
  • stage 3 — 72 percent survival rate
  • stage 4 (metastatic) — 22 percent survival rate

According to BreastCancer.Org, doctors typically class triple-negative breast cancer as grade 3. Anyone with this diagnosis should speak to the doctor about how their unique conditions affect the estimation of survival.

To read the entire article:

http://www.medicalnewstoday.com/articles/324272.php




Edited by 123Donna - Jan 28 2019 at 6:33pm
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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Post Options Post Options   Thanks (0) Thanks(0)   Quote lavi Quote  Post ReplyReply Direct Link To This Post Posted: Jan 28 2019 at 4:52pm
Question:

The article states that BreastCancer.org doctors class triple-negative cancer as stage 3. 
So Stage 1-3 Tn is all considered Stage 3?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jan 28 2019 at 6:35pm
lavi,

Good catch!  Thanks for pointing the error out in the article.  I edited the article to reflect what's on breastcancer.org's site.  They meant to say Grade 3 (not Stage 3).  Most TNBC is grade 3 when diagnosed.

"It tends to be higher grade than other types of breast cancer. The higher the grade, the less the cancer cells resemble normal, healthy breast cells in their appearance and growth patterns. On a scale of 1 to 3, triple-negative breast cancer often is grade 3."

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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Post Options Post Options   Thanks (0) Thanks(0)   Quote lavi Quote  Post ReplyReply Direct Link To This Post Posted: Jan 28 2019 at 8:19pm
Thank you Donna again for your answer. You give such a strong and prompt suport. You are gold.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jan 28 2019 at 10:33pm

Current Strategies for the Management of Locoregional Breast Cancer Recurrence


Abstract / Synopsis: 

Advances in the treatment of breast cancer have decreased the rate of isolated locoregional recurrences (ILRRs) over time. Surgery, radiation therapy, and systemic therapies are used to manage these failure events and their associated poor prognosis. Operable ipsilateral breast tumor recurrences (IBTRs) are treated by either salvage mastectomy or, in select cases, repeat lumpectomy. Axillary nodal recurrences and postmastectomy chest wall relapses are commonly amenable to surgical resection, too. Repeat sentinel node mapping may be undertaken after IBTRs and chest wall recurrences. Aberrant lymphatic drainage, especially after previous mastectomy, is frequently observed. Adjuvant radiation is recommended for most ILRR cases; the dose and volume must be adjusted for prior to receipt of therapy. Implementation of adjuvant systemic therapies after ILRR should be based on the expression of molecular markers in the recurrent tumor. Administration of chemotherapy for estrogen receptor–negative ILRR is indicated, since it significantly decreases the rate of distant metastases.

Introduction

Much of the available data on the long-term risks of isolated locoregional recurrences (ILRRs) in breast cancer are derived from studies carried out in the 1980s and 1990s, when first-line primary interventions consisted of modified radical mastectomy or lumpectomy and axillary node dissection followed by whole-breast radiation therapy.[1-6] Significant advances have occurred since then, changing the landscape in which an ILRR occurs. Implementation of sentinel lymph node biopsy (SLNB), routine use of systemic therapies, and the adoption of partial breast irradiation (PBI) after lumpectomy are foremost. Additionally, downstaging with neoadjuvant chemohormonal regimens, in combination with increasing use of postmastectomy radiation therapy (PMRT) and regional nodal irradiation (RNI), have enhanced the effectiveness of locoregional treatments, while limiting the use of more extensive surgery.

To read more:

http://www.cancernetwork.com/breast-cancer/current-strategies-management-locoregional-breast-cancer-recurrence




Edited by 123Donna - Jan 28 2019 at 10:34pm
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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Post Options Post Options   Thanks (0) Thanks(0)   Quote mainsailset Quote  Post ReplyReply Direct Link To This Post Posted: Feb 26 2019 at 9:51pm
I honestly don't know how the researchers can cope with trying to find trend lines. Back in 2005 Tneg was a pretty young determination and often was treated the same as the positive dx. It was hard to find any trials at all.

Then in the next 5 years trials became more commonplace and many discoveries were made that really helped raise the outcomes of women with Tneg, including helping with quality of life during treatments.

Each year more and more trials became available and more and better treatments arrived so I feel like a word of caution that those of us who survived from the early years didn't have the substantial boone of what's available now.

All I'm saying is that it takes a long time for stats to be generated and most likely anyone's chances of overall survival are greater and greater each year.
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 iycbuck Quote  Post ReplyReply Direct Link To This Post Posted: May 21 2019 at 10:01pm
Hi, I am new in this group.

I had mastectomy stage 1 TNBC in 2017.
No Chemo or radiation.
It came back 2018. 
Lumpectomy 5/7/2019.
I am refusing chemo but willing to do radiation. 
I found this article. Please any thoughts having low dose and fewer times?
I really would like to go with alternative therapy if possible. Am terrified to damage my lung and health cells which might come back and get me later due to radiation.

Also found this site but do not know where to obtain the supplement that is safe luteoline. https://www.sciencedaily.com/releases/2017/01/170124111511.htm


It seems that dried oregano has the most high luteoline food. I am searching Amazon but have not found a good source. Your input would be greatly appreciated. 

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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: May 21 2019 at 11:32pm
Hello icbuck,

I'm so sorry you are dealing with a recurrence.  Was the recurrence on the same side or contralateral?  I can understand your reluctance to chemo and radiation, but it's our only weapon to fight this besides surgery.  My first onc told me supplements were like trying to stop a steam roller with a thumbtack. TNBC is too aggressive to ignore tradiational western medicine.  For me, Stage 1 with bilateral mastectomy and chemo, it still came back.  The second time it could not be surgically removed so more chemo and radiation.  I was so scared of radiation and needed 40 treatments, including all of the regional nodes.  My radiation oncologist proposed IMRT CT Guided radiation, which 8 years ago was a newer technology.  Luckily my insurance covered it.  There are even newer technologies with radiation like proton therapy that you may want to check out.  Because my recurrence was to the regional nodes under my sternum, I was worried that radiation would damage my heart and lungs.  Because of the IMRT precision, I've seen no adverse affects in the past 8 years.  Don't rule out radiation without getting a couple of opinions.  I went to 3 different facilities, including MD Andersen, before deciding on a course of action.  It was worth the extra effort to make an informed decision.

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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Post Options Post Options   Thanks (0) Thanks(0)   Quote iycbuck Quote  Post ReplyReply Direct Link To This Post Posted: May 24 2019 at 8:11pm
Hi Donna,

Thank you so much for info. Your post gives hope to many.

I do have an appointment next week with radiologist. 
Currently, I had a surgery. I don't think it has metastasized. I did MRI on brain, blood test, and ultrasound on my abdominal areas. I have not done the MRI for lungs yet.
Are you taking any supplements or special diet to be in remission for last 8 years?



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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: May 27 2019 at 9:32pm
Hi iycbuck,

I really have not changed my diet.  I always tried to eat healthy before cancer.  I've been in remission after the second round of chemo for my recurrence.  We continued with 2 more rounds, then I had 40 radiation treatments in hopes of mopping up any remaining cells.

The one thing I did find out after my first diagnosis was that I was deficient in Vitamin D.  It took a while, but I got my levels up to optimal level and they've stayed there for the past 9 years.  Have you had your Vitamin D level checked?

There's a thread on this forum called Vitamin D3. 

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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