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Tumor disappears after Neoadjuct. chemo

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sweetpickle View Drop Down
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    Posted: May 17 2013 at 6:03pm
I just finishec chemo three weeks ago and went for my mamo and ultrasound to see how the tumor did before surgery next week. There was no evidence of the tumor left. The Dr. said that the only better news she could give me was that there was never anything there in the first place. The surgeon was blown away when he took a look at the scans too.

I guess Im wondeing if this might be a good indicator of a PCR? Ill find out more when they do the path on it after surgery. Has anyone else experienced this? I wonder how it affects recurrence rate if you do get a PCR?

Thanks :-)
11/13/12 DX TNBC, BRCA 1+ Grade 3, 4.3cm tumor, susp. node under arm, 4 A/C biweekly & 4 Taxol biweekly
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Post Options Post Options   Thanks (0) Thanks(0)   Quote SagePatientAdvocates Quote  Post ReplyReply Direct Link To This Post Posted: May 17 2013 at 10:24pm
Dear sweetpickle,

I don't know if there are exact figures out there but a pCR is fantastic news and bodes well for your future.

warmly,

Steve
I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates
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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: May 18 2013 at 1:39am
Sweetpickle,     

Wonderful news that the post chemo mammogram and ultrasound do not show any tumor.
Here's hoping that your path report will show pCR   (pathologic complete response).

How well we know things are often never black or white!
The following is my understanding of what feeling or not feeling a mass after neoadjuvant chemo.
Some people go into surgery and no mass can be felt.
          Some of those people have a pCR.
          Some of those people did not have a pCR even though a mass was not felt.
Some people go into surgery and have a decreased sized mass that can be felt.
          Some of these people do not have a pCR.
          Some of these people do have a pCR.
                 The mass that was left had no active cancer cells. A necrotic/fibrotic tumor bed was found.
Do not know the frequency of how often each of the above occur.

Now, in your case, you have imaging with no evidence of tumor.
This would seem to give you a good chance for a pCR.
Whether one has a pCR or not is not known for sure until the the final path report is known.


If one wants to look at what some studies have shown so far about post chemo imaging and pCR:

Accuracy of Ultrasonography and Mammography in Predicting Pathologic Response after Neoadjuvant Chemotherapy for Breast Cancer
192 patients.   Study from a NCCN Cancer Center.
Conclusions: Breast ultrasound was more accurate than mammography in predicting residual tumor size following neoadjuvant chemotherapy. Likelihood of a complete pathological response was 80% when both imaging modalities demonstrated no residual disease.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252889/

Which Imaging Modality Is Superior for Prediction of Response to Neoadjuvant Chemotherapy in Patients with Triple Negative Breast Cancer?
148 patients.   Done at a NCCN Cancer Center.
Conclusions. Breast US and MRI were more accurate than MMG in predicting residual tumor size following neoadjuvant chemotherapy in patients with TNBC. None of the imaging modalities were predictive of a pCR.
http://www.hindawi.com/journals/jo/2013/964863/

Accuracy of clinical examination, digital mammogram, ultrasound, and MRI in determining postneoadjuvant pathologic tumor response in operable breast cancer patients.
Small study of 61 patients.   (Not done at a NCCN nor NCI Cancer Center)
Conclusion: All measured tests are good at predicting the presence of disease on final pathology, but none are able to reliably predict a pathologic complete response.
http://www.ncbi.nlm.nih.gov/pubmed/21947594

Other members:
If anything I have posted above needs correction, please post and correct.



With every hope that your path report will show a pCR,
And with caring and positive thoughts,
Grateful for today..............Judy




Edited by Grateful for today - May 18 2013 at 1:44am
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debB View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote debB Quote  Post ReplyReply Direct Link To This Post Posted: May 18 2013 at 8:52am
Hi Sweetpickle!

Congratulations on finishing chemo and having great response!!!

As Judy said, there is no way to know for sure about the response until the final pathology is back. I do not know the exact percentages, but if you had a pCR, your chances of it recurrence or metastasis are very small. It can happen, as we have seen here, but your chances of it being gone forever are very, very good. BRCA+ has a greater chance of pCR and we TN gals with our fast growing tumors have a greater chance of pCR than the rest of the hormone+ breast cancer population because the very thing thing that makes them grow fast also makes them suceptible to chemo.

I was one of those people who showed no tumor remaining on imaging but did not have a pCR. They did an MRI, mammogram, magnified views, and ultrasound 3 weeks prior to surgery and found absolutely nothing. Everyone was so excited for me. The final path revealed 2 mm residual tumor. I was SO disappointed and no one could understand why. I had wondered if it was already growing back but we will never know. They told me that the size was small enough to be within the margin of not being picked up on imaging even though they knew where to look and we have seen others discover tumors that size.

I hope that your doctor and genetic counselor have told you how important vigilance is for you. BRCA+ have a much higher risk of developing another primary tumor even in the residual breast tissue, so
it is important to remain vigilant as well as monitoring the ovaries.

You are through a major part of this!! Please keep us posted on your progress and surgery. We will all be hoping that you did achieve that pCR!

Deb

The studies out there that compile data for disease-free and overall survival look at pCR or not, with no 'grey area', so to speak. My oncologist told me he thinks there must be some grey area in those stats.
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 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: May 18 2013 at 12:35pm
Pickles,

Congrats, no evidence is great news!  Hope you get a complete pCR at surgery.  It definitely is good news and a good prognosis.  

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 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: May 18 2013 at 12:41pm

Definition and Impact of Pathologic Complete Response on Prognosis After Neoadjuvant Chemotherapy in Various Intrinsic Breast Cancer Subtypes

  1. Sibylle Loibl

+Author Affiliations

  1. Gunter von Minckwitz, Valentina Nekljudova, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Michael Untch, Helios-Klinikum; Jens-Uwe Blohmer, St Gertrauden Krankenhaus; Carsten Denkert, Institute for Pathology, Charité, Berlin; Serban D. Costa, Universitäts-Frauenklinik, Magdeburg; Holger Eidtmann, Universitäts-Frauenklink, Kiel; Peter A. Fasching, Frauenklinik des Universitätsklinikums Erlangen, Erlangen; Bernd Gerber, Universitäts-Frauenklinik, Rostock; Wolfgang Eiermann, Klinikum zum Roten Kreuz, München; Jörn Hilfrich, Henrietten-Stiftung, Hannover; Christian Jackisch, Städtische Kliniken, Offenbach; Manfred Kaufmann, Universitäts-Frauenklinik, Frankfurt; Jens Huober, Kantonsspital, St Gallen, Switzerland; and Gottfried E. Konecny, University of California Los Angeles, Los Angeles, CA.
  1. Corresponding author: Gunter von Minckwitz, MD, German Breast Group, c/o GBG Forschungs GmbH, Martin-Behaim-Straße 12, 63263 Neu-Isenburg, Germany; e-mail: gunter.vonminckwitz@germanbreastgroup.de.

Abstract

Purpose The exact definition of pathologic complete response (pCR) and its prognostic impact on survival in intrinsic breast cancer subtypes is uncertain.

Methods Tumor response at surgery and its association with long-term outcome of 6,377 patients with primary breast cancer receiving neoadjuvant anthracycline-taxane–based chemotherapy in seven randomized trials were analyzed.

Results Disease-free survival (DFS) was significantly superior in patients with no invasive and no in situ residuals in breast or nodes (n = 955) compared with patients with residual ductal carcinoma in situ only (n = 309), no invasive residuals in breast but involved nodes (n = 186), only focal-invasive disease in the breast (n = 478), and gross invasive residual disease (n = 4,449; P < .001). Hazard ratios for DFS comparing patients with or without pCR were lowest when defined as no invasive and no in situ residuals (0.446) and increased monotonously when in situ residuals (0.523), no invasive breast residuals but involved nodes (0.623), and focal-invasive disease (0.727) were included in the definition. pCR was associated with improved DFS in luminal B/human epidermal growth factor receptor 2 (HER2) –positive (P = .013), HER2-positive/nonluminal (P < .001), and triple-negative (P < .001) tumors but not in luminal A (P = .39) or luminal B/HER2-positive (P = .45) breast cancer. pCR in HER2-positive (nonluminal) and triple-negative tumors was associated with excellent prognosis.

Conclusion pCR defined as no invasive and no in situ residuals in breast and nodes can best discriminate between patients with favorable and unfavorable outcomes. Patients with noninvasive or focal-invasive residues or involved lymph nodes should not be considered as having achieved pCR. pCR is a suitable surrogate end point for patients with luminal B/HER2-negative, HER2-positive (nonluminal), and triple-negative disease but not for those with luminal B/HER2-positive or luminal A tumors.

http://jco.ascopubs.org/content/early/2012/04/11/JCO.2011.38.8595.abstract


Triple-negative breast cancer (TNBC) and residual disease (non-pCR): Does size matter-


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 Lillie Quote  Post ReplyReply Direct Link To This Post Posted: May 18 2013 at 3:09pm
Hi Sweetpickle,
I hope you did attain a pCR.  But, if not, as Deb experienced; I believe your prognosis is really, really, really good. 
 
I had surgery first, so I never got the opportunity to find out.  You and I did have, basically, the same chemo and mine was 7 years ago.
 
Good Luck and God Bless Friend,
Lillie
Dx 6/06 age 65,IDC-TNBC
Stage IIb,Gr3,2cm,BRCA-
6/06 L/Mast/w/SNB,1of3 Nodes+
6/06 Axl. 9 nodes-
8/8 thru 11/15 Chemo (Clin-Trial) DD A/Cx4 -- DD taxol+gemzar x4
No Rads.
No RECON - 11/2018-12 yrs NED
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Post Options Post Options   Thanks (0) Thanks(0)   Quote MLindaG Quote  Post ReplyReply Direct Link To This Post Posted: May 19 2013 at 10:29pm
Keeping my fingers crossed for you Sweetpickle!!  I know I was thrilled when my pathology report came back and I can still hear the nurse say "We got your pathology report back and I'm pleased to tell you that you are considered to be in complete remission.  There were no cancer cells in any of the nodes or breast tissue."  I was in shock for awhile......cried......I really didn't allow myself to go there........I had prepared myself for the fact that there would be some cancer left.  Keep us posted and hoping for the best for you!!
Dx TNBC 6/12; age 59; Stage 3, Grade 3; 3.5 cm, 3/10 nodes + chest wall nodes; A/C x4, T x 12 completed 12/12 with PCR, 2/13/13 lump; IMRT Rads x 33 completed 5/22/13 BRCA 1 negative.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote sweetpickle Quote  Post ReplyReply Direct Link To This Post Posted: May 20 2013 at 8:40am
Thanks, keeping fingers crossed for sure! Surgery is this Friday and path will come back sometime next week. Will keep you guys updated!
11/13/12 DX TNBC, BRCA 1+ Grade 3, 4.3cm tumor, susp. node under arm, 4 A/C biweekly & 4 Taxol biweekly
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Post Options Post Options   Thanks (0) Thanks(0)   Quote TriplePositiveGirl Quote  Post ReplyReply Direct Link To This Post Posted: May 20 2013 at 12:15pm
Hey Sweetpickle,

Good luck with your surgery Friday. You will have a nice 3 day weekend to recover! I hope for a PCR after surgery!

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 Grateful for today Quote  Post ReplyReply Direct Link To This Post Posted: May 24 2013 at 12:20am
Sweetpickle,


Sending lots of caring, good and positive thoughts for your surgery.


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


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Post Options Post Options   Thanks (0) Thanks(0)   Quote Silver cloud Quote  Post ReplyReply Direct Link To This Post Posted: May 24 2013 at 6:06am
Sweet pickle,, thinking of you today with the most happy positive thoughts!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote tracyinva Quote  Post ReplyReply Direct Link To This Post Posted: May 27 2013 at 9:18pm
My current doc at Johns Hopkins here in Baltimore, MD said he has literally seen cancer melt away with chemo treatments so I am hoping there is some good through all this hell we all have to put ourselves though. Looks like you have a very good prognosis.
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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: May 29 2013 at 10:18pm
Sweetpickle,

Sending lots of caring and positive thoughts to you post-op.
Hope you are feeling better every day.
Hoping that you get a very good pathology report.

Be gentle with yourself and let your body heal.


With all good and healing thoughts,
Grateful for today......Judy
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Post Options Post Options   Thanks (0) Thanks(0)   Quote sweetpickle Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2013 at 1:23pm
Surgery wasnt bad, they only took three nodes and I wont get path report until Monday. The drains are the most difficult part, hoping to get them out on Monday too.
11/13/12 DX TNBC, BRCA 1+ Grade 3, 4.3cm tumor, susp. node under arm, 4 A/C biweekly & 4 Taxol biweekly
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lillie Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2013 at 2:17pm

Dear Sweetpickle,

Glad to hear the surgery is over.  You sound like the majority of us "Love Those Drains."  Good luck and praying for a GOOD pathology report for you.
 
God Bless,
Lillie
Dx 6/06 age 65,IDC-TNBC
Stage IIb,Gr3,2cm,BRCA-
6/06 L/Mast/w/SNB,1of3 Nodes+
6/06 Axl. 9 nodes-
8/8 thru 11/15 Chemo (Clin-Trial) DD A/Cx4 -- DD taxol+gemzar x4
No Rads.
No RECON - 11/2018-12 yrs NED
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2013 at 2:33pm
Sweetpickle,

So glad the surgery is over.  Yes, those drain tubes are the worst!!!!!  I had 3 on each side and hated every minute of it.  Once they're out, you'll feel so much better.

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 rosered71169 Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2013 at 4:50pm
Sweetpickle-
I am glad that you are through the worst. The drains will come out soon and you will feel like a new person. I just went through DIEP reconstruction on the 22nd and got my breast drains out today. It's a BIG OUCH when they come out but then total relief. I was told that the abdominal drains need to stay in for two more weeks which stinks but I will do what my doctors think is best. They have taken good care of me so far.
 
I also had clear scans after chemo and did get a pcr after my mastectomy. I will pray that you have the same result. Healing energy coming your way!
IDC 2-21-2012 @ age 42 TNBC, Stage IIA, Gr 3, 1.5cm Tumor Rt Breast, 3 Lymph Nodes, Neoadj Chemo, TACx6,BRCA Neg, Bilateral Mastectomy 7-30-12, 28 Rads, Bilateral DIEP 5-22-13...3 Beautiful Daughters
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