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30 yrs old with stage 3a TNBC

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VgonnaMkit View Drop Down
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    Posted: Feb 15 2016 at 2:11am
Hi....
Can't say that I am happy to be here, but it was good to see you guys fighting ur way out of this deadly thing.
This new yr (1st, Jan'16) my wife was diagnosed with TNBC. We started on neoadjuvant chemo on 22nd January and have a 6 cycle regimen (21 days gap between each) of Taxotere, Anthracycline and cyclophosphamide. Followed by surgery and rad depending on response to chemo.

We are in India and whatever I read online are Taxol based regimen of western side of globe, which leaves me with a doubt for the regimen that has been selected by our doctors. Though I trust them....but this is still a concern left in my mind.

I don't know I would get any clarity here, but thought it was worth having a try....

Good luck to all of u (y)

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gordon15 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote gordon15 Quote  Post ReplyReply Direct Link To This Post Posted: Feb 15 2016 at 5:18pm
Hello Vg- Taxotere and Taxol are both "Taxanes"  I'm not sure which is used more often here in the USA now. I ran across this thread:

https://www.whatnext.com/questions/triple-negative-bc-taxotere-vs-taxol

My wife had T(axotere)AC in 2008, the cancer did not come back. She has a more aggressive TNBC now and is received Taxol this time. Ask your wife's oncologist the difference. Perhaps Taxol is more toxic? 

The side affect neuropathy seems to be associated with both Taxotere and Taxol, oddly enough, Glutamine and Melatonin are mentioned in the above link as helping this side affect. My wife hasn't had any neuropathy.

Hope this helps.
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made2b2gether View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote made2b2gether Quote  Post ReplyReply Direct Link To This Post Posted: Feb 15 2016 at 7:16pm
Dear VgonnaMkit,
Sorry to hear about your wife's diagnosis. We too are Indian by birth but we reside in Japan.  My wife too was diagnosed at 28 with tnbc and she completed treatment around April 2015. She is now 30. 

Like Gordon Said, Taxotere and Taxol are essentially the same.  So you shouldn't worry about that, but you can always ask your doctor questions to gain a better understanding to matters that concern you.  It is only natural to worry. 

As your wife is young, so you ought to get BRCA testing done (also depends on family history, but it can be very important), and if she in fact has a family history of breast cancer, then throwing Carboplatin into the mix could be useful.  You can discuss this with your doctor and push for it (BRCA Testing) as this will guide treatment to some degree.  But if she has a BRCA mutation, then how your doctor will choose to treat this will really depend on his/her feeling about your wife's specific cancer biology.  If she does not have the mutation, then her now regimen is fine and you need to focus on how she is responding to the treatments.  Get the BRCA test done soon (all you have to give is blood), because if it can guide treatment decision, then the doctors ought to give you data and research-backed opinion to best guide you.  It is well established today that women that do have the mutation respond well to platinum chemos.  But, please know this, your wife's now chosen chemo is standard and is the right treatment guideline.  
You can always ask your doctor why Taxotere vs. Taxol, but what I have been told from other patients is that dense dose Taxotere is a strong regimen (also in terms of side effects). 
If you have any doubts, you can always speak to another breast specialist at TATA Memorial in Mumbai, Jaslok hospital Mumbai, AIIMS DELHI, Fortis, Ruby Hospital in Pune etc.  (or other top hospitals in major cities in India - Mumbai, Delhi, Bangalore, Chennai, Pune etc.) - Not just any doctor but Oncologists with specialty in treating breast cancer. 
It is only normal to hope that your loved one is being treated with the best of what is available.  I totally understand where you are because I've been there and I too felt the same at the time.  

Also, after 2-3 treatments with the Taxotere, please ask your doctor for an Ultrasound/Sonogram to measure response.  This will guide you on how she is responding to treatment, and this will give some insight to your doctor on the current regimen.  Insist on Ultrasounds after every 2-3 treatments, and ask any questions that you may have to your doctor.   

Hang in there my friend.  If your wife or you ever need to reach out, then feel free to drop us a message.  We'll speak to you anytime.

Where are you based in India?  There are plenty of fantastic institutions in India. Ensure that the doctor that you are working with has plenty of experience with TNBC and he / she is on top of research and latest studies on the subject matter.  

Take care of yourself, and also your dear wife.  

Best Wishes,

Desh




Edited by made2b2gether - Feb 15 2016 at 7:36pm
DX Jan06 `14. IDC TN 2.0cm. Grade 2. Neoadjuvant: Taxolx12,FECx4. Post Surgery LX- Tiny Micromets found in 4/17 removed LN- 6mm residual. Wide Radiation 25x. Carboplatin AUC 6 x 2, AUC 5 x 2
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VgonnaMkit View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote VgonnaMkit Quote  Post ReplyReply Direct Link To This Post Posted: Feb 16 2016 at 2:52am
Thanks for responding Gordan and Desh☺

@Gordan: She has been prescribed GSCF on 4 day after every cycle. And for neuropathy, I Found some good info and suggestions on the above mentioned weblink. Thanks again.

@Desh: we are getting it done at AIIMS. Opted Aiims as her brother who is getting treated here had a good response to recommend treatment (diagnosed with ALL last yr at the age of 22 yrs). Moreover, I respect the exposure and experience of doctors at AIIMS. We live in Delhi and our onco said that they will do BRAC testing pre- surgery and will discuss all recommendation and choices before surgery. I think that they do not have a plan to make alterations in chemo regimen based on BRAC results. My wife doesn't have a family history apart from her brother's ALL, but we will get BRAC to rule it out and decide for surgery options. Thanks for sharing ur views. ..will surely touch base incase I want some help.

Takecare


Edited by VgonnaMkit - Feb 16 2016 at 3:15am
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made2b2gether View Drop Down
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Post Options Post Options   Thanks (1) Thanks(1)   Quote made2b2gether Quote  Post ReplyReply Direct Link To This Post Posted: Feb 16 2016 at 3:15am
Dear VGonnaMkit,

Great. AIIMS is a great hospital.  

Ok on the BRCA 1, 2 Testing.  If the results do show a BRCA mutation, then you can ask for Single Agent Platinum treatment post surgery and radiation.  But this is something to discuss with your doctor, or by getting a 2nd Opinion. 
It all depends on how your wife does on this prescribed regimen and based on the  genetic testing results. 
Also, just because there is no immediate family history, does not mean that you should not test for BRCA. Because you wife is young, you ought to get the testing done.   You Genetic Counselor will work with yourself and your wife to create a family tree, they will do the testing, and when they deliver the results they will give you the necessary counselling associated with the results.  

Additional therapy may only be necessary if your dear wife does not have a PCR (Ask your doctors to tell you what the residual disease is, if any, after all chemo is finished).  

Residual Disease, if any cancer is left over after chemo, can be calculated by applying the formula in the below link:
http://www3.mdanderson.org/app/medcalc/index.cfm?pagename=jsconvert3

If there is residual disease present, then take your RCB Index Score and consult with your now doctor and an expert 2nd Opinion doctor on what you ought to do next.  This will be important. 

PCR stands for Pathological Complete Response (to the now prescribed chemotherapy). 

RCB stands for Residual Cancer Burden. 

If she has a PCR, then great. If not, then push for more treatment, or at least a good 2nd Opinion.   

You will need good counselling when you take the BRCA test,  as there are repercussion and guidelines for surgical decisions and also with regards to Ovarian Cancer (not just breast cancer).   Therefore, doing the BRCA test before surgery is vital as it has surgical implications (and will greatly impact your personal decisions on Lumpectomy vs. Mastectomy etc).  

http://www.facingourrisk.org/index.php

http://www.facingourrisk.org/understanding-brca-and-hboc/information/hereditary-cancer/genetic-testing/

(the above sites are good sites to review)

If there is no BRCA mutation, then simply consult on next steps with your doctor, as per NCCN clinical practice in Oncology guidelines. 

Focus on response to current treatment guidelines for now.  She could do very well on this treatment also, so it is important to think positive thoughts and hope for good.  Ensure she is well taken care of, she eats well, takes lots of water before her treatments, and keep her smiling and laughing as much as you can. 

Both of you look after yourselves.  It is an important time to be there for her, and to also look after yourself.
Remember, it is important to take care of You also!   

God bless you two.  






Edited by made2b2gether - Feb 16 2016 at 3:30am
DX Jan06 `14. IDC TN 2.0cm. Grade 2. Neoadjuvant: Taxolx12,FECx4. Post Surgery LX- Tiny Micromets found in 4/17 removed LN- 6mm residual. Wide Radiation 25x. Carboplatin AUC 6 x 2, AUC 5 x 2
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VgonnaMkit View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote VgonnaMkit Quote  Post ReplyReply Direct Link To This Post Posted: Feb 16 2016 at 4:51am
I genuinely appreciate ur efforts!

I'll go through these sites and yes, we try to keep that smile on with all our focus towards a balanced diet with lots of fluids.

On PCR thing.....yes we are looking for it and she had a change in consistency of her tumor after the 1st cycle itself (it's way softer than it was before chemo). They did physical examination after 1st and confirmed the changes. They also said that now they will be continuing more cycles and check for response after each cycle. ...phisical chk and scanning after few cycle.

lets c....Hoping for the best
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Tulips View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Tulips Quote  Post ReplyReply Direct Link To This Post Posted: Feb 16 2016 at 7:44am
Dear Vgonnamkit,

Well you've received really thorough responses, so I don't have any additional information for you, but I just wanted to send some support.  It sounds like you are getting great medical care (so, so sorry for your wife's family, with your brother-in-law's diagnosis as well).  It does seem like I hear of chemotherapy regimens split approximately 50/50 between Taxol vs. Taxotere.  Maybe shifted a little more towards Taxol recently, but those drugs are in the same family, and it sounds like your wife is already responding well, so that's great.

All of the advice above is spot-on, and it's obviously crucial to be on top of the medical side of things, but I especially like the advice about making sure you keep laughing....depending on whether or not your wife needs radiation, and what type of surgery she has, etc, this can be approximately a year of treatment.  Even though there are lots of tough times during this first year with treatment, etc , you don't want to look back and think you wasted a year!  I just put my photo album together for 2015 (I was diagnosed in April), and it was so great to remember through the photos that in addition to all the love & support we enjoyed last year due to the TNBC diagnosis, we also had lots of AMAZING times regardless.  Tough year in many ways, but also a fabulous year with lots of highlights.  I'm so grateful for that.  So don't be afraid to enjoy life this year!  And keep up the good work on ensuring she's getting the best medical care.  Good luck with everything!

Tulips
Dx April 2015 IDC TN 2.2 cm, Grade 3, Chemo started May 2015: Taxol/Carbo then AC, Lx with SNB Nov 2015, 33 Rad Dec 2015-Feb 2016. 6 months Capecitabine starting March 2016
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VgonnaMkit View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote VgonnaMkit Quote  Post ReplyReply Direct Link To This Post Posted: Feb 16 2016 at 8:22am
Though I am getting a lot of support from my family and friends.  Whether it is taking care of our 3 yrs old daughter or tagging up with my wife for few appointments when I am busy at office. This site and the words out of you guys feels like getting comforted from a a person who exactly knows what you are going through....

Thanks a lot Gordan, Desh and Tulips ☺
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Post Options Post Options   Thanks (0) Thanks(0)   Quote VgonnaMkit Quote  Post ReplyReply Direct Link To This Post Posted: Feb 16 2016 at 8:41am
Got carried away of being thankful😁 wanted to add something Tulips.....

Yes u r right, we have to live this moment.  In fact,  my wife started taking pics of each event of our treatment and she is always positive when I have that regular "why us?" type of thing creeping in my mind. We pull each othr on the low days and try to get fullest of the rest ☺
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