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Anyone Do Neoadjuvant for Stage 1?

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ChicagoMom View Drop Down
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    Posted: Dec 18 2019 at 12:18am
I was diagnosed with TNBC in mid October. I'm stage 1 (1.2 cm, no nodes), grade 3, KI-67 of 30% and 1-2% estrogen which they are "ignoring" for all intents and purposes.  I found an expert in TNBC at University of Chicago who recommended neoadjuvant chemo so we could monitor how the tumor responds and change treatment as necessary with the ultimate goal of PCR (or as close to it as possible).   Her recommendation was 12 Taxol (weekly) followed by 4 AC (bi weekly), lumpectomy and then some amount of radiation.  And, if there is still residual disease, Xeloda (I think that's the right name...).

I just finished by 6th treatment of Taxol yesterday and to date, have not had any side effects other than typical hair loss. 

I had a follow up ultrasound today to see if my tumor was responding and the tumor has changed from looking "solid" to something more "hole-y" with the general size staying the same. The radiologist suggested that the Taxol is working and that the "holes" most likely represent dead cells or the "breaking up" of the tumor. The surgeon and oncologist are going to review the films and get back with me tomorrow.

Has anyone done neoadjuvant for Stage 1?  I know it has been less common in the past but curious if anyone else has gone this route.  If so, what was your experience?

Thanks in advance,
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Marymom Quote  Post ReplyReply Direct Link To This Post Posted: Dec 18 2019 at 5:25am
Hello Chicago Mom,
My diagnosis was close to yours and I did not have neoadjuvant chemo.  I had a lumpectomy, 4 ac 12 taxol and 20 rads which included 4 power blasts. I am two years clear 12/12/19.  I had no bad side effects from chemo and no left over effects, actually had a bad cold this week and was sicker with the cold...go figure!  So, God was very good to me.
I am responding to your post...because I often think about the Neoadjuvant setting for early stage.  I will be eager to hear more from you.  I actually think it is good...to see the response as you travel through chemo.  I went to Sloan in nyc.

So, my prayers are with you...as I remember all on this site.  This site offers so much advice and education to us all. Thankful for it!

Godspeed in your journey!  You will be ok! Stay strong and positive...I think you all ready are👍
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ChicagoMom View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote ChicagoMom Quote  Post ReplyReply Direct Link To This Post Posted: Dec 18 2019 at 4:04pm
Thanks for the response!  Neoadjuvant is definitely the less common approach (at least previously) for Stage 1 which is why I was curious if anyone else went down this path.  It seems like it is becoming a bit more common per my doctor.  Or maybe she is taking a more academic approach as she is the principal investigator for the Translational Breast Cancer Research Consortium (TBCRC) and the I-SPY 2 Clinical Trial Network.  

Either way - I would love to find someone else who has had a similar experience as nothing I can find (articles, etc) really pertains to the journey I'm taking!

I'm 47 and am feeling very lucky to be feeling as good as I do.

My next question is to get a port or not.  I have 10 more treatments but my veins are starting to harden.  My doctor only wants chemo on my left side to "save" my "good" arm for the future so my options are becoming a bit limited.  I've heard some unpleasant stories about AC and vein irritation so not sure how I'm going to proceed.  Pros and cons to both.

Obviously, not a MAJOR problem all things considered but something I'm on the fence about.

Thanks for your reply!  Congrats on 2 years!

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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Dec 18 2019 at 7:44pm
Just my two cents - get the port.  I didn't have a port with my initial adjuvant chemo.  I had 4 treatments and during the 3rd one, it burnt the vein in my hand.  You could actually see the outline on my skin.  My vein that was always so plump and easy to access was non-existent.  The 4th chemo had to be in my arm because there wasn't a good vein left in my hand.  Fast forward to my recurrence, I had a port because I knew I was getting many more treatments.  It made everything so easy and pain free.  While it's a hassle to get it placed and then have it removed at a later date, it makes chemo much easier and hassle free.  After treatment, you need to have it flushed every few weeks.  One onc waited over 8 weeks and the port almost because clogged and wouldn't draw.  They kept flushing and flushing and it finally worked the next time.
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 Kellyless Quote  Post ReplyReply Direct Link To This Post Posted: Dec 19 2019 at 11:08am
Iíve had two ports and they were both awesome. Easy in, easy out installation wise - no pain. Never had pain having it accessed either. My facility did all blood draws from it as well as chemo and other meds. I was hospitalized sick during chemo, they put the IV in my port during my hospital stay - way preferable to the usual IV! And now, even after all the care Iíve had thru to long chemo slogs my veins are great! Giving blood labs is a breeze, they never have to stick me more than once because my arm veins are great. And with the lymph node removal they only want you using your one good arm for everything in the future, so protect that arm! 
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 Tamara Quote  Post ReplyReply Direct Link To This Post Posted: Dec 20 2019 at 7:22am
My port was my best friend - first because I get woozy at the sight of a needle stuck in my arm and second because Iíve heard too many people with complications without a port. I highly recommend the port!!
Wishing you all the best
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Neen Quote  Post ReplyReply Direct Link To This Post Posted: Dec 21 2019 at 1:50pm
I was diagnosed in September of this year, Stage 1, 1.6 cm,KI-67 >30%. Surgeon let me decide on neoadjuvant chemo or adjuvant. I chose neoadjuvant, I have completed 4 rounds of A/C 2 weeks ago, ultrasound showed tumor has not changed. Had MRI this week surgeon and oncologist are trying to decide on doing lumpectomy now. Or maybe doing 6 rounds of Taxol & Carboplatin then doing another ultra sound, after they get results from MRI. Trying to stay positive about all the changes, hopeful after reading your post that maybe my tumor has dead cells also...
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Kellyless Quote  Post ReplyReply Direct Link To This Post Posted: Dec 21 2019 at 2:51pm
Ugh Neen, thatís the worst! Iím sorry youíre stuck with such a sh!tty decision to make. I donít know the right answer, but just Taxol and Carboplatin completely wiped out my 2 cm tumor 3 years ago. And it was my second go round, Iím 3 years out again so far so good. If you do the chemo insist on scans at 3 weeks in, at that point I had 30% shrinkage so itís possible. How are your blood numbers? Do you still have an decent immune system, not too anemic and a hearty platelet #? Carboplatin feeds on platelets a lot. Whatís your odds of staying on schedule and out of the hospital starting this after AC would be a good questions for your drs. Speaking of doctors, have you gotten a second opinion? Always a good idea. Itís an unusual situation, that might get another good specialist interested enough to see you quick? Let us know what happens, Iíll be thinking about you.
Kelly
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 Neen Quote  Post ReplyReply Direct Link To This Post Posted: Dec 21 2019 at 3:28pm
Kellyless, My numbers have remained really good...I am thankful for that, I am a little anemic. Meet with the oncologist Monday to go over MRI results, we will see...  I personally would like to do at least 3 rounds of Taxol/Carbo to see what we get. How did you do on the Taxol/Carbo...is it as bad as A/C?? Do you have to do neulasta with Carbo?
I am outside the Houston area, I really haven't thought about a second opinion with it being Stage1. I know I have the best breast surgeon/oncologist in area, my oncologist is highly recommended. But, I hear what you are saying...
Take care
Neen
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Dec 22 2019 at 1:19pm
Neen,

How often will you be getting Taxol/Carbo?  I had Carbo with Gemcitabine and had it once a week for two weeks, then off a week.  I was able to work full time.

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 Neen Quote  Post ReplyReply Direct Link To This Post Posted: Dec 22 2019 at 6:00pm
Donna,
They will be giving the Taxol/Carbo weekly, so it will not be as toxic. I meet with onc tomorrow to see what they decide... more chemo or surgery, then finish chemo.
We will see.
Neen
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