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Post Options Post Options   Thanks (0) Thanks(0)   Quote Plume Quote  Post ReplyReply Direct Link To This Post Posted: Jul 28 2018 at 9:52am
Originally posted by 123Donna 123Donna wrote:

Hi Wildburg,

I'm posting the link to the NCCN Guidelines for TNBC.  The recommendation is chemo for any tumor larger than 1.0 cm.  Unfortunately surgery, chemo and radiation are the only options for triple negative breast cancer.  We don't have targeted therapy yet and we only get one shot of trying to stop this beast the first time.  TNBC is more likely to spread through the lymphatic and blood than other types of breast cancer.  Chemo is used to hopefully mop up any stray cells that might have escaped.  





Donna, thank you for the link.  Brilliant and takes away a lot of the anxiety about opting for chemo.  These are very clear guidelines.

I have found the forum rather late as I have just passed my first anniversary.  But it's confirmed to me that my treatment plan was absolutely spot-on and could not have been bettered.

I hope your link helps lots and lots of people who are confused and frightened about chemo.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lucky22 Quote  Post ReplyReply Direct Link To This Post Posted: Jul 31 2018 at 9:52am
Yes, you want to get chemo as soon as you can, but women who have chemo delayed for true reasons, like I had a severe infection, should not live in fear. I had my chemo 57 days after my first surgery, less after my re excision. I wanted to hurry it up, but it is much worse to dtart chemo with an infection than to delay.
Also, using my stats as an example, with chemo my chance of death in five years is 8%. If my delay truly did screw things up as much as possible per this article, my mortality rate would go to a little over 12%. I Judy think we need to be careful of scaring people unnecessarily, because sometimes delays are unavoidable.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Plume Quote  Post ReplyReply Direct Link To This Post Posted: Jul 31 2018 at 10:52am
Lucky22, I do completely take on board your point of view.  But I don't agree about "scaring people unnecesarily".  Just having our diagnosis is in itself completely frightening.  I think people, like cancers, come in all shapes and sizes.  Some like to know the worst case scenarios, all the facts however dreadful, whilst others prefer to look on the bright side and hope for the best.

If the facts and stats are out there, then that is the "truth" as far as our present knowledge allows.  BTW, I would not find a 50% increase in mortality rate, as described by you, is a small matter.

Having said that, I am truly happy that you are getting on OK.  You are right of course that some delays are unavoidable.  Doesn't make the delays acceptable or easily ignored.  Me, I am a bit of a precision fiend:  I'd have all the bad news, whatever it is, and live (or die) with ALL of the facts....
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Dec 10 2018 at 7:46am
From SABCS 2018:

Earlier Adjuvant Chemotherapy Benefits Patients with TNBC
Adjuvant therapy is treatment given to patients after they undergo surgery and radiation therapy for their cancers. A new study indicates that in TNBC beginning treatment sooner is better. The study done in Peru showed that patients who began their adjuvant therapy within 30 days of completing treatment have better outcomes than those whose treatment is delayed. These results support evidence from other trials.

Physicians and patients need to balance the time required to recover from surgery and radiation with the benefits of starting adjuvant therapy sooner. Current guidelines call for beginning treatment within 4-6 weeks but these studies may change the view of the optimal timing.

ďWe can see that the time to adjuvant therapy is an independent prognostic factor for overall survival,Ē sad Zaida Morante, MD, who presented the study.

Carlos Arteaga MD of the University of Texas Southwestern Medical Center, who moderated the session in which this data was presented noted that more patients would be treated within 30 days in the United States.



Edited by 123Donna - Dec 10 2018 at 7:46am
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 12 2018 at 10:43am
DR. CARLOS L. ARTEAGA, mentioned here was named the Director of my facility, the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern in 2017. I feel very lucky that this renowned breast cancer physician and researcher is now our guy! I just wanted to point that out, for anyone needing TNBC care in North Texas.
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 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jan 07 2019 at 8:20pm
Delaying Adjuvant Chemo Associated with Worse Outcomes for Patients with Triple-Negative Breast Cancer

Patients with triple-negative breast cancer who delayed starting adjuvant chemotherapy for more than 30 days after surgery were at significantly higher risk for disease recurrence and death compared with those who started the treatment in the first 30 days after surgery, according to a retrospective study presented at the 2018 San Antonio Breast Cancer Symposium.

"For this study we included triple-negative breast cancer patients who underwent surgery as first treatment followed by chemotherapy and/or radiotherapy," said Zaida Morante, MD, a medical oncologist at Instituto Nacional de Enfermedades NeoplŠsicas in Lima, Peru. "Most guidelines recommend starting this adjuvant chemotherapy within four to six weeks after surgery for any type of breast cancer. Others recommend starting as soon as clinically possible within 31 days of surgery; however, the optimal time to initiate chemotherapy is unknown.

"We have seen in our clinical practice that, for many reasons, there is often a delay in starting adjuvant chemotherapy for patients with triple-negative breast cancer," continued Morante. "We analyzed real-world data to determine whether these delays impact disease-free or overall survival for patients."

Morante and colleagues found that patients who delayed starting adjuvant chemotherapy for more than 30 days after surgery had a more than 90 percent increased risk for disease recurrence and death compared with those who started the treatment in the first 30 days after surgery. This risk is increased if the adjuvant treatment is given after 60 days.

"Our data show that it must be a priority for patients with triple-negative breast cancer to begin adjuvant chemotherapy within 30 days of completing surgery," said Morante. "After this period of time, the benefit of the chemotherapy is significantly diminished."

Morante and colleagues retrospectively analyzed data obtained from the medical records of 687 patients with stage 1-3 triple-negative breast cancer who had undergone surgery and went on to receive adjuvant chemotherapy in a public institution. The median follow-up was 101 months and the median time to starting adjuvant chemotherapy was 41 days; 189 patients started the treatment at or before 30 days, 329 started it from 31 to 60 days, 115 started it from 61 to 90 days, and 54 started it more than 90 days after surgery.

As the time to starting adjuvant chemotherapy increased, the 10-year disease-free survival rate decreased; it was 81.4 percent, 68.6 percent, 70.8 percent, and 68.1 percent among patients who started the treatment at or before 30 days after surgery, 31 to 60 days after surgery, 61 to 90 days after surgery, and more than 90 days after surgery, respectively. The 10-year overall survival rate also decreased as the time to starting adjuvant chemotherapy increased; it was 82 percent, 67.4 percent, 67.1 percent, and 65.1 percent for the four groups of patients, respectively.

The researchers then studied how the extent of delay in starting chemotherapy was associated with an increased risk for disease recurrence and death. They found that compared with patients who started adjuvant chemotherapy in the first 30 days after surgery, risk for disease recurrence was increased by 92 percent for those who delayed starting the treatment for 31 to 60 days after surgery, by 138 percent for those who delayed starting the treatment for 61 to 90 days after surgery, and by 147 percent for those who delayed starting the treatment for more than 90 days after surgery. The risk of death compared with patients who started adjuvant chemotherapy in the first 30 days after surgery increased by 94 percent, 145 percent, and 179 percent for the three groups, respectively.

According to Morante, the main limitation of the study is that it is a retrospective analysis of a single institution experience.

SOURCES:
2018 San Antonio Breast Cancer Symposium, December 4-8, 2018, San Antonio, TX
American Association for Cancer Research (http://www.aacr.org)


http://www.hopkinsbreastcenter.org/artemis/201901/6.html




Edited by 123Donna - Jan 07 2019 at 8:23pm
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: Jun 21 2019 at 11:44am
bumping for new members
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 Danzig482 Quote  Post ReplyReply Direct Link To This Post Posted: Jun 22 2019 at 7:38am
why are some people having surgery first? Iíve consulted a few doctors and it was not even considered for me. They said in general with tnbc you donít know if the cancer is responding to chemo if you remove tumors first
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Alicia89 Quote  Post ReplyReply Direct Link To This Post Posted: Nov 08 2019 at 4:00pm
I found my lump in early August. Did not get a full diagnosis until the end of September as the local pathologist was unable to identify the type of cancer. And my surgery was scheduled for late October. I am now two weeks post surgery and awaiting my final Pathology report. Hopefully these delays don't prove to be a problem. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Kellyless Quote  Post ReplyReply Direct Link To This Post Posted: Nov 08 2019 at 4:35pm
Danzig, I've been puzzling over that for a long time now and I still can't figure it out. We are seeing many women come thru here after having surgery first that are upset that there's no way to know if the chemo is working. Upset that they can't know if they achieved a "PCR". I wonder if they are only seeing a surgeon and not a medical oncologist before letting the surgeon go for it? That's sorta what happened to me the first time. When I learned better I changed not only surgeons but cancer facilities entirely. I read something yesterday that said only 50% of TNBC patients respond to the usual chemo drugs?? That seems extreme, I'd like to know if that's true. If it is, then having surgery first is dangerous. And getting scans during each type of chemo should be mandatory - standard operating procedure. More than half the time the women I stay in touch with have to ASK for ultrasounds and mammos during chemo. We need some clarity on these things. 
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 sophie Quote  Post ReplyReply Direct Link To This Post Posted: Nov 08 2019 at 5:15pm
I did surgery first and hegemonies, my MO performed petscan on me last week see nothing ... so does this mean chemo works for me or at least if any cancer cell remains not growing at least during the chemo? Can I drew a conclusion that chemo works on me?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote sophie Quote  Post ReplyReply Direct Link To This Post Posted: Nov 08 2019 at 5:16pm
I did surgery and then did the chemo
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Post Options Post Options   Thanks (0) Thanks(0)   Quote dono7392 Quote  Post ReplyReply Direct Link To This Post Posted: Nov 26 2019 at 11:28am
Sadly I did not know about this information until after surgery (in which I chose immediate reconstruction). That automatically put me on a 6 week delay for chemo based on surgery recovery times. I wish my doctors were aware of this ... my plastic surgeon told I had 3 months to start.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Plume Quote  Post ReplyReply Direct Link To This Post Posted: Nov 26 2019 at 3:27pm
I had surgery first, then chemo within 30 days.  Was not given the option to have chemo first.  But, if I HAD to choose, I would have chosen surgery first because the tumour was growing very fast and I was very frightened of it and wanted it out.

I think if the medical team thought chemo first would have been best for me, they would have done that.  I am not party to what criteria they based their collective decision on.

So far (but it's early days) so good.  I had my second year check-up with the surgeon followed a few months later with the onco and all seems well.  I expect to have my reconstruction next year.  Apparently it's best to wait for 2 years after the end of radiotherapy.

At the moment, it is envisaged that I will have what they call a lipomodelage; that is liposuction from the abdomen and the fat transferred to my breast.  Then a bit of a lift to the other breast to match.

The promise of this procedure has kept me going and I am massaging my breast scars to keep them supple and eating good, nutritious food to get my body surgery-ready...ha!ha! 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Portia Quote  Post ReplyReply Direct Link To This Post Posted: Nov 28 2019 at 2:44pm
Re: Chemo
Iím not really sure what is driving the anxiety and dread about chemo. When my dad had bladder cancer in 1994, chemo was really rough. But it still helped him. He lived longer than expected. 
These days, chemo is nothing like what he went through. It was actually quite gentle to me and I had Taxol/carbo and adriamycin/cisplatin. The anti emetic drugs were so effective that I had mild nausea twice, easily fixed by my complezine.  My biggest side effects were weight gain from steroids, fatigue and low RBC. But it wasnít debilitating enough to prevent me from getting to work everyday and putting in 8 hours. I didnít need to take even one sick day. 
Now, Iím not going to say everyone will have the same experience that I had. But Iím going to bet there are a lot more of us getting through it with mild symptoms than there were 24 years ago. 
AND it can be extremely effective. I mean, WOW, my Thing melted away. It was amazing. Iím a believer and hope that all of you have as good a response as I did. I only wish my dad had access to new chemo. 
My chemo nurses told me that my attitude and anticipation would have an effect on how well I tolerated it. So, verily I say unto you, donít dwell on the scary side effects that the pharmacist is obligated to tell you about. Follow all directions faithfully, donít drink alcohol do you can give your liver itís best chance to do its thing without competition and stay on top of your nausea. All I am saying is give drugs a chance. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Portia Quote  Post ReplyReply Direct Link To This Post Posted: Nov 28 2019 at 3:00pm
I asked my oncologist about this. I had neoadjuvant therapy with 12 weekly sessions of paclitaxol to start. It made sense to do it this way. Itís like that saying, ďif youíre opponent is drowning, through him an anchorĒ.  Pounding that sucker week after week, not allowing it to get up while it was down seems to have worked and I knew it about 3 weeks into treatment when I could tell the Thing had started to shrink, a hunch confirmed by my doctor. 
So I asked her, what if it hadnít worked by then? She said she would have sent me to surgery right away. 
Here is my best guess why I got chemo before: I had one lesion and my pet scan showed no lymph node involvement. She had a little bit of time to play with. Plus, Iím guessing that she had the cells tested for susceptibility to chemo agents. 
One thing I did find kept my anxiety in check was NOT to google too much. I have a background in pharmaceutical research and can read papers with pretty good understanding. I didnít want to freak myself out. So, my guess about neoadjuvant vs adjuvant chemo criteria is just a guess. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Kellyless Quote  Post ReplyReply Direct Link To This Post Posted: Nov 29 2019 at 9:51am
The oncologists recommending chemo first are not "guessing," it's not just an "opinion", there's rock solid science behind it. Not every chemo works for every person  - we've seen it here over and over and over. Without a tumor to watch there's no way to know if the chemo you are doing is killing YOUR cancer. We're not doing chemo to just kill the tumor in our breast, it's to kill cancer that is systemic. Doing  the chemo that is is right for us, that kills  YOUR particular cancer obviously makes a big difference. 
Studies show that the smaller the tumor at surgery the lower the recurrence odds and higher long term survival odds. And we now know as 100% fact that achieving PCR with neoadjuvent chemo significantly reduces recurrence odds and increases long term survival numbers. 
There is no study showing doing Taxol before AC increases benefit. On the contrary, the AC we do every 2 weeks is Dose Dense - very high dose that does not stop "working" after one week. Actually doing Taxol Dose Dense every two weeks is effective as well - we've gone to lower dose weekly due to side effects, not because weekly chemo "makes more sense". In some cases higher dose less often is indeed more effective. 

Adding carboplatin does increase the odds of obtaining PCR...BUT I've not seen anything comparing doing AC first then Taxol + Carboplatin. The only reason that started was that Merck, the maker of Keytruda, only allows the use of Keytruda with that order and types of chemo. It's not FDA approved, so to use it you play by their rules. Carboplatin often destroys your immune system (ANC), causes extreme anemia and kills platelets. The highest number of treatment delays I see in the last 10 years are on carboplatin. And AC after T+C is a dicey ride - over and over and over I keep seeing women getting hospitalized during AC when doing it after T+C. 

So I would love to see a study on WHY women are doing chemo or surgery first.  How many are only seeing a surgeon prior to surgery, not seeing a medical oncologist? How many are strictly making an emotional decision, the "Just get it out!!!!" decision? What are the fact based, science based reasons for it? That's what intrigues me. 


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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