Post surgical chemo after neoadjuvant chemo? |
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simplelife4real 
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Joined: Oct 24 2013 Location: Crossville, TN Status: Offline Points: 73 |
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 Topic: Post surgical chemo after neoadjuvant chemo?Posted: Dec 26 2013 at 2:31am |
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Hi All,
I'm nearing the end of my neoadjuvant chemo. I did Taxol x12 first and now I'm doing AC x4. My tumor has shrunk considerably and I'm hoping there will be nothing left of it after two more infusions of AC. However, since my chances are getting a pCR seem to be around 30% (depending on which study I read), I would really like to explore the possiblity of additional chemo or meds after surgery if it turns out I don't have a pCR. I've done some research and I know there is one clinical trial like that, but unfortunately in order to the in the trial the participants had to have AC first and then Taxol. Since I'm the reverse, I highly doubt they would take me. My oncologist (Ingrid Mayer--Vanderbilt) is very up to date on TNBC and presents at many BC conferences. I trust her, but I also have found that if I bring up other options she is more likely to explore them with me. Does anyone have any ideas/suggestions of things I might want to explore post surgery in terms of drugs/chemo etc. if I don't have a pCR? I really appreciate the great knowledge base here on this site. Thanks, Kay
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DX Aug 2013 @ age 60, Stage 2b, grade 3, 2.3 Cm, node positive, BRCA-; neoadjuvant taxolx12 and ACx4:
2/13/14 LX and ALND-2mm residual in 2 nodes |
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123Donna
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Joined: Aug 24 2009 Location: St. Louis, MO Status: Offline Points: 13510 |
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Posted: Dec 26 2013 at 11:33am |
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Kay,
Are there any clinical trials that include a platinum chemo like Carboplatin or Cisplatin? I hope you achieve pCR, but if you don't, you are very wise to be investigating your options now. You have a very good oncologist. I found the good ones like it when you bring ideas to the table too. It shows your knowledgeable and involved in your treatment plan and decisions. Donna
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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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Lee21
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Joined: Dec 22 2011 Location: Michigan Status: Offline Points: 752 |
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Posted: Dec 26 2013 at 1:10pm |
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There was a trial involving cisplatin and a PARP inhibitor for women in situations like the one you describe. That trial however is closed.
There is another one using eribulin for similar circumstances that you may wish to explore. http://clinicaltrials.gov/ct2/show/NCT01401959?term=breast+cancer+AND+eribulin+AND+residual&rank=1 It doesn't seem to require that you had to have chemo in any particular sequence. I think there is a very good chance you will have a very good response, given that the tumor has already shrunk considerably. Lee |
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12/9/11 @59,IDC,grade3, TNBC,3cm(MRI),SLNB0,stage IIA, BRCA1 variant
1/30/12 DD AC-T, 6/7/12 Lumpectomy, ypT1b(0.8 cm), 7/9/12 Rads x 30 11/9/12, clinical trial cisplatin/rucaparib, cisplatin-only arm |
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simplelife4real
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Joined: Oct 24 2013 Location: Crossville, TN Status: Offline Points: 73 |
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Posted: Dec 26 2013 at 3:59pm |
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Donna and Lee, thank you for your responses.
Lee, the pricipal investigator of the trial you sent me a link to is in Nashville (not with Vanderbilt), so it would be very easy for me from a logistics point of view to participate if they are still looking for people. Also, the site for that link is a different site than the one I have been using to look for clinical trials so I gives me more places to look. My 3rd AC treatment is New Year's Eve and what I plan to do is take in a print out of all the clinical trials that I think I might be eligible for an see what my MO thinks about them. It may also be possible that she is willing to give me more post surgical chemo of some sort. My tumor shrunk by about half in the first 6 weeks of Taxol, then it seemed to sit there for the next 6 weeks. The AC has really got it shrinking again big time. YEAH! I'm even wondering if I am "almost there" with AC and it is still shrinking, if I could get a 5th infusion of AC. I know there is a lifetime limit on the Adriamycin and I've never heard of someone getting a 5th infusion of it, but I figure it doesn't hurt to ask! Thanks again for your input! I have learned so much about TNBC from reading the wisdom of others on this site. Kay
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DX Aug 2013 @ age 60, Stage 2b, grade 3, 2.3 Cm, node positive, BRCA-; neoadjuvant taxolx12 and ACx4:
2/13/14 LX and ALND-2mm residual in 2 nodes |
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littleradish
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Posted: Jan 01 2014 at 7:38pm |
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Kay
I had 4 rounds of TC and we thought my tumor was no longer there. After surgery it was found that 50% of the tumor was still there it basically became Swiss cheese a tumor with holes all over it. After surgery I had 4 rounds of gemzar/cisplatin. |
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Diagnosed March 2013, TC chemo from April-July 4 rounds. Double mastectomy Aug of 2013 clear margins and no lymph nodes involved. 4 rounds of gemzar and cisplatin September to October
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Lillie
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Posted: Jan 01 2014 at 9:01pm |
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Dear Kay,
It is good news that your tumor is shrinking. Shrink Tumor Shrink!!!!
I had a mastectomy first and then chemo. I did a clinical trial and the trial drug was gemzar. I'll never know if it made a difference, or not, but I've had 7 cancer free years.
Good luck to you and may all the choices you make, or that are made for you, be good ones.
I love your code name "SimpleLife4Real".......
God Bless,
Lillie
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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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simplelife4real
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Joined: Oct 24 2013 Location: Crossville, TN Status: Offline Points: 73 |
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Posted: Jan 01 2014 at 10:01pm |
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I saw my oncologist yesterday before my third infusion of AC. We went over the printouts of clinical trials that I appear to qualify for and she told me which ones she felt would be the most likely to actualy do me some good if I needed it. She also told me that if I did not get a pCR that she would consider giving me Cisplatin depending on how much cancer remained.
This may all be a moot question because the AC is really doing it's work on my tumor. Today, I can just barely feel it. It shrunk dramatically around day 7 post chemo with infusion #2 and I still have one more infusion to go...so things are really looking up in terms of a potential pCr. I also found out the results of my BRCA test yesterday. I am negative. It was good that I was tested in case I had been positive, but it's nice to know that I'm not. Things are starting to look up after a string of not so good test results. I'll take it!
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DX Aug 2013 @ age 60, Stage 2b, grade 3, 2.3 Cm, node positive, BRCA-; neoadjuvant taxolx12 and ACx4:
2/13/14 LX and ALND-2mm residual in 2 nodes |
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Jojocat
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Joined: Jan 11 2014 Location: New York Status: Offline Points: 108 |
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Posted: Jan 12 2014 at 11:46am |
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Hi: I am in almost the same situation like yours except I had 4 rounds of ac first. My tumor has shrunk to 1/3 of its size and I still can feel my swollen lymph notes about 1/3 of their original size. I hope 4 more taxol will kill them all. You just mentioned about the clinical trial with ac first. Can you give me the info that I might need in case I don't have PCR.
Thank you very much. Joanie. |
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Cathieroh
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Joined: Dec 02 2013 Location: ohio Status: Offline Points: 28 |
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Posted: Jan 12 2014 at 12:55pm |
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Simple--How wonderful that the AC is whittlting away at the tumor! Good news always makes things seem a little easier. Hang in there. Cathie
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11/07 DCIS lft breast; lumpectomy & rads then 5 yrs Femara.8/13 dx TNBC age 62 StageI gradeII 6mm single focus no nodes. BRCA neg lft mast with DIEP flap recon. 4 rounds Taxotere/Cytoxan
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simplelife4real
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Posted: Jan 12 2014 at 4:07pm |
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Jojocat..here's a clinical trial that might apply to you. Nice thing about it is that it is in NY
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DX Aug 2013 @ age 60, Stage 2b, grade 3, 2.3 Cm, node positive, BRCA-; neoadjuvant taxolx12 and ACx4:
2/13/14 LX and ALND-2mm residual in 2 nodes |
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Jojocat
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Joined: Jan 11 2014 Location: New York Status: Offline Points: 108 |
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Posted: Jan 12 2014 at 10:41pm |
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Thank you. I am in New York . How about you? I will try this trial.
Joanie |
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clarkjennifer
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Posted: Jan 13 2014 at 3:23am |
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I think your situation is somehow matches to one of my friend's situation. She was diagnosed with ovarian tumor and she got surgical treatment by gynaecologist. After biopsy report it was diagnosed that the tumor in her ovary was cancerous so she was given the chemotherapy treatment with 4 rounds. After this whole treatment, CT Scan was suggested by the Oncologist in which one more tumor got diagnosed. Same procedure repeated again and now she is healthy and fine.
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simplelife4real
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Posted: Jan 13 2014 at 8:03am |
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Jojo, I haven't had surgery yet, so I don't know if chemo produced a pCR yet either. Right now, I'm just exploring my options just in case. My MO thinks that particular clinical trial holds a lot of promise. If I was close by and didn't have a pCR, I would be all over it. Right now, I just have to wait and see what the path results of my surgery turn up.
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DX Aug 2013 @ age 60, Stage 2b, grade 3, 2.3 Cm, node positive, BRCA-; neoadjuvant taxolx12 and ACx4:
2/13/14 LX and ALND-2mm residual in 2 nodes |
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Loveforlife
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Posted: Jan 13 2014 at 4:15pm |
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Kay,
I had 6 rounds of AC, since I was only able to have one of taxol (had a lung reaction to taxol.) 6 is the lifetime limit, I believe. Laura |
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Dx 1/2011 2b, Gr 3, TNBC, AC/T chemo, L lumpectomy/re-excision/lymph node diss/rads. DX DCIS R Breast 4/2012 - Lumpectomy/Rads.
DX Lung Spine mets 5/2013 Carbo/Gemzar 10/2013 Xeloda 1/2014 Ixempra |
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TNinTN
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Posted: Jan 13 2014 at 11:18pm |
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Hi Kay,
My wife, Susan, is also one of Dr. Mayer's patients and we think she is wonderful. Susan was in a clinical trial where she had neoadjuvant taxol and cisplatin +/-RAD001. She did not have a pCR and had to have AC after surgery. I just wanted to give you some words of encouragement. Susan was diagnosed in the summer of 2010. It took a while after surgery and radiation for Susan to regain her strength, but she has achieved her "new normal" and is doing very well and shows NED. Hang in there! You're in good hands. Martin |
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Wife age 53@dx TN IDC Stage IIA 7/10; BRCA1&2 Neg; BROCA Neg; LN Neg; taxol+cisplatin+/-RAD001x12(clinical trial); lumpectomy 12/10;ACx4; 33 Rads complete 4/11; NED 5/5/11
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simplelife4real
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Posted: Jan 19 2014 at 8:28am |
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I had my last AC infusion 5 days ago (last Tuesday). On Wednesday, less than 24 hour hours later, I had an ultrasound, mamogram and met with the breast surgeon and plastic surgeon. There was still some cancer left according to the ultrasound. It was 14mm at the widest part....way down from 2.3 cm at the time of diagnosis, but I was quite upset to see the cancer on the ultrasound. Wednesday was an understandably exhausting day!
I still have hope for a pCR since the last AC really hadn't had time to work yet, but I'm not as hopeful as I had been. My MO has approved me getting my port out at the time of surgery. I believe she considers whatever cancer load I may have left not sufficient to need to treat with additional chemo since the tumor has shrunk so much. I feel like one cancer cell left is one too many! I have some time to think about all this. They haven't called me yet with a surgery date yet. I think it will be around Valentine's Day. I'll be having a lumpectomy with an ALND because I was node positive at the time of diagnosis. |
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DX Aug 2013 @ age 60, Stage 2b, grade 3, 2.3 Cm, node positive, BRCA-; neoadjuvant taxolx12 and ACx4:
2/13/14 LX and ALND-2mm residual in 2 nodes |
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Jojocat
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Joined: Jan 11 2014 Location: New York Status: Offline Points: 108 |
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Posted: Jan 19 2014 at 9:08am |
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Hi Kay:
You wont know anything until you get the pathology report after your surgery. The ultra sound just shows the mass. It does not mean the mass is cancer. right? Have you heard about immunotherapy(raise own cells to kill cancer)? I hope there will be a clinical trial of immunotherapy for people who do not achieve PCR to join. Joanie |
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MandyM16
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Posted: Feb 05 2014 at 9:29pm |
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Not sure if you would qualify or not but you might want to look at clinical trials of Eribulin conducted through Sarah Cannon in Nashville. I also had neoadjuvant chemo 4 ac and 12 Taxol with really good results by e time of surgery but there was still some residual disease so my oncologist recommended a clinical trial of Eribulin. I finished Eribulin on early September 2013. It was fairly easy to tolerate (much better than ac) and hopefully it will prevent a reoccurrence. Good luck to you!
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Lillie
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Posted: Feb 05 2014 at 9:53pm |
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Hi Kay,
Just noticed that your surgery will be sometime near valentines day. How are you since your last treatment? Do you know if you had any more shrinkage of the tumor after the last infusion? Please let us know how you are.
God Bless,
Lillie
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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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simplelife4real
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Posted: Feb 06 2014 at 11:58am |
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Thanks for asking Lillie!
My surgery is a week from today....Feb. 13. I can't feel my tumor any more at all, so I'm keeping my fingers crossed for a pCR. I keep telling myself that even if I don't get a pCR that it's clear that chemo has done a lot in terms of killing cancer cells. If there is something left, it will be very small. I'm hoping that means that the chemo got all the loose cancer cells floating around. I'll post here as soon as I hear anything. |
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DX Aug 2013 @ age 60, Stage 2b, grade 3, 2.3 Cm, node positive, BRCA-; neoadjuvant taxolx12 and ACx4:
2/13/14 LX and ALND-2mm residual in 2 nodes |
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