Post surgical chemo after neoadjuvant chemo?
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Topic: Post surgical chemo after neoadjuvant chemo?
Posted By: simplelife4real
Subject: Post surgical chemo after neoadjuvant chemo?
Date 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 ------------- 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 |
Replies:
Posted By: 123Donna
Date 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 ------------- 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 |
Posted By: Lee21
Date 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" rel="nofollow - 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 ------------- 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 |
Posted By: simplelife4real
Date 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 ------------- 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 |
Posted By: littleradish
Date 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. ------------- 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 |
Posted By: Lillie
Date 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 ------------- 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 |
Posted By: simplelife4real
Date 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! ------------- 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 |
Posted By: Jojocat
Date 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. |
Posted By: Cathieroh
Date 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 ------------- 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 |
Posted By: simplelife4real
Date 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 http://clinicaltrials.gov/ct2/show/NCT01289353?recr=Recruiting&cond=triple+negative&cntry1=NA%3AUS&rank=48" rel="nofollow - http://clinicaltrials.gov/ct2/show/NCT01289353?recr=Recruiting&cond=triple+negative&cntry1=NA%3AUS&rank=48 ------------- 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 |
Posted By: Jojocat
Date 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 |
Posted By: clarkjennifer
Date Posted: Jan 13 2014 at 3:23am
| 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. |
Posted By: simplelife4real
Date 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. ------------- 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 |
Posted By: Loveforlife
Date 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 ------------- 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 |
Posted By: TNinTN
Date 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 ------------- 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 |
Posted By: simplelife4real
Date 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. ------------- 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 |
Posted By: Jojocat
Date 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 |
Posted By: MandyM16
Date Posted: Feb 05 2014 at 9:29pm
| 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! |
Posted By: Lillie
Date 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 ------------- 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 |
Posted By: simplelife4real
Date 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. ------------- 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 |
Posted By: MLindaG
Date Posted: Feb 07 2014 at 6:52am
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Simple, Thinking of you and wishing you the best! I had my lumpectomy last year 2/13! Keep positive thoughts going! :) ------------- 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. |
Posted By: simplelife4real
Date Posted: Feb 07 2014 at 7:23am
MLindaG, Thanks! Congratulations on your one year and getting a pCR. Hopefully, 2/13 will be a lucky day for me too. ------------- 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 |
Posted By: MLindaG
Date Posted: Feb 07 2014 at 8:43am
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Simple, Do you how similar our journeys are?? Just to let you know.......on my 9th Taxol treatment my Onc said....I feel something but I'm not sure it is still the lump or just fibrous tissue that is sometimes left after the cancer is gone.......then at my 12th visit......could not feel anything....... Went for an MRI......they saw nothing but said you can't be sure until after surgery and they do the path report. I did not get any scans during or between my chemo's ( I did the A/C first and the 12 taxol second). They felt I should leave my port in just incase they felt I needed to do Chemo after surgery. I ended up having the port out in June which they gave me a choice of keeping it in or taking it out. Will be thinking of you next week! Prayers coming your way! Fingers crossed for a PCR! ------------- 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. |
Posted By: simplelife4real
Date Posted: Feb 07 2014 at 10:18am
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Linda, I noticed the same thing about how similar our situations have been! My MO has approved taking my port out, but I'm seriously thinking of telling them I want to leave it in. Just in case. ------------- 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 |
Posted By: simplelife4real
Date Posted: Mar 02 2014 at 7:46pm
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Well, I had my surgery. I couldn't decide until the day of the surgery whether to let them take my port out. I told them to take it out at the last minute. I got my path report. There was no sign of the primary tumor in my breast, but I had 2 positive lymph nodes with my ALND. The largest amount of cancer was 2mm in one node. I didn't think to ask how much cancer was in the other node when the BS called with the path report. I have appointments with both my MO and BS on Wednesday. I also have an appointment with the RO that day too. Long day.... I plan to question my MO in particular about what the significance is of the cancer in my nodes after neoadjuvant therapy. I cried for two days after I got the call with the report, but now, after doing some research...I'm realizing I was very close to a pCR. At least, I think I was. I'll learn a lot more on Wednesday. ------------- 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 |
Posted By: JulieKCA2013
Date Posted: Mar 03 2014 at 6:52pm
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I had my surgery July 2013. At the time I was not sure what the path report would say. I could feel a hardening where I had first felt my lump but I hoped the mass was just scar tissue. I too felt crushed when I got the news I had some residual. Mine was .9mm left in the largest diameter. I had 4 out of 24 nodes with positive. They did not measure the cancer in the nodes but I was told it did not break the node capsule and they were not the most axillary nodes (not the farthest from the primary from what was taken). When my doctor said standard care was just to observe I too wanted more. We know chemo acts better on a smaller cancer load, why not come out guns loaded? I was fortunate the eribulin trial was in state for me. My doctor almost halted the trial, she wasn't familiar with the drug and didn't like that it was "taxol like" and I had already experienced some neuropathy. Also I would have to do radiation with the treatment. You must start the treatment prior to radiotherapy. So I did my research and found eribulin is used with radiation in metastatic therapy. I convinced her I would be fine and if there were any ill effects I couldn't handle we would re-evaluate. I handled the trial fine. Along side of radiation I was very burned. The center I go to uses a bollus material for 25 treatments to bring the ray up to the surface. I had to stop using the bollus after 25 treatments and still had some raw skin. I used Domboro salt washes and aquafor to keep the area clean and moist. I had some neuropathy, but whether it was residual from Taxol I do not know. I do not have neuropathy now, I had my last treatment 12-3-2013. but I do notice my toe nails are not growing, also when very cold my feet hurt bad. Thanks to coldest winter in Michigan for decades. :) I wish you the best, and hope you find what you are looking for. Remember you are your best advocate and you can battle anything you put your mind to. Love Julie ------------- Dx 3-7-13 TNBC, 5cm pT2N1M0 3-19-13 ACx4, 5-14-13 Taxolx4 7-17-13 BMX ypT1N2M0(.9mm) 4/24 nodes. 10-8-13 completed Rads x 30 12-3-13 completed Eribulin Trial 10-18-13, 3-19-14 Bone/Ct Scan Clear |
Posted By: simplelife4real
Date Posted: Mar 03 2014 at 7:09pm
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Thanks Julie. I talked to my MO about this trial several months ago. She wasn't real crazy about it just because of the particular chemo, but you are the second person I that has contacted me that has participated in it without problems. It would be the easiest trial for me to participate in because they have a location in Nashville, TN which is where I'm currently getting my treatment. I'll post about it, whatever I end up doing. ------------- 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 |