Let's Talk About Chemotherapy - With or Without Chemo?

Print Page | Close Window

With or Without Chemo?

Printed From: TNBC Foundation
Category: TNBC Forums
Forum Name: Let's Talk About Chemotherapy
Forum Description: A place to discuss Chemotherapy
URL: http://forum.tnbcfoundation.org/forum_posts.asp?TID=13133
Printed Date: Mar 26 2026 at 9:22pm
Software Version: Web Wiz Forums 12.01 - http://www.webwizforums.com

Topic: With or Without Chemo?

Posted By: euniceywt
Subject: With or Without Chemo?
Date Posted: May 16 2017 at 3:46am

Hi everyone, this is a post from Taiwan. My mom was diagnosed with tnbc this March, mastectomy, two foci, one tumor size 0.9cm DCIS and another one 3.3cm also DCIS but with 0.3cm invasive, grade 2, stage IA. Most of the doctors we've consulted didn't recommend chemo for such early stage <5mm, but they left it up to us to decide since there is no standard treatment for tnbc right on this borderline, and some of them regard chemo for a case at such early stage not so effective as a preventive treatment. My mom is glad she doesn't need to go through chemo, but I am really concerned about recurrence. Anyone here has experienced similar situation to my mom's without chemo and didn't have relapse in long term? I cannot find similar case to relate to in my country, I'm really anxious whether we've made a proper choice or shall we accept chemo?

Replies:

Posted By: 123Donna
Date Posted: May 16 2017 at 9:57am

You are correct that the guidelines for chemo is 5mm. Most TNBC is diagnosed at a higher grade and stage than your mom's so it's probably the reason you can't find too many similar cases. I had a friend who was dx over 9 years ago with TNBC DCIS and lobular with a small IDC portion. She had a mastectomy only without chemotherapy and no recurrence. Wishing your mom the best.

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: Tulips
Date Posted: May 16 2017 at 9:59am

Oh Eunice, what a difficult decision! I'm sorry I can't help with having gone through the same decision, but I will just confirm that that is what I've always heard in the US--that the cutoff for standard-of-card chemo is >= 5 mm. But it sounds like this is being left up to you to weigh the pros & cons and make your own decision, which I can sympthasize with how difficult that is. Best of luck to you both!

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

Posted By: euniceywt
Date Posted: May 17 2017 at 3:23am

Dear Donna and Tulips, thank you for confirming the guideline, and I felt much reassured by knowing a case similar to my mom's without recurrence. I was in a panic when my mom was dx with tnbc since information about this type of cancer I've searched in our country appears ugly......but now I believe we can fight that beast! I am glad I've found this place where I can seek support and info. Wish both of you nothing but the best Smile

Posted By: gordon15
Date Posted: May 19 2017 at 5:07pm

euniceywt: I don't know what age your Mom is, but I think my numbers are accurate, that chemotherapy increases lifetime survival (or chances of recurrence, that is a different percentage)by about 5%, so if she is older (over 70) if it was my mother, I would ask that question of percentages versus damage from chemo drugs.

-------------
wife: IDC/Lobular Stage2B 2008 lumpectomy/TAC+rads
TNBC Stage 3A/w/metaplastic/squamous Nov2015 Carboplatin-Gemzar chemo/masectomy Taxolchemo+rads 4-16
PET scan stable 9-2016/ 1-2017

Posted By: euniceywt
Date Posted: May 20 2017 at 1:03am

Thanks for providing certain statistics, Gordon. My mom is 59, but she is not willing to accept chemo unless it's being recommended (highly I may say) by doctor. One of the oncs we've consulted said that the percentage of chances of recurrence reduced by chemo is less than 1% for case like hers. I'm not sure why that is but I guess it might be related to her IDC tumor size less than 5mm. We've got four opinions, two of them didn't recommend chemo and the other two left it up to us. We finally decided not to do chemo and try to keep a healthy diet plus regular exercise. Thanks again for informing me the number!
Eunice

Posted By: gordon15
Date Posted: May 22 2017 at 6:09pm

euniceywt: you said : < diagnosed with tnbc this March, mastectomy, two foci, one tumor size 0.9cm DCIS and another one 3.3cm also DCIS but with 0.3cm invasive, grade 2, stage IA.>

I think you made the right decision for your Mom NOT to have chemo. Like Donna said, TNBC is almost always Grade 3 (more aggressive) I stand by my statistic that most circumstances chemo reduces chances of recurrence and/or survival by "up to" 5%, but I'm not a doctor.

My wife has had an aggressive cancer that needed to be bombarded with chemo, because a 1% could make a real difference. That's why it's great you asked a lot of questions on behalf of your Mom.

-------------
wife: IDC/Lobular Stage2B 2008 lumpectomy/TAC+rads
TNBC Stage 3A/w/metaplastic/squamous Nov2015 Carboplatin-Gemzar chemo/masectomy Taxolchemo+rads 4-16
PET scan stable 9-2016/ 1-2017

Posted By: euniceywt
Date Posted: May 24 2017 at 12:35am

You are right that every percentage does count! That's why I had been struggling to make decision for my mom. Knowing that tnbc can be more unpredictable than other types, I want to make sure that we've done what's best for her after weighing pros and cons. Thank you for letting me know I've done what I can do! Best wish to you and your wife, may her be well ever after!

Posted By: gordon15
Date Posted: May 24 2017 at 8:33pm

Thanks for letting us know, if there is only a 1% survival rate for NON-recurrance after 5 years, but there is a higher rate of getting leukemia from chemo, that is the question for your Moms' oncologist. Also, chemo and radiation cause mutations to the dna.

It's great you have weighed all the options for your Mom. Radiation and chemo both cause mutations to the dna and existing cancer, so the cancer can come back, if it's chemo-resistant, somewhere else, or stronger.

That's why it's important to weigh the remedies for an early stage cancer vs an aggressive Stage 3 cancer, which my wife was told she needed to undergo the maximum therapy.

Hope this helps....

-------------
wife: IDC/Lobular Stage2B 2008 lumpectomy/TAC+rads
TNBC Stage 3A/w/metaplastic/squamous Nov2015 Carboplatin-Gemzar chemo/masectomy Taxolchemo+rads 4-16
PET scan stable 9-2016/ 1-2017

Posted By: euniceywt
Date Posted: May 27 2017 at 10:20am

Just like what you said, treatment differs according to stage. According to our onc, since the recurrence of IDC tumor less than 5mm is comparatively low, the benefit brought by chemo might be less than 1%, but for most tnbc cases the effectiveness is much higher than that. I've came across a study even claims that chemo reduces recurrence by 41%. Most oncs in our country also consider ki67 as a useful info, but some studies don't yet agree on that. Thank you for sharing those info about chemo and radiation, Gordon. I'm really glad I found this site!
Eunice

Posted By: pshemant
Date Posted: Jun 07 2017 at 8:13am

Dear All,

I am newly joined to this forum from Pune, India and wanted to your opinion and experiences on CHEMO NEEDED or NOT?

My mother Age-69 years, Scantty DCIS of comedo type. has TNBC with Mastetomy done with tumor size around 20mm, Nuclear Grade II, Stage I (Early stage II). All removed 24 lymph are active and free of Tumor metastases 0/24; Tumor lymph metastases 0/20(Right Axillary) + 0/4 (Right Apical Lymphnodes; EIC negative ; Modified RB score is 3+2+2=7

Pathalogical Stage is pT2N0Mx.

As it is not spread out of the lump. Still CHEMO is needed ???

Please share...

Posted By: 123Donna
Date Posted: Jun 07 2017 at 8:59am

pshemant,

I believe your mother is considered Stage 2 TNBC. Chemo is recommended for Stage 2 Triple Negative. Chemo is recommended when the tumor is greater than 5mm.

http://www.nccn.org/patients/guidelines/stage_i_ii_breast/files/assets/basic-html/page-48.html" rel="nofollow - http://www.nccn.org/patients/guidelines/stage_i_ii_breast/files/assets/basic-html/page-48.html

Donna

Posted By: euniceywt
Date Posted: Jun 08 2017 at 10:33am

Hi pshemant, as Donna said, chemo shall be recommended for your mother's case with regard to her tumor size. Chemo for this phase after surgery mainly aims to reduce the risk of recurrence.

Eunice

Posted By: pshemant
Date Posted: Jun 09 2017 at 12:48am

What will be the chances of reoccurrence in my mother case?

Posted By: 123Donna
Date Posted: Jun 09 2017 at 11:20am

Her oncologist will be able to tell her the statistics. It depends on several variables like type (TNBC), size, grade, margins, lymph node involvement, etc. I can tell you in my case I had stage 1, grade 3, 0 out of 5 nodes all clear, clear margins, mastectomy. I was told without chemo, I had a 25% chance of recurrence. With chemo the odds improved to about 13%.

Posted By: euniceywt
Date Posted: Jun 09 2017 at 12:28pm

Pshemant,

It's my understanding that since your mother's prognostic factors already meet the above mentioned criteria of guideline, the advantages brought by chemo may accordingly outweigh the disadvantages, but don't quote me on that, you'd better consult her oncologist. As Donna said, there are many markers to consider.

Posted By: 123Donna
Date Posted: Jun 09 2017 at 4:25pm

Pshemant,

I remember my oncologist telling me that TNBC is more likely to spread through the blood or lymphatic system so adjuvant chemo is used to try and reduce the risk.

Posted By: pshemant
Date Posted: Jun 10 2017 at 1:30am

After getting if we are getting the advantage of safer side(minimize recurrence rate). But also more interested to know the chemo disadvantages on overall body fitness when patient is in old age of 69years.
Please share the experience, if anybody can.
Thanks !

Posted By: 123Donna
Date Posted: Jun 10 2017 at 12:03pm

I found these links:

http://www.breastcancer.org/research-news/chemo-less-beneficial-for-women-over-80" rel="nofollow - http://www.breastcancer.org/research-news/chemo-less-beneficial-for-women-over-80

http://www.cancernetwork.com/oncology-journal/cancer-chemotherapy-elderly-patient" rel="nofollow - http://www.cancernetwork.com/oncology-journal/cancer-chemotherapy-elderly-patient

http://www.cancernetwork.com/oncology-journal/adjuvant-therapy-breast-cancer-women-70-years-age-and-older-tough-decisions-high-stakes" rel="nofollow - http://www.cancernetwork.com/oncology-journal/adjuvant-therapy-breast-cancer-women-70-years-age-and-older-tough-decisions-high-stakes

http://theoncologist.alphamedpress.org/content/15/suppl_5/57.full" rel="nofollow - http://theoncologist.alphamedpress.org/content/15/suppl_5/57.full

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874410/" rel="nofollow - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874410/

Posted By: euniceywt
Date Posted: Jun 17 2017 at 6:43am

Dear all,

I hate to feel like this, but my mind is no longer at peace with the decision we've made (no chemo for T1a tumor less than 5mm) once I happened to see this:

http://www.practiceupdate.com/content/stage-trumps-biology-for-most-small-triple-negative-breast-cancers/21908" rel="nofollow - http://www.practiceupdate.com/content/stage-trumps-biology-for-most-small-triple-negative-breast-cancers/21908

It says "Those who received chemotherapy for T1a TNBC as defined by a tumor size not greater than 5 mm had a 5-year distant relapse-free survival (DRFS) of 100%, but the rate was still close to 95% in those not treated with chemotherapy." Someone sent me another study even claims 10-year DRFS 100% for T1a TNBC with chemo, but the number drops to nearly 70% without chemo?? How come the results are at odds that the information I saw before states that there is no significant difference for T1a TNBC with or without chemo? Anyone here has any other sources of info to share or any thought about such disparity? I know it may be too late for my mom to have chemo that it has been three months since her mastectomy, but at this moment I feel like urged to talk her into chemo regardless of what our oncologists said......It may sounds crazy but I think maybe deep inside I feel insecure about tnbc without chemo, please help......

Eunice