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important-TNBC may change characteristics

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=13865
Printed Date: Aug 13 2022 at 4:59am
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Topic: important-TNBC may change characteristics
Posted By: SagePatientAdvocates
Subject: important-TNBC may change characteristics
Date Posted: Jun 21 2022 at 8:36pm
Dear TNBC family,

I think this article is important. 

A study by Dr. Naoto Ueno a Breast Medical Oncologist at MD Anderson Cancer Center in Houston shows that the TNBC characteristics may change-

https://ascopubs.org/doi/abs/10.1200/PO.20.00368?journalCode=po" rel="nofollow - https://ascopubs.org/doi/abs/10.1200/PO.20.00368?journalCode=po

The above study may pertain to certain members of this wonderful forum. I am not a medical professional so please don't rely on anything that I am writing but go to the article above. Dr. Ueno also answers questions. 

with my love to all here,

Steve


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I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates



Replies:
Posted By: 123Donna
Date Posted: Jul 15 2022 at 7:23pm
Hi Steve!

Thanks for posting this very interesting study showing a high percentage (56%) of sub-type change after neoadjuvant chemo without a pathological complete response.

PURPOSE

Lehmann et al have identified four molecular subtypes of triple-negative breast cancer (TNBC)—basal-like (BL) 1, BL2, mesenchymal (M), and luminal androgen receptor—and an immunomodulatory (IM) gene expression signature modifier. Our group previously showed that the response of TNBC to neoadjuvant systemic chemotherapy (NST) differs by molecular subtype, but whether NST affects the subtype was unknown. Here, we tested the hypothesis that in patients without pathologic complete response, TNBC subtypes can change after NST. Moreover, in cases with the changed subtype, we determined whether epithelial-to-mesenchymal transition (EMT) had occurred.



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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



Posted By: Penny
Date Posted: Jul 18 2022 at 3:13pm
I have a question that seems simple.  When you have a lumpectomy and "clear margins" is that considered a PCR?  Just wondering.  

Chemo mops it up post and radiation finishes the project.  Do I have this right?


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DX IDC, TNBC 12/7/16 (age 55), Stage 1a Grade 2, .6cm, 0/1 nodes, Lumpectomy & node dissection 12/22/16, BRCA1&2 negative 1/23/17 Chemo TC. Chemo completed 3/28/17. 30 RADs completed 6/6/17.



Posted By: SagePatientAdvocates
Date Posted: Jul 18 2022 at 4:08pm
Hi Penny,

I don't think it is that simple because many people on this forum have had lumpectomies but have not had neo-adjuvant chemotherapy, or even at times, rarely, no chemotherapy post lumpectomy. 

https://Pathological%20complete%20response%20%28pCR%29%20is%20defined%20as%20disappearance%20of%20all%20invasive%20cancer%20in%20the%20breast%20after%20completion%20of%20neoadjuvant%20chemotherapy,%20although%20some%20authors%20require%20clearance%20of%20residual%20disease%20in%20axillary%20nodes%20as%20well%20%28von%20Minckwitz%20et%20al.,%202012%29." rel="nofollow - https://Pathological complete response (pCR) is defined as disappearance of all invasive cancer in the breast after completion of neoadjuvant chemotherapy, although some authors require clearance of residual disease in axillary nodes as well (von Minckwitz et al., 2012).

So, in the case you are mentioning the chemotherapy would have had to be completed prior to the lumpectomy for it to be defined as a pCR. It sounds like you had a lumpectomy and then chemo?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249452/#:~:text=Pathological%20complete%20response%20%28pCR%29%20is,et%20al.%2C%202012%29." rel="nofollow - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249452/#:~:text=Pathological%20complete%20response%20(pCR)%20is,et%20al.%2C%202012).

Hope the above helps. Also, there are women who have neoadjuvant chemo and then bi-lateral mastectomies (like my daughter) who did not have lymph node involvement and were advised that they did not need radiation therapy. The bi-lateral mastectomies were eventually advised due to her having the BRCA mutation. Unfortunately, her breast surgical oncologist did not have her tested for the BRCA mutation in 2004. That still happens today but, fortunately, no genetic testing happens much less frequently.

warmly,

Steve


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I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates


Posted By: Penny
Date Posted: Aug 03 2022 at 5:21pm
Thanks Steve.  

My path was lumpectomy, chemo (4 rounds) then 30 days of RADS.  A lot for a small stage 1 TNBC.  


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DX IDC, TNBC 12/7/16 (age 55), Stage 1a Grade 2, .6cm, 0/1 nodes, Lumpectomy & node dissection 12/22/16, BRCA1&2 negative 1/23/17 Chemo TC. Chemo completed 3/28/17. 30 RADs completed 6/6/17.



Posted By: SagePatientAdvocates
Date Posted: Aug 03 2022 at 7:27pm
Hi Penny,

I think one of the few things that I have learned for sure in the last 18 years helping my daughter and then many on this site with TNBC is that oncologists can craft protocols and not know with any precision whether they will work or not.

I rejoice in your information, below, that you have just passed your 5 year mark passed your RADS and I don't see any other issues, which unfortunately is not the case, all too often, with others on this forum. 

I tell everyone I help to "please try to find the beauty in each day" and be grateful for that beauty. My daughter is now NED for 18 years and we are both grateful she is and I am grateful to see no further incidents after 2017 in your history.

Could you have gotten by with less treatment? Maybe? But what you did, seems to have worked, and for others here with less or more treatment it has not for whatever reason.
So, I rejoice for you that you seem to be NED, the nicest acronym in the English language to me, No Evidence of Disease. May it always continue for you, my daughter and for so many here.

And for those of you still fighting the fight, my heart is with you and I wish you success and hope you can find the beauty in each day, as often as possible. 

with my love to all here,

Steve


-------------
I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates



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