Question about conflicting chemo opinions
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Topic: Question about conflicting chemo opinions
Posted By: AC and JC
Subject: Question about conflicting chemo opinions
Date Posted: Apr 16 2009 at 12:50pm
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Hey all: My wife has stage IIa TNBC (2.2cm, no nodes). She's had a mastectomy (last month) and also has the BRCA1 mutation (likely to follow up with another mastectomy). My question is about conflicting opinions on her chemo. The hospital where she was originally diagnosed and had surgery have recommended (via their tumor board) DD AC + DD T & Carboplatin. We've since switched treatment hospitals (she was traveling out of country when diagnosed & initially treated). Our new Dr., who we like, has recommended only DD AC + DD T, saying that he's not comfortable with the tested efficacy of Carboplatin (i.e. not enough potential benefit for the extra toxicity). We are a bit torn here obviously, since we're under equipped to deal with such a conflict. On one hand, we want to be aggressive as possible so we don't have to deal with "what ifs". But, it seems there are some concerns about Carboplatin in my wife's case. We are not doctors but we're doing what we can to educate ourselves and make the best decision. Any thoughts about this situation? Anyone go through something similar? Thanks, Jason |
Replies:
Posted By: trip2
Date Posted: Apr 16 2009 at 1:29pm
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Jason, http://annonc.oxfordjournals.org/cgi/content/full/18/1/202 - http://annonc.oxfordjournals.org/cgi/content/full/18/1/202
http://www.cancernetwork.com/display/article/10165/1340727?pageNumber=3 - http://www.cancernetwork.com/display/article/10165/1340727?pageNumber=3
http://meeting.ascopubs.org/cgi/content/abstract/25/18_suppl/1086 - http://meeting.ascopubs.org/cgi/content/abstract/25/18_suppl/1086
http://clinicaltrials.gov/ct2/show/NCT00691379 - http://clinicaltrials.gov/ct2/show/NCT00691379
http://www.chemocare.com/bio/carboplatin.asp - http://www.chemocare.com/bio/carboplatin.asp
Maybe some of these articles will help you. I don't believe, although could be wrong, that many if any get carboplatin right off the bat but some docs may be incorporating this now. There are still trials going on but the word is that the platins hold hope for us.
What your second doc is suggesting is what many of us get. You might even consider a third opinion but I know it is stress and money.
I have not experienced this situation and hopefully someone can come along soon to help.
Best of luck with your decisions.
------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |
Posted By: cg---
Date Posted: Apr 16 2009 at 1:54pm
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New Insights about Platinum Sensitivity Extending these findings John Chia's team7 conducted a retrospective analysis to determine the response rates of such patients treated with paclitaxel and carboplatin (TC) chemotherapy, finding that TC induces a high response rate in patients with metastatic / recurrent triple negative disease, even for patients with prior exposure to taxanes and moreover, and impressively, even for those with large volume disease. Collectively, therefore data from preclinical and clinical studies indicate that both BRCA1 and triple negative tumors have unique sensitivities to platinum agents such as cisplatin and carboplatin, as well as to the genotoxic biological agents, the PARP (poly(ADP-ribose)polymerase) inhibitors, and these observations are helping to guide a new series of clinical trials, and at least as importantly, helping to hone and optimize the treatment of triple negative disease, and suggest for instance that adding platinum agents to taxane chemotherapy may induce high levels of efficacy for triple negative disease. Dear Jason,
I hope the above explains the reason why one doctor is considering a platinum agent. Your wife is BRCA1 positive.
Dose Dense AC + T has been the "gold standard" used for the last couple of years. The more current trend is AC x 4 followed by Taxol weekly for 12 weeks (it is more tolerable for side effects) and when studied against giving it every 3 weeks it was found to be more effective - (no trials were done with it being given every 2 weeks). Triple Negative is aggressive, and sneaky and the current thinking is to hit it hard right from the starting gait. I am sure bilateral mastectomies and bilateral ovary removal were also mentioned to your wife since she is BRCA1 positive. Is the chemotherapy tough for some - yes, but for others not. Given enough support, treatment for side effects, your dear wife will be able to do whatever treatment plan she decides on....and we will be here for you every step of the way.
I think it would be a good idea to ask each oncologist why they proposed the chemotherapy regimen they presented as options.
If you have any more questions or thoughts you went to discuss - please write again.
Love,
Connie
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Posted By: AC and JC
Date Posted: Apr 16 2009 at 2:24pm
Thanks Pam and Connie. That info is very helpful. We are writing to our past doc to get more info, and will follow up with the current onc on our next visit. Chemo of any sort is on pause now while she gets another MRI for a potentially suspicious area in her other breast (sigh, it never ends  ).I think I am mainly frustrated with the general idea of conflicting opinions. It just continues to drive home the fact that this is not at all a straightforward disease if there is disagreement on treatment from docs that are on top of their fields - that's what's really depressing me now. It would be great to be dealing with something much simpler, but such is life I suppose. Thanks, Jason |
Posted By: cg---
Date Posted: Apr 16 2009 at 2:49pm
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Jason,
You tell us what they said and we will find the medical opinion for and against each treatment plan.
Connie
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Posted By: trip2
Date Posted: Apr 16 2009 at 3:00pm
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You are so right Jason, this is all very complex. Just when you think you might have things figured out they come out and say something else.
So we do the best we can with the info we can gather and try not to look back. We just know we did the best we could at the time.
So your wife has found another suspicious lump? Good grief, when will the mri be done?
You know what, this is hard on you also and sounds like you could use a break. Don't forget some "Jason" time, ok? ------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |
Posted By: AC and JC
Date Posted: Apr 16 2009 at 7:11pm
| Thanks Pam - her MRI is actually on Monday. She didn't really find it, but it did show up as an area of possible concern on the original MRI (the radiologist that reviewed the original MRI noted it as likely benign but suggested short interval follow up). When our new doc saw it on the MRI report, he wanted to have it checked again to make sure we know what's there before any treatment starts. So, best case scenario, it will get confirmed as benign and we can start treatment in the next couple of weeks. |
Posted By: trip2
Date Posted: Apr 17 2009 at 4:34pm
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Good, sounds like your doc is doing the best thing.
Let us know how it goes and have a good week-end! ------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |