TNBC Neoadjuvant vs Endocrine therapy
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Topic: TNBC Neoadjuvant vs Endocrine therapy
Posted By: trip2
Subject: TNBC Neoadjuvant vs Endocrine therapy
Date Posted: May 16 2009 at 4:21pm
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http://www.curetoday.com/index.cfm/fuseaction/news.showNewsArticle/id/5/news_id/1067 - http://www.curetoday.com/index.cfm/fuseaction/news.showNewsArticle/id/5/news_id/1067 ------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |
Replies:
Posted By: JanetK
Date Posted: May 16 2009 at 4:33pm
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Thanks Pam, Great article. Makes me feel a little better about going this route. LOVE & HUGS Janet ------------- TNBC feb 13,2009 2.6x 3.5 neoadjuvant chemo 8 rounds Lumpectomy successful Oct 09 axillary node dissection Nov 09 still awaiting results |
Posted By: krisa
Date Posted: May 16 2009 at 4:43pm
| it compared chemo before surgery and endocrine therapy before surgery. i dont read in this article that having chemo before surgery or after has a different outcome. |
Posted By: trip2
Date Posted: May 16 2009 at 4:46pm
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I will look into it Krisa. It does seem I am running into alot of articles lately saying neoadjuvant is advised for tnbc.
Will get back with ya on that. How are you doing Krisa, feeling ok??
Janet I feel better making you feel better. I've been worried about you.  ------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |
Posted By: JanetK
Date Posted: May 16 2009 at 5:06pm
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My surgeon and Onc both have said that the outcome of survival going neoadjuvant is the same as going adjuvant. The benefits of going Neo is that they can actually watch what and how the tumor responds. If its out they cant watch it! Also, if the tumor shrinks enough that breast conservation is possible(with clear margins and no node involvement) I feel that I am ahead of the game. This is EXACTLY what mine is doing! I had my third chemo yesterday and the tumor has shrunk 25% and has almost broken in half! I am so UP WITH THAT!!! ------------- TNBC feb 13,2009 2.6x 3.5 neoadjuvant chemo 8 rounds Lumpectomy successful Oct 09 axillary node dissection Nov 09 still awaiting results |
Posted By: trip2
Date Posted: May 16 2009 at 7:15pm
Ohhhh Janet that is so cool. ------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |
Posted By: mefowler
Date Posted: May 16 2009 at 7:50pm
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The reason that survival does not change overall for patients who receive neoadjuvant chemotherapy is that survival only improves for people who have a complete pathologic response to the neoadjuvant chemotherapy. If a person has a complete pathologic response (no remaining invasive cancer, the survival of those people goes up to ~95%. Those who do not have a complete pathologic response goes down to ~68%. All together these average 80%. For adjuvant chemotherapy, there is no way of determining whether there is a response of any residual cancer cells, so some people do well and others do not, but one can't tell who is responding because there is no mass that can be followed, since it was surgically removed before the chemo.
This is not necessarily bad, it just means there is more uncertainty for those who receive adjuvant chemotherapy. For those who receive neoadjuvant chemotherapy and do not have a complete response, adjuvant therapy is often done to mop up any remaining cancer.
Maire
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Posted By: Frenchie
Date Posted: May 17 2009 at 3:31am
This has puzzled me for a while, and I'll be asking my wife's Onc of the next few weeks. Why, with TNBC having recurrence rates higher than other strains, is additional chemo not administered to adjuvant patients anyway? Following mastectomy, Andrea's come through the AC & Taxol, is now doing well on Rads, and her hair is coming back. So after the next couple of months. If she's still NED and strong again, does it not make sense to go through further chemo as insurance - perhaps Carboplatin (which has shown some promise with TNBC)? ------------- Age 39 Dx Nov 2008 2cm 2/13 nodes - 4 x AC 4 x Taxol 2 Weekly - 25 rads. Avastin (trial). |
mefowler wrote:Posted By: dmwolf
Date Posted: May 17 2009 at 6:17am
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Frenchie, Additional chemo is not administered to adjuvant patients (or to many neoadjuvant patients without pCR) because as counterintuitive as it is, more chemo does not necessarily mean better odds. They used to give chemo to women over two years, and experimented with really high doses. Over time, clinical trials showed that all this did was lower quality of life. It did not result in more cures. That's why the current standard is a fairly short course of chemo. The only realm that's been overturned, as far as I know, is with hormonal therapies for ER+s. There, longer therapy is indeed better, as one can see with the changing standards. Now ER+s have 5 years of tamoxifen and some years of aromatase inhibitors after that. It used to be that they were put on tamoxifen for just 3 years, and before that, just for 18 months. The difference might be that hormone blockers don't really kill cancer - they just keep it quiet. Then over time normal cell death rates can wipe out isolated interlopers. The drugs we take are cytotoxics - they work by killing actively dividing cells. For many women, the cancer contains cell subpopulations that are not sensitive to the drugs. Therefore, higher concentrations or longer periods of therapy don't affect these cells. Also, TNBC has a highly disordered genome, much more so than ER+s. This might mean that they are genetically unstable, which means that they evolve rapidly. Slightly resistant subpopulations can therefore possibly evolve to highly resistant subpopulations during therapy. More is not always better. We are in a primitive era of medicine. Someday in the I hope not-too-distant future, people will look back at these treatments and shudder at how off base they are. We are largely at the mercy of luck. -Denise ------------- DX 2/08@43 stg II IDC; gr2,0 nodes. Neoadj chemo, first ACx2 (fail) then CarboTaxotereX6(better). Lump, Rads done 11/08; Clodronate. False alarm queen: PetCT lung & TM marker. NED. PBM w/recon 9/10. |
Posted By: dmwolf
Date Posted: May 17 2009 at 6:22am
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One more thing about neoadjuvant. The studies show no survival difference in neoadjuvant vs adjuvant, but that is for neoadjuvant applied *as if* no new information were being supplied by the response of the tumor. Some day, we may see a survival difference in favor of neoadjuvant if we get better at using the information from the tumor response to adaptively change chemos if the tumor is not responding. Many people are working on that, and there is a trial starting soon, called ISPY2, that does exactly that. -Denise ------------- DX 2/08@43 stg II IDC; gr2,0 nodes. Neoadj chemo, first ACx2 (fail) then CarboTaxotereX6(better). Lump, Rads done 11/08; Clodronate. False alarm queen: PetCT lung & TM marker. NED. PBM w/recon 9/10. |
Posted By: Frenchie
Date Posted: May 17 2009 at 7:18pm
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Hey Denise
Great stack of information - thanks.
So from the clinical trials you mention, this implies that, regardless of the tumour reaction with Neoadjuvant chemo, any additional chemo is fruitless.
Think I'm more confussed than ever now.
 ------------- Age 39 Dx Nov 2008 2cm 2/13 nodes - 4 x AC 4 x Taxol 2 Weekly - 25 rads. Avastin (trial). |
Posted By: Frenchie
Date Posted: May 17 2009 at 7:22pm
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One more point guys.
Isn't the title of this thread misleading?
It implies TNBC is treated better with Neoadjuvant compared with Adjuvant. Whereas, this isn't what the report is about at all. ------------- Age 39 Dx Nov 2008 2cm 2/13 nodes - 4 x AC 4 x Taxol 2 Weekly - 25 rads. Avastin (trial). |
Posted By: trip2
Date Posted: May 17 2009 at 7:41pm
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I don't understand what you mean Frenchie.
The article says neoadjuvant is better for TNBC. ------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |
Posted By: krisa
Date Posted: May 17 2009 at 8:34pm
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pam, what the report said was-that neo adjuvant chemo is more effective than neo adjuvant endocrine therapy...not that neo adjuvant chemo is better than adjuvant chemo...anyhoo, that is what i got from the article...now i will have to go read it again. |
Posted By: Suzanne
Date Posted: May 17 2009 at 8:43pm
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Pam, I believe Krisa and Frenchie are correct. The article does not discuss neoadjuvant vs adjuvant. Perhaps it would be good to change the topic title so others are not confused. Suzanne------------- 1/2/07 IDC, stage 1 (T1c), 1.56cm, lumpectomy 1/8/07, triple neg., grade 3, sentinel lymph node biopsy negative, BRCA 1/2 negative; 4 AC/4 Taxol dose dense, 30 rads 2/07-7/07 |
Posted By: Frenchie
Date Posted: May 17 2009 at 8:44pm
That's correct guys - that's what I'm trying to say.
First impressions from the thread title indicate that neoadjuvant chemo is better than adjuvant chemo - which isn't the case. ------------- Age 39 Dx Nov 2008 2cm 2/13 nodes - 4 x AC 4 x Taxol 2 Weekly - 25 rads. Avastin (trial). |
Posted By: lisalaw
Date Posted: May 18 2009 at 3:49am
| I am curious where you are getting your statistics on survival for those who have achieved pathological complete response with neoadjuvant therapy and the statistics for those who have not. I would love to believe that I have a 95% survival rate since I had a pathological complete response to my 7 cm node positive grade 3 IDC tumor after neoadjuvant chemo and lumpectomy and radiation. |
Posted By: trip2
Date Posted: May 18 2009 at 7:23am
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Okie dokie ------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |
Posted By: mefowler
Date Posted: May 18 2009 at 9:19am
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Dear Lisalaw, From the Journal of Clinical Oncology in 2/2008 is one of the many places I have seen this statistic. The web address is: http://www.medwire-news.md/380/73077/Breast_Cancer/Residual_disease_increases_mortality_in_triple-negative_breast_cancer_.html - http://www.medwire-news.md/380/73077/Breast_Cancer/Residual_disease_increases_mortality_in_triple-negative_breast_cancer_.html
Hope this is helpful.
Maire
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Posted By: trip2
Date Posted: May 18 2009 at 3:29pm
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Thank you so much Maire, I will put this in the Resource section. ------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |
Posted By: TracyBendele
Date Posted: May 25 2009 at 6:30pm
| I just looked up ISPY2 to find out about it, and found nothing at all. Can you direct me to info about this drug and how it works? |