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Attention Newbies: Important New Chemo Study

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Topic: Attention Newbies: Important New Chemo Study
Posted By: dmwolf
Subject: Attention Newbies: Important New Chemo Study
Date Posted: Jan 12 2011 at 5:40pm

Newbies: you might want to discuss this study with your doctor as you work together to come up with a treatment plan.


Chemotherapy Sequence Affects Early Breast Cancer Outcomes

Elsevier Global Medical News. 2011 Jan 7, B Jancin

SAN ANTONIO (EGMN) — The sequence in which paclitaxel and anthracyclines are given for treatment of early breast cancer makes a big difference in long-term outcomes.

That's the conclusion reached in what is believed to be the largest-ever retrospective study of the clinical impact of the sequencing of taxanes and anthracyclines. The study involved 3,010 early breast cancer patients who were treated during 1994-2009 and entered into the prospective online database at the University of Texas M.D. Anderson Cancer Center, Houston.

The clear winner was paclitaxel, followed by anthracycline-based therapy with 5-fluorouracil, doxorubicin (Adriamycin), and cyclophosphamide or 5-fluorouracil, epirubicin, and cyclophosphamide, Dr. Ricardo H. Alvarez reported at the San Antonio Breast Cancer Symposium.

Starting with paclitaxel rather than an anthracycline-first regimen led to better long-term results in the settings of adjuvant chemotherapy and primary systemic (or neoadjuvant) therapy.

The adjuvant chemotherapy analysis included 1,596 women, three-quarters of whom received paclitaxel followed by anthracyclines. The 5-year relapse-free survival rate with this regimen was 88.8%, compared with 79.5% when anthracyclines were followed by paclitaxel. The 10-year relapse-free survival rates were 81.8% and 73.5%, respectively.

Five-year overall survival was 93.1% with paclitaxel followed by anthracyclines, compared with 83.2% for the reverse. The 10-year overall survival rates were 83.9% and 65.6%, respectively.

In a multivariate analysis that was stratified for potential confounders, including age, clinical stage, hormone receptor status, tumor grade, and era of diagnosis, the anthracyclines-first sequence was associated with a 67% increased risk of relapse (P less than .0001) and a 2.5-fold greater risk of mortality (P = .001), according to Dr. Alvarez, a medical oncologist at M.D. Anderson.

Among 1,414 patients who underwent neoadjuvant therapy, the 5-year relapse-free survival rate was 79.0% with the paclitaxel-first regimen vs. 61.2% with the anthracyclines-first regimen. Ten-year relapse-free survival occurred in 61.7% and 50.5%, respectively, of these patients.

Overall survival was 84.2% and 66.2% at 5 and 10 years, respectively, in patients who received paclitaxel followed by anthracyclines, compared with 71.3% and 53.4% in those who got anthracyclines first.

In a multivariate analysis, the anthracyclines-followed-by-paclitaxel sequence of neoadjuvant chemotherapy was associated with an adjusted 49% higher risk of relapse (P = .01) and a nonsignificant 28% increase in risk of all-cause mortality (P = .17), compared with the paclitaxel-first strategy.

The mechanism that accounts for the increased efficacy of taxane-first regimens for treatment of breast cancer is unclear, according to Dr. Alvarez.



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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.



Replies:
Posted By: 123Donna
Date Posted: Jan 12 2011 at 7:28pm
Denise,

Thanks for posting this article.  It's the total opposite of what is usually prescribed.  Maybe tx protocol will change.

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: tAugusta
Date Posted: Jan 12 2011 at 7:38pm
I scheduled to start chemo.  So scared. Told Dr. that my insurance wouldn't start tell Feb 1. she just called
today and said "changed my mind, won't treat, come back Feb 1" Just Don't wait for chemo!

Maybe blessing as her protocol was taxol last.


Posted By: zoomommy2
Date Posted: Jan 12 2011 at 7:43pm
Thanks, Densie.  Like Donna said, it's the opposite of what most of us have gotten in the past!  Hmm, things are always changing thanks to studies that we participate in!
Lee in Denver


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dx6/09,stageII,gr3,(L)mastectomy 7/09,ACx4,Taxolx7,Avastin study,gall bladder surgery 1/10,4/11 Stage 4, mets to lung, 4/11 Started Taxotere and Xeloda, 5/11 Taxotere stopped, off Xeloda


Posted By: dmwolf
Date Posted: Jan 12 2011 at 8:16pm
It would be great if there was a way to 'pin' this thread so that it doesn't get lost with time.   Most oncologists will NOT be familiar with this result, probably for years until it makes its way into the guidelines, so it will be up to us to educate new patients so they can educate their doctors.  The gain in survival odds with this simple change in protocol is just huge. 

d




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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: The Texas Woman
Date Posted: Jan 12 2011 at 8:50pm
MDAnderson does Taxol first. I started treatment Sept. '09 so they've been doing it that way for at least that long. Can't recommend them enough!

cher


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Dx: 7/09 TN IDC Stage llB, T2, N1, Grade 3 and associated DCIS, BRCA Neg, Taxol x 12, FAC x 4, left mastectomy March 2010


Posted By: mom&grandma
Date Posted: Jan 12 2011 at 9:46pm

This is so disturbing!  MD Anderson has known about this since at least 9/2009 but Dana Farber had my daughter do AC then T.  So annoying....



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Bonnie, mom of Heather, age 32, Dx on 9/1/09 TN IDC Stage 1, 1.4 c, lumpectomy, 10/8/09, DD AC & T, 3/9/10 bilateral mastectomy and immediate reconstruction, BRCA 1/2-


Posted By: 123Donna
Date Posted: Jan 12 2011 at 9:48pm
If the data was available since 2009, why did it take over a year to publish the results? 




-------------
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: mom&grandma
Date Posted: Jan 12 2011 at 9:56pm
Just noticed patients who also had cytoxan were excluded.  Wonder why?

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Bonnie, mom of Heather, age 32, Dx on 9/1/09 TN IDC Stage 1, 1.4 c, lumpectomy, 10/8/09, DD AC & T, 3/9/10 bilateral mastectomy and immediate reconstruction, BRCA 1/2-


Posted By: The Texas Woman
Date Posted: Jan 12 2011 at 10:10pm
tAugusta, I waited five weeks to get into MDA, with the tumor visibly growing that whole time. Drove me crazy. Feb. 1 isn't so far away so hang in there. It is SO expensive to do on your own. And when you do get the insurance going, insist on Taxol first.

I'm sorry, Mom&Grandma, that your daughter's doctor did things differently. As much as I recommend MDA, my onc and I had to insist on radiation after surgery and chemo. The surgeon didn't think I needed it - and he is one of their top guys! That's why I haunt the boards, so I KNOW what I want to do. I am in charge of my own treatment! 

Good luck, everyone.

cher


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Dx: 7/09 TN IDC Stage llB, T2, N1, Grade 3 and associated DCIS, BRCA Neg, Taxol x 12, FAC x 4, left mastectomy March 2010


Posted By: 123Donna
Date Posted: Jan 12 2011 at 11:06pm
Bonnie,

Cyclophosphamide is the generic for Cytoxan.




-------------
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: mom&grandma
Date Posted: Jan 12 2011 at 11:45pm
Is this the same study?
 
Clinical Outcome of Two Sequences of Administering Paclitaxel (P) and Anthracyclines (A) as Primary Systemic Therapy (PST) and Adjuvant Chemotherapy (ACT) in Breast Cancer (BC) Patients: A Retrospective Analysis from the M. D. Anderson Cancer Center (MDACC).

Alvarez RH, Bianchini G, Hsu L, Cristofanilli M, Esteva FJ, Pusztai L, Buzdar AU, Hortobagyi GN, Valero V. The University of Texas, M.D. Anderson Cancer Center, Houston; Fondazione IRCCS- Istituto Nazionale dei Tumori, Milan, Italy


Background: P- and A-based regimens are widely used as PST and ACT of early BC. It is unknown whether the efficacy of such combinations is affected by their sequence of administration. The purpose of this retrospective analysis was to assess the clinical outcome of two different sequences of P and A in pts receiving PST and ACT.
Methods: We analyzed 3,010 pts (1,414 PST and 1,596 ACT) with stage I - III BC treated between 1994 -2009. These pts were identified through our prospective online MDACC breast cancer database. Pts treated with trastuzumab, docetaxel or adriamycin/cyclophosphamide-regimen were excluded. Pathological complete response (pCR) was defined as no residual invasive disease in breast and ipsilateral axillary lymph nodes.
Results: PST cohort included 1.071 pts (75%) with clinical stage I-IIIA and 343 (24.2%) stage IIIB-IIIC BC; 1,188 pts (84%) received the sequence P→A and 226 pts (16%) A→P. In the PST cohort 958 pts (67.7%) and 161 (11.3%) had hormone-receptor (HR) positive (+) and HER-2 + BC, respectively. ACT cohort consisted of 1,503 pts (94%) with pathological stage I-IIIA and 93 (5.82%) stage IIIB-IIIC. 1,196 pts (75%) received the sequence P→A, and 400 pts (25%) A→P. In the ACT cohort 1,122 (70.3%) and 93 (3.9%) had HR+ and HER2+ BC, respectively. Both cohorts of pts were balanced by HR-status, clinical stage, and menopausal status. The combined p-values for ACT and PST cohorts were calculated and they were significant for both RFS (p=0.022) and OS (p=0.002). In univariate analysis the sequence A→P was associated with inferior outcome. In Cox multivariate analysis, after stratification for period at diagnosis and adjustment for age, clinical stage, HR status, grade, and LVI the A→P sequence administered as PST was associated with significantly higher risk of relapse (HR 1.49; CI 1.10-2.03; p=0.01) but not death (HR 1.28; CI 0.90-1.84; p=0.17). In the ACT cohort, the Cox multivariate analysis, after stratification for age, HR status, HER2 the sequence A→P was significantly associated with higher risk of death (HR 2.02; CI 1.33-3.06; p=0.001) but not relapse (HR 1.21; CI 0.82-1.79; p=0.33).
Conclusions: The P→A sequence compared to the A→P sequence is associated with lower risk of relapse and death in PST and ACT, respectively. This retrospective analysis is hypothesis-generating and should lead to a prospective randomized trial to compare the two sequences as PST or ACT in locally advanced or early BC, respectively.



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Bonnie, mom of Heather, age 32, Dx on 9/1/09 TN IDC Stage 1, 1.4 c, lumpectomy, 10/8/09, DD AC & T, 3/9/10 bilateral mastectomy and immediate reconstruction, BRCA 1/2-


Posted By: MsBliss
Date Posted: Jan 13 2011 at 5:12am
I've been gone from the forum and just saw this thread which touches on a subject that I have been concerned with for a long time.  I would like to add my two cents.
Here is my understanding of the reasons or mechanisms behind this finding.  Taxol has a tendency to do a few things which are problematic:  yes, it is a brilliant chemotherapy drug which has it's place, but it tends to increase the numbers of circulating tumor cells in cases for which there is tumor mass present; this process has been poorly studied or understood.  Secondarily, taxol, by virtue of it's mechanisms with regard to tubulin, increases the micro tentacles on circulating cancer cells.  The micro tentacles are the mechanism that cancer cells use to anchor into blood vessels and "set up shop".  The University of Maryland School of Medicine has shown that this mechanism happens and is problematic and so there are questions to be answered in this regard.  It may not be that giving taxol first works better as a consequence of sequential treatment; it may be that giving taxol first allows for Adria and Cytoxan to mop up these cells which have acquired unfavorable mechanisms as a direct result of taxol's effects on microtentacles.  If taxol is given last, there is no counter measure should there be circulating cancer cells which have acquired these aggressive mechanisms. 


Posted By: krisa
Date Posted: Jan 13 2011 at 7:11am
Ms Bliss-
Fascinating information. For those who have started chemo AC/Taxol - perhaps inquire about adding a carbo after completing Taxol to kill the micro cancer cells.


Posted By: outnumbered
Date Posted: Jan 13 2011 at 9:46am
This is very interesting.  Two years ago the buzz was instead of 4 biweekly dose dense AC and 4 biweekly T, to do 4 biweekly AC and 12 weekly T. 
 
It makes a lot of sense what MsBliss says.  This is great for the newbies to have more info and to go to their oncs armed with data. 
 
Thanks!


-------------
~Sara

DX @ age 40 6/24/08 Stage 1 Grade 3 BRCA1+ 187delAG

BMX (nipple-areola-sparing) 8/5/08

Redo BMX (remove nipple and areola) w/ Lat Flap 7/6/09

BSO 9/3/09

NED since 08/05/2008


Posted By: thenewme
Date Posted: Jan 13 2011 at 10:12am
Wow, definitely interesting information!  The progress in understanding is so encouraging, but if only it would happen faster... !

MsBliss- do you happen to have a link to the study you mention about the taxol micro-tentacles?  I had seen a news press release at http://wearecentralpa.com/fulltext-healthcast/?nxd_id=237187 - http://wearecentralpa.com/fulltext-healthcast/?nxd_id=237187   but I can't seem to find the actual study and I'd love to read more about it.  Does anyone know?


-------------
DX: IDC/TNBC 11/08 5-cm Stage IIb Grade 3. Age 39. Double Mast 12/08 (prophy right) with tissue expanders . ACx4-Tx3. Suspicious IM node. 25 Rads. BRCA NEG.


Posted By: Barbi
Date Posted: Jan 13 2011 at 10:20am
I am getting exactly what Outnumbered mentions above plus (12 weeks of cisplatin, 11 weeks of taxol as neoadjuvant therapy, followed by sx, rads, and 4 treatments of AC - once every 2 weeks).  I have to admit that although the above study indicates that further randomized studies are needed, I am glad to be having my taxol 1st.  And the Outnumbered's info makes me feel even better.  What I'm not sure of, when would you suggest/insist on another Pet/CT. My onc has negated the presx imaging, nobody wants to biopsy my supraclavicular nodes(much less remove them), and I would at some point like to know if all this struggling is worth it if you're not going to at least check to be sure these nodes are responding to tx. 


Posted By: Lillie
Date Posted: Jan 13 2011 at 11:15am
In 2006 I got 4 dd A/C and then 4 dd Taxol and Gemzar. According to this study I would have benefitted by getting the taxol first. I was in a clinical trial so I will hope that the gemzar did some magic in the last 4 infusions. Any thoughts??

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: godlovinmomof3
Date Posted: Jan 13 2011 at 12:28pm

WOW, I learn something new every day.  I have just finished my second round of A/C which will be followed by 12 weekly taxol.  I am also in the avastin study, so maybe that will kill any stragglers.  My gut feeling is that I am getting the avastin, but who knows for sure.  Wis I would have known this 3 weeks ago before starting, but I still think there is hope with the avastin.  THANK YOU SO MUCH for posting on this site.  I must admit this site was so helpful and inspiring in the beginning days and weeks of my journey, but the last few weeks have been rough to read with all the recurrance and passing of two amazing ladies.  My husband all but forbid me to get on here again.   LOL  However I am thankful and feel blessed to have found you ALL!!!  Most people do not understand, they try to be comforting by saying "well if you have cancer, Breast is the best to have" and yes they have come a long way, but This TN monster is a whole different ball game so it seems.  THANK YOU ALL FOR POSTING AND FOR THIS SITE!!!



-------------
Diag - 11/9/2010
Stage 2b
single mastectomy 11/23/2010
clear margins
3.5cm tumor 2N grade 3
AC biweekly 12/23/2010
T weekly Feb/2011 finished 5/4
begin radiation 6/2/2011


Posted By: dmwolf
Date Posted: Jan 13 2011 at 12:53pm
This would upset the clinical trial folk, but if you wanted to you could drop out of the trial, do your 12 taxol now, and then finish up with 2 AC.   It's not too late.
Just a thought,
d



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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: tAugusta
Date Posted: Jan 13 2011 at 3:08pm
thank you bless you
my doc will not change protocols, nor will she let me change to another doc in her
group.
only group going in Winchester, VA.
Should I go to Richmond? Great center there.


Posted By: dmwolf
Date Posted: Jan 13 2011 at 4:40pm
That's bizarre.  Did you show her the abstract?  Why woudn't she allow you to switch protocols if there is brand new research showing that a slight variation would give you a large survival advantage?  I'd say maybe try one more time, and if she doesn't get with the program then dump her and find someone who will do right by you.   The purpose of this research is to SAVE LIVES.
d


-------------
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: outnumbered
Date Posted: Jan 13 2011 at 6:53pm
tAugusta,
 
Sometimes the local doc is not the best doc.  I don't know how far from Richmond you are, but it might be worth it.  Its always wise to get second opinions anyway, if you can.


-------------
~Sara

DX @ age 40 6/24/08 Stage 1 Grade 3 BRCA1+ 187delAG

BMX (nipple-areola-sparing) 8/5/08

Redo BMX (remove nipple and areola) w/ Lat Flap 7/6/09

BSO 9/3/09

NED since 08/05/2008


Posted By: zoomommy2
Date Posted: Jan 13 2011 at 9:41pm
Gee, and I was told that I'd gotten the "big guns" when I had all my DD A/C, but only allowed to finish 7 of my Taxol infusions.  That was the basis for telling me that since I'd had major surgery after 7 Taxols and had to be off chemo for a long time, there was no point in finishing the last 5 Taxol treatments.  I was told I'd lost the snowball effect of the chemo.  Now, it looks like the Taxol was the treatment I should have finished.  Since that trial lasted from 1994-2009, a very long time in my book, couldn't the docs see where the data was leading them?
Lee in Denver


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dx6/09,stageII,gr3,(L)mastectomy 7/09,ACx4,Taxolx7,Avastin study,gall bladder surgery 1/10,4/11 Stage 4, mets to lung, 4/11 Started Taxotere and Xeloda, 5/11 Taxotere stopped, off Xeloda


Posted By: Belle_Laide
Date Posted: Jan 13 2011 at 10:13pm
What an interesting read! I am also a DD/AC then Taxol kinda girl...and if this is of any comfort to anyone out there who feels as though they lost precious ground because they did AC first:

My mass had NO shrinkage with Taxol, which I had administered after the AC. The only reduction in my mass/tumor came with the AC, which I had first. I shudder to think that all those weeks of Taxol were for nothing;since I had treatment first, then surgery, it was several months after my AC was finished before I had surgery to remove the beast.    

Did everyone here who had AC/Taxol, in that order, have tumor/mass shrinkage?

I didn't.

If the Taxol didn't help me afterward, how do we know it would have helped me beforehand? Are there guarantees that we will all react the same?

All I am saying is, ladies, please don't beat yourselves up if you did not have the treatment in this order. I am sure as hell not going to (beat up myself.) I'm happy if this works for somebody. But apparently it wouldn't have worked for me. And BTW, if anybody is not happy with their onc, DUMP them immediately if you can.

-------------
Did everything right; got screwed anyway. BRCA Negative.


Posted By: zoomommy2
Date Posted: Jan 13 2011 at 10:21pm
I had surgery before chemo.  I didn't know at the time there was any other way to do things.  Having had surgery first, there wouldn't be anyway to know what chemo would have worked or worked better.   I'm waiting for the day that the docs can figure out which chemo will kill off your particular tumor.  Won't that be a grand day for all of us! Until then, I'm just going to assume I am cancer free.
Lee in Denver


-------------
dx6/09,stageII,gr3,(L)mastectomy 7/09,ACx4,Taxolx7,Avastin study,gall bladder surgery 1/10,4/11 Stage 4, mets to lung, 4/11 Started Taxotere and Xeloda, 5/11 Taxotere stopped, off Xeloda


Posted By: tAugusta
Date Posted: Jan 13 2011 at 11:11pm
thanks for the post. guest that is why the really unpleasant chemo doc is invested in her protocol.
perhaps she has valid points ...
however, talking to me would be nice
"Trust Your Doctor", yes I repeat, she did say that ...
now, time and place for that, should be earned. not hard earned, but earned. Last week, didn't know this gal from whom-ever?
Yes, I did, gosh darn, forget to pick up my Med School degree, she has me on that. However, San Antonio trip neg presentation looked like a properly done, large control group, overtime (not all triple-negs?s, double-blind, do not know, heaven's since 1994) run-it-up the flag pole I think we can salute this one ladies and gents.
Sorry, I do go on. Got  honors in my stats class, anyway.
RANT. Please anyone. Anywhere.  Are you hearing, "Trust your doctor" at first meeting?
Not counting, like social situations, dating an intern, joking and he wants more smooching? END RANT



Posted By: bjoangtx
Date Posted: Jan 14 2011 at 1:13am

http://www.journalofsurgicalresearch.com/issues?Vol=163 - Volume 163 , http://www.journalofsurgicalresearch.com/issues/contents?issue_key=S0022-4804%2810%29X0010-5 - Issue 1 , Pages 52-57 (September 2010)

I obviously can't cut and paste but along the same lines as the study Denise found about sequencing drugs I found this about neoadjuvant vs adjuvant therapy for triple neg.
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Neoadjuvant Versus Adjuvant Chemotherapy for Triple Negative Breast Cancer

< = name=authors1 =/search/quick method=get>< = value=yes name=search_medline>< = value=plat+medline name=search_area>< = value=author name=restrictname_author>< = value=author name=restrict_author>< = name=restrictterm_author>< = name=restrictdesc_author> http://www.journalofsurgicalresearch.com/article/S0022-4804%2810%2900363-X/fulltext?articleId=&articleTitle=&citedBy=false&medlinePmidWithoutMDLNPrefix=&overridingDateRestriction=&related=false&restrictdesc_author=&restrictDescription=&restrictterm_# - Carlie R. Kennedy , B.S. http://www.journalofsurgicalresearch.com/article/S0022-4804%2810%2900363-X/fulltext?articleId=&articleTitle=&citedBy=false&medlinePmidWithoutMDLNPrefix=&overridingDateRestriction=&related=false&restrictdesc_author=&restrictDescription=&restrictterm_#aff1"> , http://www.journalofsurgicalresearch.com/article/S0022-4804%2810%2900363-X/fulltext?articleId=&articleTitle=&citedBy=false&medlinePmidWithoutMDLNPrefix=&overridingDateRestriction=&related=false&restrictdesc_author=&restrictDescription=&restrictterm_# - Feng Gao , Ph.D. http://www.journalofsurgicalresearch.com/article/S0022-4804%2810%2900363-X/fulltext?articleId=&articleTitle=&citedBy=false&medlinePmidWithoutMDLNPrefix=&overridingDateRestriction=&related=false&restrictdesc_author=&restrictDescription=&restrictterm_#aff2 - , http://www.journalofsurgicalresearch.com/article/S0022-4804%2810%2900363-X/fulltext?articleId=&articleTitle=&citedBy=false&medlinePmidWithoutMDLNPrefix=&overridingDateRestriction=&related=false&restrictdesc_author=&restrictDescription=&restrictterm_# - Julie A. Margenthaler , M.D. http://www.journalofsurgicalresearch.com/article/S0022-4804%2810%2900363-X/fulltext?articleId=&articleTitle=&citedBy=false&medlinePmidWithoutMDLNPrefix=&overridingDateRestriction=&related=false&restrictdesc_author=&restrictDescription=&restrictterm_#aff1"> http://www.journalofsurgicalresearch.com/article/S0022-4804%2810%2900363-X/fulltext?articleId=&articleTitle=&citedBy=false&medlinePmidWithoutMDLNPrefix=&overridingDateRestriction=&related=false&restrictdesc_author=&restrictDescription=&restrictterm_#cor1">Corresponding Author Information mailto:margenthalerj@wudosis.wustl.edu">email address

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Received 5 January 2010 published online 10 May 2010.

Background

The study aim was to investigate factors that predict the use of neoadjuvant versus adjuvant chemotherapy in patients with triple negative breast cancer (TNBC) and the overall survival in each group.

Methods

We identified 493 patients with Stage I-III TNBC between 1998 and 2008. Patients were divided according to receipt of neoadjuvant, adjuvant, or none/unknown chemotherapy. Data were compared using χ2 and Fisher's exact test. For more than two group comparisons and analyzing multiple dependent variables, MANOVA was used. Kaplan-Meier curves were generated.

Results

Of 493 patients with TNBC, 154 (31%) received neoadjuvant chemotherapy, 251 (51%) received adjuvant chemotherapy, and 88 (18%) had no or unknown chemotherapy. Patients undergoing neoadjuvant chemotherapy were younger (mean 50, range 20–83) compared with those undergoing adjuvant chemotherapy (mean 53, range 25–83) or none/unknown chemotherapy (mean 62, range 29–86) (P < 0.0001). The three groups did not differ significantly by patient race, tumor histology, or tumor grade. Increased tumor size, nodal positivity, and advanced stage were more likely to be associated with use of neoadjuvant chemotherapy (all comparisons P < 0.0001). After controlling for covariates associated with survival in unadjusted tests, patients undergoing adjuvant therapy were less likely to die compared with patients undergoing neoadjuvant therapy or none/unknown therapy (overall aHR 0.476, 95% CI 0.295–0.770).

Conclusions

Women with TNBC who underwent adjuvant chemotherapy were 52% less likely to die overall compared with those who received neoadjuvant chemotherapy or none/unknown chemotherapy in this institutional series. Prospective studies are necessary to determine if this finding is durable.

Key Words http://www.journalofsurgicalresearch.com/search/quick?search_area=journal&search_text1=breast%20cancer&restrictName.yjsre=yjsre - breast cancer , http://www.journalofsurgicalresearch.com/search/quick?search_area=journal&search_text1=triple%20negative&restrictName.yjsre=yjsre - triple negative , http://www.journalofsurgicalresearch.com/search/quick?search_area=journal&search_text1=neoadjuvant%20chemotherapy&restrictName.yjsre=yjsre - neoadjuvant chemotherapy , http://www.journalofsurgicalresearch.com/search/quick?search_area=journal&search_text1=adjuvant%20chemotherapy&restrictName.yjsre=yjsre - adjuvant chemotherapy

http://www.journalofsurgicalresearch.com/article/S0022-4804%2810%2900363-X/fulltext?articleId=&articleTitle=&citedBy=false&medlinePmidWithoutMDLNPrefix=&overridingDateRestriction=&related=false&restrictdesc_author=&restrictDescription=&restrictterm_#back-aff1">  Department of Surgery, Washington University School of Medicine, St. Louis, Missouri

http://www.journalofsurgicalresearch.com/article/S0022-4804%2810%2900363-X/fulltext?articleId=&articleTitle=&citedBy=false&medlinePmidWithoutMDLNPrefix=&overridingDateRestriction=&related=false&restrictdesc_author=&restrictDescription=&restrictterm_#back-aff2 -  Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri

http://www.journalofsurgicalresearch.com/article/S0022-4804%2810%2900363-X/fulltext?articleId=&articleTitle=&citedBy=false&medlinePmidWithoutMDLNPrefix=&overridingDateRestriction=&related=false&restrictdesc_author=&restrictDescription=&restrictterm_#back-cor1">Corresponding Author Information To whom correspondence and reprint requests should be addressed at Department of Surgery-WUSM, 660 S. Euclid Ave., Campus Box 8109, St. Louis, MO 63110.

PII: S0022-4804(10)00363-X

doi:10.1016/j.jss.2010.04.015



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St 2 Gr 3 2/5 nodes dx 8/9 age 56 Neoadj ACT @ x 6 @3wks bi mst. 12/09 Infect expander 12/31 remvd, replcd 1/27. 28 rads 4/10 Brkn rib 5/10 PET   6/10 NED Recon 9/17 & 12/10 Ki67 85% basal


Posted By: PTE
Date Posted: Jan 14 2011 at 1:18am
thank you all for allowing a husband to join this group.  I unfortunetly must become educated so I can become an informed advocate for my spouse.
 
Someone asked if you could "pin" this thread so you dont lose it.  I opened the thread and then did a bookmark.  After closing my browser, I was able to come right back and not lose anything.
 
since my wife will begin chemo very soon, the study that you show is going to help (I think).  I dont yet understand all the acronyms and verbage but I'm sure in time I will.
 
Again thank you for allowing me to join your forumn group.


Posted By: kirby
Date Posted: Jan 14 2011 at 1:52am
welcome PTE.....glad you found the thread. There are quite a few hubbies on board so I know you will feel welcome.
 
 


-------------
kirby

dx Feb. 2001. Age 44
Lumpectomy

2cm. no nodes stage 1 grade 3

4 rnds AC, 35 rads


Posted By: SagePatientAdvocates
Date Posted: Jan 14 2011 at 6:41am
Dear PTE,

welcome to our TNBC Foundation family...you are now officially a member...sorry you have need to be here but you are most welcome...

My daughter was dx with TNBC when she was 36, 6 years ago, and I have found this website to be incredibly supportive and informative..

You are fairly close to a marvelous (in my unprofessional opinion) Medical Oncologist who is very knowledgeable about TNBC. Dr. Hope Rugo at UCSF. I would encourage you to see her, if you are open to a second opinion.

http://cancer.ucsf.edu/people/rugo_hope.php - http://cancer.ucsf.edu/people/rugo_hope.php

good luck to you and your wife and again, welcome,

Steve

p.s. suggest you go through our Resources section..you can’t post there but lots of good info...






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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: cheeks
Date Posted: Jan 14 2011 at 7:21am
I received 12 weeks of taxol and after a 3-4 week break had 6 of a/c @ 3 weeks apart - I think I remember my oncologist mentioning this study - I didn't lose my hair until a good ways into the a/c therapy. It has grown back thick and curly and it was thinner and straight but no change in color. I was fortunate and had no ill affects to the chemo.


Posted By: 123Donna
Date Posted: Jan 14 2011 at 7:41am
Originally posted by Belle_Laide Belle_Laide wrote:

What an interesting read! I am also a DD/AC then Taxol kinda girl...and if this is of any comfort to anyone out there who feels as though they lost precious ground because they did AC first:

My mass had NO shrinkage with Taxol, which I had administered after the AC. The only reduction in my mass/tumor came with the AC, which I had first. I shudder to think that all those weeks of Taxol were for nothing;since I had treatment first, then surgery, it was several months after my AC was finished before I had surgery to remove the beast.    

Did everyone here who had AC/Taxol, in that order, have tumor/mass shrinkage?

I didn't.

If the Taxol didn't help me afterward, how do we know it would have helped me beforehand? Are there guarantees that we will all react the same?

All I am saying is, ladies, please don't beat yourselves up if you did not have the treatment in this order. I am sure as hell not going to (beat up myself.) I'm happy if this works for somebody. But apparently it wouldn't have worked for me. And BTW, if anybody is not happy with their onc, DUMP them immediately if you can.


I remember a thread talking about this where some of the tumors actually started growing during the Taxol part of treatment.  I think the discussion was over a year ago but it was from a member who was posting for a cousin.  I wish we could find that thread or discussion.  It would be interesting to compare it with this study.


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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: 123Donna
Date Posted: Jan 14 2011 at 8:14am
Belle Laide,

I just remembered the member's name, Terje, and found the older discussion threads on the Taxol subject.

http://forum.tnbcfoundation.org/research-on-new-therapies-to-limit-mets_topic5910.html#51303 - http://forum.tnbcfoundation.org/research-on-new-therapies-to-limit-mets_topic5910.html#51303

http://www.medicalnewstoday.com/articles/182239.php - http://www.medicalnewstoday.com/articles/182239.php

http://www.youtube.com/watch?v=RjNzAJRvGAg - http://www.youtube.com/watch?v=RjNzAJRvGAg







-------------
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: Dagmar
Date Posted: Jan 14 2011 at 10:46am
Good morning all,

I was diagnosed with TNBC (spread to 3 lymph nodes) in April 2010 and decided on treatment at Mayo rather than in my home town Chicago. I was treated with AC (8 bi-weekly sessions) followed by Taxol (12 weekly sessions). Halfway through AC the tumor already had shrunk significantly and after Taxol the tumor was no longer visible on scans. I had surgery in October (lumpectomy and an axillary dissection, 22 nodes removed) and had a complete pathological response. I just finished radiation (30 rounds, incl 5 boosts) days before Christmas. 

On the day of my diagnosis I changed to a raw/vegan diet, combined with Budwig. On top of that I continued daily exercise (hiking) and added meditation (Jon Kabat Zinn method). Not an easy switch but I feel it had a life changing impact on me. Yes, I lost all my hair, eye lashes, etc. and I'm happy it all came back:-).  

Throughout it all I had minor to no side effects and did not need special medication for nausea. My outlook at the start was very grim to say the least. I guess all situations are different. But I am a firm believer my personal choices and attitude were essential too. I'm still on the diet, continue the exercise and enjoy the mindfulness meditation!

Good luck to us all!




Posted By: MsBliss
Date Posted: Jan 14 2011 at 2:53pm
Dear Dagmar,
Congratulations on your PCR!  That is wonderful. 

On the subject of diet and lifestyle, I believe these choices are crucial to helping chemo and radiation work better, and for helping the body recover from all the interventions. 

Since Budwig includes cottage cheese in large quantities, does it compromise the vegan intentions of your diet?  Also, are you juicing?  I would love to hear what a typical daily diet for you would include as I need some motivation.  I have fallen off the veggie train and have even stopped many of my supplements lately... but I am eager to see what others are doing always as it helps get me back to good habits.

Bliss


Posted By: MsBliss
Date Posted: Jan 14 2011 at 3:00pm
Newme,

The links that Donna 123 posted will help you understand the latest findings.  Watch the Youtube video on microtentacles....it is convincing evidence of the matter at hand as they have actually filmed the process as it takes place. 

Donna, as always, thank you for updating the thread with the links....

Bliss


Posted By: MsBliss
Date Posted: Jan 14 2011 at 3:02pm
Trip 2,
Also want to thank you for originally posting these findings.  These studies are so important for us to read and understand so we can make informed choices. 
Bliss


Posted By: zoomommy2
Date Posted: Jan 14 2011 at 9:58pm
PTE,
The guys are always welcome here.  You will find Steve amazingly informative!  I don't know where else the husbands or dads could go to find out so much information on TNBC.  We are always here to listen and help as best we can.  Best of luck in your wife's treatment.
Lee in Denver


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dx6/09,stageII,gr3,(L)mastectomy 7/09,ACx4,Taxolx7,Avastin study,gall bladder surgery 1/10,4/11 Stage 4, mets to lung, 4/11 Started Taxotere and Xeloda, 5/11 Taxotere stopped, off Xeloda


Posted By: NinaE
Date Posted: Jan 15 2011 at 4:09am
I also wonder why the study didn't include cytoxan. The regimin that we're actually getting is AC-T.

T-A vs A-T survival stats are interesting, but not as interesting as AC-T vs T-AC would have been, since that's what we're actually getting.

As far as we know, the addition of cytoxan could change the results, right? Maybe AC->T is better than T->A, or even better than T->AC.




-------------
Stage IV at dx in Dec 09, at age 38. Mets to lung, axillary, IM and mediastinal nodes.

4xAC-->dd Taxol. Dbl mast, 6/10. Radiation, 8/10. NED since June 2010.


Posted By: Dagmar
Date Posted: Jan 15 2011 at 7:38am
Hi Bliss and others,

Mixing the Cottage Cheese with Flax Oil actually changes it's composition and as such fits within the diet. The important thing is to stick with it. What I forgot to mention is that I also use Curcumin/Turmeric, an Indian herb I use in capsule form and in my food/curries.

What concerns me a bit about the way we talk about this study "Taxol before Adriamycin" (I believe Cytoxin isn't mentioned as this study piles up all sorts of chemo next to Taxol first), is that it doesn't focus on TNBC, but breast cancer in general. Unfortunately TNBC is a different animal and needs to be treated as such. AC and Taxol, followed by surgery was the best tested and tried way to go in my situation given the size of the tumor and spread to lymph nodes. My medical team shared solid information about research and gave me confidence about the direction we took as a team. 

Have a great Saturday.



Posted By: 123Donna
Date Posted: Jan 15 2011 at 11:15am
Originally posted by dmwolf dmwolf wrote:


The clear winner was paclitaxel, followed by anthracycline-based therapy with 5-fluorouracil, doxorubicin (Adriamycin), and cyclophosphamide or 5-fluorouracil, epirubicin, and cyclophosphamide, Dr. Ricardo H. Alvarez reported at the San Antonio Breast Cancer Symposium.



Cytoxan was included in this study.  Cyclophosphamide is the generic name for Endoxan, Cytoxan, Neosar, Procytox, Revimmune, also known as cytophosphane.  The only difference was the anthracycline drug, either Adriamycin or Epirubicin was used.

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: bonsi77
Date Posted: Jan 15 2011 at 11:19am
They actually were getting Cytoxin as well. Here is the line from the study. It says doxorubician (Adriamcyin) and cyclophosphamide (ie: Cytoxin). See excerpt below. It seems as though the C was grouped in with Adriamycin and 5-FU to be called anythracyclien based therapy ie: (AC). So they were getting Cytoxin. Here is the excerpt from the article. 

< ="utf-8">"The clear winner was paclitaxel, followed by anthracycline-based therapy with 5-fluorouracil, doxorubicin (Adriamycin), and cyclophosphamide or 5-fluorouracil, epirubicin, and cyclophosphamide, Dr. Ricardo H. Alvarez reported at the San Antonio Breast Cancer Symposium."




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My Mom DX 7/13/2010 at age 61 TNBC Stage 2B/3A - 4.5cm tumor 3/19 nodes . Chemo AC x4 DD, Tx4 DD. BMX 12/10/10.


Posted By: Dagmar
Date Posted: Jan 15 2011 at 11:26am
Just concerned we're not jumping to conclusions to fast. TNBC -as we all know too well- is not comparable to other breast cancers. Any MD out there to shine some light...

-------------
Female 48, diagnosed April 2010; April/September 2010: AC/T 8/12; October 2010: Lumpectomy/Axillary Dissection Complete Pathological Response; November/December 2010: 30x radiation. Vegan, Raw, Budwig


Posted By: 123Donna
Date Posted: Jan 15 2011 at 11:39am
Dagmar,

I think what we'd like to see from this study is for the results to be broken down by breast cancer sub-type.  Unfortunately, the article doesn't do it and it leaves us wondering if the results would be the same for Triple Negative or different (maybe even better).  If there was a way to get access to the entire study, there may be more detail by breast cancer sub-types.  I agree with you, we can't treat all breast cancer the same.

Donna


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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: bonsi77
Date Posted: Jan 15 2011 at 11:41am
I think you can't get too caught up in all of this if you have already had treatment. Every day things are changing and they are finding better drugs or different regiments to use. Think women who were dx years ago and got AC and T every 3 weeks were probably saying the same things when DD proved to give a better outcome. There's always going to be break through's in science and them finding better ways to treat and cure BC.  There are women who were DX 20 years ago when standard of care was who knows what and they are alive today and cancer feee.  
 Info like this is more important for women who have just been DX so that they can make sure they are getting the best up to date info on what treatment is the most effective. My mom was DX in July and she got AC then T. Nothing we can do about that now as at that time this press release didn't exist. But if she got DX today I'd want to point out this research to her Onc ya know. 
 
Anywho here's to hoping that they continue down a path that finds all BC to be curable and rates go up to 100% instead of numbers like 70-80 etc. 
< ="utf-8">

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My Mom DX 7/13/2010 at age 61 TNBC Stage 2B/3A - 4.5cm tumor 3/19 nodes . Chemo AC x4 DD, Tx4 DD. BMX 12/10/10.


Posted By: dmwolf
Date Posted: Jan 15 2011 at 11:58am
Yes BUT survival rates improve every decade, presumably because of improved treatments. So you can't really infer anything from people who received older treatments who are still around to wonder about this.  Though I agree that what's done is done and we might as well accept that we made the best choices we could based on the available information.     And so we return to the luck of the draw, right?
May we all have excellent luck!!
d


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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: Jan 15 2011 at 12:05pm
One more note:  I wouldn't expect that epirubicin vs adriamycin would make a difference, but they do have a third drug in there, 5-FU in FEC, that those of us who got AC didn't get.  True, it is a close relative of cytoxan so maybe it doesn't matter, but still.    We'll get some answers - although from a much smaller patient population - from the ISPY1 trial once the data from the extension patients come in.  The last about 80 patients got T followed by AC.   Rumor has it they did significantly better than the ACT folk in the initial cohort, but I haven't seen any data yet.    ISPY2, which just started and includes investigational drugs like PARPi's, has all patients getting T before AC.

d


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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: 123Donna
Date Posted: Jan 15 2011 at 12:14pm
Denise,

Do you know when the results of ISPY1 will be released?  I wonder why 5-FU isn't widely used?  I was at a party in 09 and met a woman who was a 19 year bc survivor.  She had the same surgeon I did and had a mastectomy.  The only thing she can remember was she had a chemo drug called 5-FU.  She kind of laughed at the name and said it was the only reason she could remember it this long.

I agree with you that the only thing those of us who've had treatment is know we made the best decision at the time given the information we had.  It's keeping the would of, should of, could of thoughts away that's hard to do.

Donna


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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: bonsi77
Date Posted: Jan 15 2011 at 12:23pm
Agreed! Survival rates increase as better tx come out. I was just saying that women who treated in the past have to go with the fact that they got the best TX at that time as there isn't much else you can do. I brought up the every 3 week thing to DD just as away to say that I'm sure those women were feeling the same thing - wishing that the DD had existed when they got treated etc.  My mom only recently being DX it is disappointing that this article wan't around. When I found this article on BC.org and originally posted it here I was thinking to myself damn if this was only around a few months ago. But alas it wasn't  but  I wanted to post it on here so that if anyone was dx now or recently could benefit. Every day there is something new and that is how science and technology operate. But thank goodness for science and it getting better so that future people can benefit and hopefully BC will no longer be the 2nd leading killer among women in the US. 
 I admire all of you women on here who have been a great help and plethora of information for me during this time. Everything I have read on here has helped me help my mom to deal with her DX and treatment etc.  Thank goodness for the internet.

 Wishing you all the very best and hoping for cancer free future!

Diane


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My Mom DX 7/13/2010 at age 61 TNBC Stage 2B/3A - 4.5cm tumor 3/19 nodes . Chemo AC x4 DD, Tx4 DD. BMX 12/10/10.


Posted By: dmwolf
Date Posted: Jan 15 2011 at 12:31pm
Diane, thank you so much for posting it.  Think - you might save some lives with that single act of kindness! 
d


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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: NinaE
Date Posted: Jan 15 2011 at 7:57pm
Donna and others who commented -- did this study compare CA-T to T-AC?

As I understood it, it didn't. But based on what you just posted today, I wonder if I misunderstood.


-------------
Stage IV at dx in Dec 09, at age 38. Mets to lung, axillary, IM and mediastinal nodes.

4xAC-->dd Taxol. Dbl mast, 6/10. Radiation, 8/10. NED since June 2010.


Posted By: bonsi77
Date Posted: Jan 15 2011 at 8:23pm
Denise it is you and all the other great women on here that deserve the thanks. I was glad to be able to contribute a small amount and help but it is all of you who have poured so many hours into this site that deserve the thanks. You guys have helped me gain so much knowledge and as we all know knowledge is power.  I'm thankful for this forum b/c without it I don't know that my mom would have gotten the right treatment or maybe something would have been overlooked. 

Diane



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My Mom DX 7/13/2010 at age 61 TNBC Stage 2B/3A - 4.5cm tumor 3/19 nodes . Chemo AC x4 DD, Tx4 DD. BMX 12/10/10.


Posted By: 123Donna
Date Posted: Jan 18 2011 at 1:48pm
Bump

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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: LRM216
Date Posted: Jan 18 2011 at 7:35pm
My mother in law had a Halston Radical Mastectomy 40 years ago for her breast cancer and that was all, and all her lymph nodes removed.  It was a very rough surgery back then, but the surgery of choice then.  There were no lumpectomies back then either.  She is still alive and doing very well in her 80's.  They didn't know about hormone receptors back then, but I'm assuming since she had no chemo, no relapse, etc, she was probably HR positive - but she has no idea.  My husband died of esophogeal cancer at the age of 46  - 23 years ago and he had 5 FU (its Flourocil spelling may be incorrect) and cisplatin.  So 5 FU is actually an older drug, but is still used often today.

-------------
Linda - diagnosed at age 62
Diag 2/23/09 IDC 1.2 cent. IDC right breast,Stage 1, Grade 3,0/1 nodes - Triple Neg
4 DD AC every two weeks, 1 Dd Taxol, then 3 Taxotere every three weeks - rads x 33


Posted By: PTE
Date Posted: Jan 19 2011 at 1:25pm
Thank you all for the vast amount of information posted.  My wife went to her doctor/patient meeting to discuss the future treatment.  We thought for sure it was scheduling the chemo.  Doctor hit us with a "choice".  Chemo or no chemo!  Here are some facts.
DX 11-11-10 TRNB.  Lumpectomy 11-29-10.  Tumor was 0.9cm X 0.6cm X 0.5cm (kinda small oval) entire tumor removed and "hoped" for clear margins. 5 nodes pulled, all clear-no traces.  Stage 1, Histolic Grade 3.

 Had to go back in 12-21-10 to get remaining DCIS on medial edge.  Last path showed ALL cancer and DCIS is gone. Neg for BCRA (wife is first in family to ever have BC)

This is what the doctor said:
   national study has shown that 71/100 women survive 10 years cancer free WITHOUT further  
   treatment (in her situation)
   Same study shows that with chemo the rate is 78/100 survive that same period.  This is only a 
   7% increase with chemo.  Radiation is still a must.

However (this was a biggie)  The treatment can be hard on heart health.  Wife has a family history of heart trouble.  Grand mother died at age 45 congestive heart failure.  Mother died age 70 same thing.  Brother (age 54) currently has heart problems (enlarged heart etc).  All the above were/are diabetic, wife was DX'd as "pre-diabetic" but is controlled via diet.  Wife has never been diagnosed with any heart trouble (to date) wife is 60 years young.

Here is our question.  Which way to go.  With chemo or without chemo.  Doctor told us to do some research, think about it and get back to her next week, no life emergency here (we were set for the doctor to "tell" us this is what's going to happen, not give a choice in treatment).  Anyone on the forum ever have to make this decision?  What further questions do we need to ask?  Our heads are swimming!!!
.
Pete



Posted By: TracyAMac
Date Posted: Jan 19 2011 at 2:05pm
Dear Pete

Glad you are posting on this site - I am sure many will chime in with their thoughts including from women who decided not to have chemo.

My initial thoughts:

Keep in mind chemo is the only current treatment for triple neg. BC (other than clinical trials which have not been adopoted yet for standard treatment).  There are no targeted hormone therapies for TNBC as there are for non-TNBC (I had one of those too!)  Stage 1 is great but her grade level is high.

Re the heart issues - perhaps one question to ask the onc.  is if there are chemo options that would eliminate or reduce the heart risks. Your wife's age , general health, and menopausal status (pre or post) may also be factors to consider. My onc. wanted me to have Adriamycin along other chemo agents, however I had had the "life time limit" of Adria. 30 years ago for another cancer.  I haven't had any heart problems but having more of the A may have caused heart problems. Instead, I had 6 rather than 4 standard rounds of Taxotere and Cytoxan. Many  women on this site have had this drug protocol as well. 

Tracy in Toronto


-------------
TN&non-TN tumors April/10 Gr3&2;1 metaplastic
Rmast.1/9 nodes w/isolated t.cells
Taxotere&Cytoxan x6
Bone cancer 1980 age17;surgery&chemo AC+Methotrexate
BRCA-ve
On hormone therapy & Metformin Trial


Posted By: 123Donna
Date Posted: Jan 19 2011 at 2:26pm
Pete,

I think Tracy has offered you some great advice.  Another thought is to get a second opinion from another facility, maybe associated with NCCN or a teaching hospital. 

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: LRM216
Date Posted: Jan 19 2011 at 4:29pm
Pete:
 
I think all the advice you have gotten to this point is very good.  I am in favor, as Donna is, of another opinion.  I know that anything .5 mm and smaller is not usually given chemo, your wife's tumor being a bit larger than that, and being TN, I think I would be seeking a second opinion.  If by chance she decides to do chemo (and I was a just turned 62 yr. old, otherwise totally healthy, when I was diagnosed and began chemo), I was given three choices and was told to go as agressive as possible as I have only this one chance at killing this beast.  Of course my tumor size was not as small as your wife's, as mine was 1.2 cms, but no nodes.  I chose the AC&T - very agressive and that is the chemo that can cause heart problems.  My heart was tested prior to the chemo and after, and has been fine.  There is a 2% chance of heart damage, but of course, no one certainly wants to be in that 2%.  I don't understand why they would want to use such an agressive chemo on her with a .9 tumor - why not T&C?  That is why I feel a second opinion and most especially from someone knowledgeable in TN breast cancer.
 
I wish you both every success and an uneventful cancer journey.


-------------
Linda - diagnosed at age 62
Diag 2/23/09 IDC 1.2 cent. IDC right breast,Stage 1, Grade 3,0/1 nodes - Triple Neg
4 DD AC every two weeks, 1 Dd Taxol, then 3 Taxotere every three weeks - rads x 33


Posted By: Belle_Laide
Date Posted: Jan 19 2011 at 5:18pm
Donna, thanks for the article. Denise and everybody, yeah, life is a crap shoot. We do the best we can with what we've got at any given moment.



-------------
Did everything right; got screwed anyway. BRCA Negative.


Posted By: dmwolf
Date Posted: Jan 23 2011 at 11:31pm
bump

-------------
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: Mary58
Date Posted: Jan 24 2011 at 7:44pm
Hello - I quess I am one of the very few TN that did not have chemo.  My tumor size was small and for other various factors I chose not to do chemo.  I think we are bombarded with so much scary information with all of this.  Yes, there is so much unknown.  Yes, we have absolutely no control over re-currence or metatasis.  I sometimes feel that every doctor has their own opinion and when you gather so many opinions - it can lead to much confusion and indecision.  I think when you are starting out on this journey you need to gather different opinions and make the best decision with all the information you are given.  I wish you well in finding your way through this.   Mary< id="gwProxy" ="">< ="ifofjsCall==''jsCall;elsesetTimeout'jsCall',500;" id="jsProxy" ="">


-------------
Dx: 1/10, 5mm, 1/28/10 SN negative, lumpectomy, 30 rads, no chemo.


Posted By: tnbcsucks
Date Posted: Jan 26 2011 at 1:25pm
Hi, very interesting.  I just got done with treatment.  I did A/C every two weeks for four treatments followed by   taxol for 12 weeks.  21 Rads.  Now what do I do?  Do I go ask for another round of Adrimacyn? or just pray that it doesn't come back?  Any thoughts, I would appreciate it!

-------------
TNBC DX April, 2010,Lumpectomy May 3.5cm with clear nodes,Stage 2, Grade III Started Chemo on June 7: 4 A/C every other week and then 12 weeks of Taxol. followed by 6 weeks of radiation.


Posted By: LRM216
Date Posted: Jan 26 2011 at 1:46pm
I think this is really a subject to be discussed with your oncologist and not jump to conclusions because one study was done and posted on board here.  If this was so mind-blowing different in outcome - then I ask why this was not spoken of and implemented since the last San Antonio convention??  I spoke with my oncologist about this, and once again, with the roll of the eyes, informs me that one study, no matter what the size - will ever be the deciding factor of how drugs will or won't be given and in what order.  That's not to say this may not someday change, but anyone that had their chemo drugs in the sequence that you did (and many millions have, I assure you) can still be assured that they got the best treatment they could.
 
Because a study such as was posted suggests that to reverse the order of the drugs is preferential - does not convince me as a newbie that I am now ready to tell my oncologist how she/he should be giving me my drugs and in what order.  Believe me, when this is a proven and die-hard thing, the oncologists will be doing it on their own, without the help of any breast cancer forums advising them as to how they should be treating patients.  
 
While the article certainly has merit, and perhaps may even be something that will change the course of how chemo is given, I think far too many people have taken it and run wildly with it.  If you have doubts, again, I suggest you speak to your onc, after all they are the ones that are trained and we are the ones that pay for their services.
 
 


-------------
Linda - diagnosed at age 62
Diag 2/23/09 IDC 1.2 cent. IDC right breast,Stage 1, Grade 3,0/1 nodes - Triple Neg
4 DD AC every two weeks, 1 Dd Taxol, then 3 Taxotere every three weeks - rads x 33


Posted By: tnbcsucks
Date Posted: Jan 26 2011 at 2:17pm
I do plan on  bringing it up with my oncologist...I'm not in panic mode by any means...but curious as to what some people might do.  It is what it is when it's all said and done.  Just trying to stay on top of things.  Thanks for your thoughts!  Greatly appreciated!

-------------
TNBC DX April, 2010,Lumpectomy May 3.5cm with clear nodes,Stage 2, Grade III Started Chemo on June 7: 4 A/C every other week and then 12 weeks of Taxol. followed by 6 weeks of radiation.


Posted By: Lillie
Date Posted: Jan 26 2011 at 3:11pm
I also got my treatments backwards according to the lastest reports. I just accept that I got what (at that time) was the best (standard of care) and pray that it will continue to work for me. Numerous are the girls who got AC-T and are doing well, years later. I am thankful that I knew I was TN and understood why I had to have such harsh, agressive treatment.

I spoke with a lady this morning who can't remember how many years ago it was that she had breast cancer. She had a small tumor but chose a mastectomy with reconstruction from her own tissue. She took tamoxafin for five years and that was it. (No chemo and No radiation). Her cancer was ER-PR+. I told her she was very lucky and if hers had been triple negative she probably would know the years, months and days since her cancer diagnosis. She sneered and said, "Yes, I'm aware that there are many types of breast cancer." I, at that point dropped the subject. I felt a tyrade brewing in my head and I didn't want to acknowledge how angry I still get over the stupidity of other people, even women who have had breast cancer.

Thanks,
I needed that.....

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: LRM216
Date Posted: Jan 26 2011 at 7:21pm
And that is sure the truth, Lillie !  I, like you, had the AC & T too - what's done is done, but my onc who treats many TN's and has through the years - still has not changed her sequence and is also aware of this study.  Guess it's just too early to really tell, even though the study's stats looked good.  Time will tell.  Back when my mother in law had breast cancer - they didn't even give her chemo - just a Halsted radical - took most of the chestwall muscle - ribs and every lymph node in her arm and armpit.  I remember she had a god-awful recovery and Lymphedema in that arm that would often get to be the size of a sumarai wrestler, but she's in her mid 80's and never a relapse or progression of any sort.  I am sure she must have been ER/PR+.  When I asked if she was hormone positive -  she looked at me as if I was some sort of alien.  Lol!  Didn't even bother mentioning the TN to her!

-------------
Linda - diagnosed at age 62
Diag 2/23/09 IDC 1.2 cent. IDC right breast,Stage 1, Grade 3,0/1 nodes - Triple Neg
4 DD AC every two weeks, 1 Dd Taxol, then 3 Taxotere every three weeks - rads x 33


Posted By: kirby
Date Posted: Jan 27 2011 at 4:31pm
Since I was dx, they have come out with DD and much more aggressive chemo regime. The DD didn't have me too concerned but the amount of chemo did. This was years after the fact. It took me a bit to settle in and realize I couldn't change what had already been. I would have to force myself to remain logical.
 
Know you did the best for that time. Life is for living.


-------------
kirby

dx Feb. 2001. Age 44
Lumpectomy

2cm. no nodes stage 1 grade 3

4 rnds AC, 35 rads


Posted By: DianeEE
Date Posted: Jan 29 2011 at 8:39pm
Interesting topic.  Am I the only one that is getting AC/Cytoxin/Taxotere all at the same time?  I am get all 3 as neoadjuvant therapy.  Schedule is all 3 drugs every 3 weeks for 5-6 treaments total before surgery.  Wonder how this new info. affects me (if at all since I'm getting all 3 at once).
 
Diane from Michigan


Posted By: 123Donna
Date Posted: Feb 05 2011 at 4:06pm
bump

-------------
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: dmwolf
Date Posted: Feb 10 2011 at 9:43am
bump

-------------
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: Momof2NJ
Date Posted: Feb 10 2011 at 10:46pm

Interesting info...especially considering for stage 1's, the new gold standard is eliminating Adriamycin from primary treatment.  I did Cytoxan and Taxotere when I was dx.  For my recurrence it was AC x 4, then 12 Taxol...I only did 3 taxol...got bad neuropathy and was switched to Abraxane (which I'm actually happy about as its generally for metastatic disease and not recurrent disease). 

Gotta look at it this way...any info we get is a crap shoot...hopefully one day they will find the magic  bullet.

-------------
2008 BRCA 1+ dx stg 1,gr 3 IDC triple neg. BM w/ recon. CT x 4. Prophy TAH 2007. Recurrence 9/13/10. 10/5/10 tumor excised. ACx4, Taxol x3, abraxane x 9. 38 rads. 7/11 NED!!!


Posted By: dmwolf
Date Posted: Feb 13 2011 at 11:49pm
bump

-------------
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: PTE
Date Posted: Feb 15 2011 at 1:31am
Well, the chemo has started.  T/C four times followed by rads for 6 weeks.  The first chemo wasn't to bad, but the Neupogen has been a real bear.  Wife is very tired, aching all the time and feels more like she hit a brick wall being driven by a mack truck!  I feel at such a loss because there isn't a darn thing I can do to make it all go away. So in the mean time, I'll cook and clean as much as I can, stay home as much as possible and continue to read things posted here.

I did find that gentle massage (referred to as "caring touch") does wonders.  She gets a little relaxed and can sleep a little better. The feet, hands and back are very relaxing, I just have to remember not to rub deeply.

Thank you all for all the posting and encouragement.

Pete


Posted By: sue
Date Posted: Feb 15 2011 at 11:36am
Pete,

Thanks for the update. 

I just finished my last of 4 chemos Feb. 9.  I also had Neulasta for the first 3 chemos with very similar reaction, had to take a pain pill for a few days after shot kicked in, but since my ANC count and white count were high throughout, I did not need to have Neulasta after last chemo and had much less pain. Will have my counts checked on Feb. 22.  

I am sure all of your care has made a positive difference too.  The back of my neck hurt just to brush with my fingers and my shoulders hurt so much I could not lift my arms up without pain.  I also found a little gentle neck massage helped with relaxation and sleeping after the second shot.  

After the last chemo it seems I became somewhat dehydrated even though I had been drinking over 90 ounces of water a day and my electrolytes and sugar were off some too.  It was very cold and dry here during that time which may have contributed.  Doc said drink, drink, drink, GatorAde, juice, water, and eat anything wet, fruit, even eat Big Macs, pizza when tolerated.  He said not the time to diet even though I am somewhat overweight.  

I also take a blood pressure pill and all of the above lowered my blood pressure too much and I fainted, so I had to stop taking it, and my blood pressure remains normal without it 3 days later.  Thank God I was sitting on the sofa when I fainted.  

Hopefully you can avoid these issues.  It sounds like you are a great caregiver.  
 
Take care.  


-------------
Dx 7/10, age 53. TNBC left breast, stage I, grade 3, IDC 0.5 cm, DCI 2.5 cm, 0/8 lymph nodes neg. BRCA-. T/C x4 finished 2/09/11, rads x34 finished 4/21/11.          


Posted By: Jwatrlily
Date Posted: Feb 15 2011 at 12:17pm
Thanks LRM216 and Lillie for stating what you have.  My chemo was completed on Feb. 8.  I ran across this thread a few weeks ago and it really upset me.  Enough so that it is a miracle I am back here now posting anything.  I am going to stop coming to the support threads some of these days because honestly ones like this are of NO support to me.  I know it is good to be informed but when you are well into your program, nearing completion, and getting along and see stuff like this it is scary as all get out!!  It makes you feel like you are in a death sentence because you didn't do it according to the latest report.
 
That being said, I asked my Oncologist about it when I first saw it and he almost got angry.  He attends nearly all of the seminars around the country.  He is a top notch Oncologist.  He said one study/report does not make a treatment plan.  He said it may have merit down the road but he was not willing to change the gold standard of care he provides until a lot more evidence suggested otherwise.  He does A-C first then Taxol and has for years.  I asked him about it in relation to my TNBC and he said his opinion is still the same, that the order of chemo drugs, even with TNBC, until further studies indicate, do not mean one thing to him, that he has successful survival and cure rates with the plan he uses.  I HAVE to trust him so that is what I'm going to do.  As far as I am concerned and it is just my opinion, this thread serves NO PURPOSE until further studies are done.  It only serves as making a lot of us feel like we signed our own death certificate because we had A-C first then Taxol!!!!!!  Down the road if this proves to change and my Oncologist endorses it, then I will see it as a better way.  For now, it is just Internet postings.  Sorry but this has angered me for all the wonderful women like me who are battling enough without having something this depressing entered into our day.  Thus my reasoning to stop coming to some of these threads.  Like I said, it is important to stay informed but only when it becomes an approved fact and not just one report.  I'm sorry, this is just how I feel.
 
Juanita   


-------------
Diag. June 4, 2010 IDC Stage 1, Grade 3, Node 0/2 TNBC. Lumpectomy 8/9/2010 Started chemo 9/16/2010 AC x 4 every 2 weeks, Taxol x 12 weekly, 33 rads, finished 4/15/11. NED as of Sept 3, 2013


Posted By: LRM216
Date Posted: Feb 15 2011 at 12:36pm
Jwaterlily:  I am so sorry that you had to endure any unnecessary stress while going through treatment over a topic heading, but I can understand why you did.this.  I too am bothered by the title of this thread, as it appears almost to be a demand as to how one should have their treatment, when in fact, there is not one oncologist on this board or for that matter any one else either that  would even have the credentials warranted to make such a statement in the first place.  While abstracts and reports on trials, tests, etc. are interesting to read - that is exactly what they are for - to read,  and perhaps to discuss  same with your onc, but in no way should they attempt to take the place of the newbies oncologist.  
 
I know it was posted as be informative and helpful, and perhaps in time, this may even become routine, but at the present time, it is merely another study that is shedding some light on the possible outcome of a switch to the order two drugs are given. 
 
My oncologist is a very learned doctor with a very impressive CV, and has been treating Triple neg on a daily basis for many years.  She states that one study, large or small, will never be a changing factor to any set cancer protocol.  It  would take many studies, many years, and while she is certainly aware of it, she has no intentions of changing anything at this time.  She also still regards A/C & T, when supported by good MUGA/Echo testing, to be gold standard for any triple neg- node neg or positive and yes, even with Stage 1 cancer.  
 
So, in the future, no matter how startling something may appear - good or bad - just remember it is only one small aspect in the whole scheme of things - and nothing written in stone. 


-------------
Linda - diagnosed at age 62
Diag 2/23/09 IDC 1.2 cent. IDC right breast,Stage 1, Grade 3,0/1 nodes - Triple Neg
4 DD AC every two weeks, 1 Dd Taxol, then 3 Taxotere every three weeks - rads x 33


Posted By: Scott
Date Posted: Feb 15 2011 at 1:23pm
Not to stir the pot, but are there any studies that show that A/C then Taxol are the most effective for TNBC, the words Triple Negative were first coined only 4 years ago in 2006. Heck, it hasnt even been long enough for any 5 year studies to be done. I'm betting that the reason that they use that combo is because its a pretty aggresive chemo combo, not because of any studies that show its the most effective on Trips.


Posted By: 123Donna
Date Posted: Feb 15 2011 at 4:36pm
Scott,

You bring up a good point.  We need specific studies for TNBC regarding different chemo regimes for each stage of bc.  If there are such studies, I haven't seen them. 

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: zoomommy2
Date Posted: Feb 15 2011 at 4:51pm
Pete,
I felt much like your wife when on Adriamycin and Cytoxan.   The fatigue was pretty bad.  I had Neupogen, too, that caused lots of pain.  Afterwards, I learned on this site to take Claritin.  I don't know how/why it would help, but it's done wonders for lots of women.  The pain is the bone marrow expanding to make more white cells.  Once my onc told me the reason for the pain, it seemed somewhat better.  I had Percocet to take and took it when the pain was really bad.  Your way of helping your wife is wonderful.  Help her all you can because her energy will be quite low.  She will be very grateful even if she doesn't realize it due to her fatigue.  If she goes onto Taxol or Taxatere, it may well be easier on her and won't require Neupogen.  My appetite returned a bit on Taxol and my energy picked up a bit.  Best of luck to both of you in this fight.
Lee in Denver


-------------
dx6/09,stageII,gr3,(L)mastectomy 7/09,ACx4,Taxolx7,Avastin study,gall bladder surgery 1/10,4/11 Stage 4, mets to lung, 4/11 Started Taxotere and Xeloda, 5/11 Taxotere stopped, off Xeloda


Posted By: dmwolf
Date Posted: Feb 15 2011 at 11:40pm
We all make the best choices we can with the information available at the time.  I didn't have taxane first either, and it may have made a difference, who knows.   Adriamycin first sure didn't do squat to my tumor.  What I do know is that this is a very large study showing a large survival advantage to the different order.  I also know that sometimes women come to this site before they decide on a treatment plan - if we can help them get the best possible treatment using the newest best research results, we might be saving lives.    I stand by putting threads like this on here, even if it makes those of us who already had a different treatment protocol feel scared.  Its part of our mission, right, to be of service in any way we can?

MDA isn't the only place now giving taxanes first.  Many of the best oncologists at UCSF do it now too, bolstered by this latest research.  This is the ONLY study I've seen that looks at head to head comparison between T, AC and ACT.     Any oncologist who says they always give ACT and many people survive, therefore they will continue giving ACT is not making a lot of sense.    That is anecdotal reasoning, not scientific reasoning.   It's true that this study, though large, is retrospective instead of prospective, a weakness, but there are a LOT of patients in it.   I'd say that a bigger prospective study would have been better, but in the absence of more information the most prudent course of action for a patient to take is to do the Taxol before the AC.   People need to decide for themselves, of course, in collaboration with their oncologists.  But the advice here is ok.

-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: krisa
Date Posted: Feb 15 2011 at 11:57pm
I appreciate the information members post. The study shows that in a certain percentage of patients, taxol can cause cancer cells to grow.. Most of us don't fit into that category. Unfortunately, unless you did chemo before surgery and could see how taxol might effect your tumor, none of us know. I think most are safe with what chemo regimen was used... No guarantees for anyone no matter what was used.


Posted By: 123Donna
Date Posted: Feb 16 2011 at 10:24am
I think information is the key.  It's what we can use to talk and discuss with our perspective oncologists, surgeons, etc regarding our treatment.  If there are conflicting studies or new studies like this one, it's a good idea to bring these conversations to your doctor and talk about it.  There may be valid reasons why a surgeon or onc chooses a certain course of action.  I know myself I'd feel better if I asked the questions, even if the answer didn't change regarding treatment.  Sometimes just being diagnosed with this disease and making some very important decisions in an extremely short time is overwhelming.  The anxiety can be too much for new members and they don't want to hear controversial information.  It's a coping mechanism we all use at times.  However, I believe it's best to throw the information out there and let each person decide what they want to do with it, eg, ignore, embrace, review and discuss, etc.

For those of us that have been already treated, we have to have faith that the treatment plan was the best for us at the time.  On the same chemo regime, we've seen recurrences and no recurrences.  At the best, chemo is crap shoot, but doing what fits most of us.  Until we can get personalized treatment unique to our own tumors, we are using the one drug (chemo) fits all approach.

Now I'm climbing on my soapbox.  What I'd like to see is a large scale study using a database unique to TNBC.  The study would break TNBC down by Stage, BRCA, surgery type, chemo type, radiation, etc.  It could give stats of recurrence and no recurrence within the first 5 years and longer.  Maybe it would show which chemos worked best for us.  I'd think that most women with TNBC wouldn't mind their data being entered into a database for research.  Does anyone know if someone is doing this?  How do we get something like this started?  Can the TNBCF help? 

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: LRM216
Date Posted: Feb 16 2011 at 11:39am

I completed my treatment 1 1/2 years ago, it's done and over and I chose to go aggressive in the hope of annihilating this beast, and I too had my AC & T in the "traditional" order. 

Of course, information such as this thread needs to be posted and is terribly important; however, perhaps "discuss with your doctor re AC/&T" or "Important read before starting AC & T" - something a bit less daunting and fearful than "Do Taxol BEFORE Adriamycin" might be a better choice as a handle for the topic.  Our cancer holds many more negatives than just our receptors, and when just beginning treatment, or at the very first onc visit - most of us are not prepared to go in and delegate to the onc how we want our treatment and in what order - or worse yet, the poor new gal that is just getting her first or second treatment - what's she to do - refuse any further treatment unless it's done the way the article states?  This is exactly what has happened and this is how not only newbies, but seasoned gals are reading it too.  We are attempting to inform and share what we find important, good or bad, about our disease, as all we have is each other, but it's equally important that we don't terrify by how we post it.
 
All I ask is that when posting info such as this, each of us needs to and present it in a way that won't scare newbies and seasoned gals away from this forum, because it has.
 
 


-------------
Linda - diagnosed at age 62
Diag 2/23/09 IDC 1.2 cent. IDC right breast,Stage 1, Grade 3,0/1 nodes - Triple Neg
4 DD AC every two weeks, 1 Dd Taxol, then 3 Taxotere every three weeks - rads x 33


Posted By: dmwolf
Date Posted: Feb 16 2011 at 12:46pm
Linda, your point is well taken.  I can be a real drama queen. :)
I chose the title because there are so many threads with information in them that can get easily passed over, and I wanted to grab newbies' attention.   But I agree that something less fear-mongering but still attention-grabbing would be better.
Sorry about that.
d


-------------
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: 123Donna
Date Posted: Feb 16 2011 at 12:55pm
Denise,

Just a thought, maybe just change the thread name to something like:  Attention Newbies:  New Chemo study to discuss with your ONC (or something along these lines).  I know you're limited to the number of characters in the thread name.  I think you just have to go to your first post, then the Post Options button to change the thread title.  I've done it a couple of times and it works.

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: dmwolf
Date Posted: Feb 16 2011 at 2:36pm
Ok, done.  I couldn't fit the whole thought in the title, but I put it as intro to the first post. 
Thanks everyone, d



-------------
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: LRM216
Date Posted: Feb 16 2011 at 8:02pm
Denise:  Please do not think I was singling you out, as  I most certainly was not.  It was just the most recent post that has caused a few newbies and even some of us already through our treatment great anxiety, and I merely wanted to state that perhaps if we toned it down in our headings a bit, some of the fear and anxiety would be dissipated.  As I said earlier, ours appears many times to be more negative in anything we read than other types of breast cancer, and I have heard from a few people on the board that did find this terribly confusing, as they were new and it made them feel even more desperate in thinking the current regime was all for naught. 
As for being a drama queen - I hardly think so, and if you feel you are, then you have some competition on this board, as we all could qualify as "drama queens"!
Absolutely no apologies necessary.  You always supply a wealth of info - I just didn't want this potentially important info to chase anyone already petrified away from us.  They need us as much as we need them.
 
Keep on doing what you have always done so well and with so much love.  A little change to a few words wasn't meant to slow you down.  You are a tremendous asset to each and every one of us that have moved on, those remaining and all those yet to come.
 
Hugs,
Linda


-------------
Linda - diagnosed at age 62
Diag 2/23/09 IDC 1.2 cent. IDC right breast,Stage 1, Grade 3,0/1 nodes - Triple Neg
4 DD AC every two weeks, 1 Dd Taxol, then 3 Taxotere every three weeks - rads x 33


Posted By: zoomommy2
Date Posted: Feb 16 2011 at 8:53pm
I've been finished with chemo for a 13 months and the best thing for chemo for us changes frequently.  All we can do is be thankful we are finished and hope that whatever our treatment was, that it was good enough to keep us NED.
Lee in Denver


-------------
dx6/09,stageII,gr3,(L)mastectomy 7/09,ACx4,Taxolx7,Avastin study,gall bladder surgery 1/10,4/11 Stage 4, mets to lung, 4/11 Started Taxotere and Xeloda, 5/11 Taxotere stopped, off Xeloda


Posted By: PTE
Date Posted: Feb 22 2011 at 12:54am
Today is day 15 since the first chemo. The real emotional part has started.  Just when wife was feeling better, the hair started coming out. Not real big globs, but enough to know it's gonna be gone soon. :(   I knew that would hit hard, but guess I wasn't prepared for how much of a downer that was gonna be. The only thing I can do is to hold her and let her cry when she needs to.

We did get involved with a person from work that walks the Avon Breast Cancer Walk in San Francisco.  We've helped her raise about $1500 for her goal.  I think that helps mentally, sort of like you can help fund your own research and have some, albeit,  small control on the outcome. Our friend has told wife she will walk to honor her and that was emotional, just knowing you have someone in your corner. And, one of our members here is my wife's hairdresser!!  She's "been there, done that" and is also a great resource for help and encouragement (an good laughs-you need good laughs).

Next chemo is this coming Monday. After that one, we're half done with the icky cau-cau drugs. Cant wait for summer. This will all be behind us (except for the periodical testing).

Pete


Posted By: zoomommy2
Date Posted: Feb 22 2011 at 1:03am
Pete,
Your wife is right on schedule for losing her hair.  I had my hair shaved once it started falling out.  It was less depressing to have it all gone at once than watch if falling out all over the place.  I had one short cry and was done with that part.  It's something that we all go through.  Her hair will grow back.  It's easier to get ready with no hair to deal with.  My DIL has walked the Avon Walk in my honor in Colorado for 2 years and my son will walk it this summer.  It's humbling to know that they are doing something like that for me.  Good luck to you and your wife as her treatment continues.
Lee in Denver


-------------
dx6/09,stageII,gr3,(L)mastectomy 7/09,ACx4,Taxolx7,Avastin study,gall bladder surgery 1/10,4/11 Stage 4, mets to lung, 4/11 Started Taxotere and Xeloda, 5/11 Taxotere stopped, off Xeloda


Posted By: The Texas Woman
Date Posted: Feb 22 2011 at 10:05am
Pete, My family had a lot of fun with my hair falling out. They gathered to me from the distant towns and cities they live in and gave me a Mohawk haircut. One of my boys got one too. I wore it proudly for about three weeks, until my hair was at such a point it wouldn't stand up anymore. Then hubby shaved off the Mohawk part. By then my side hair had grown in a little so we had matching hairdos - nothing on top but a little something on the sides. Of course, at every stage we took pictures. A lot of laughter in an uncertain time. Hope your wife can find some humor in the same situation. It certainly helps ease the burden cancer presents to us.

cher


-------------
Dx: 7/09 TN IDC Stage llB, T2, N1, Grade 3 and associated DCIS, BRCA Neg, Taxol x 12, FAC x 4, left mastectomy March 2010


Posted By: Lillie
Date Posted: Feb 22 2011 at 12:08pm
Hi Pete,
My husband was my greatest fan during my hair loss. He complemented me and made me feel good about myself when I was totally bald. He complemented me on my wig and my hats. You supportive husbands are priceless. I am glad to hear that your wife's hairdresser is a part of this process.
Before I started chemo my hairdresser went with me to choose a wig. She cut and styled it for me. After my 2nd chemo treatment she cut my hair to about 1/8 in. all over my head. I began to wear the wig and scarfs I had bought. Within a few days the little stubbles started coming out and it was traumatic and emotional. Having it so short made the process of losing it much easier and I had a lot of support from my husband to accept the loss of my hair.
I then purchased a few hats and found them more comfortable than the wig. I sort of mixed it up, depending on where I was going.
Good luck with everything and I will keep your wife in my prayers.

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: SagePatientAdvocates
Date Posted: Feb 22 2011 at 12:54pm
Dear Pete,

There is a wonderful book out that might help your wife get through her hair loss..

It is called Turning Heads by my friend, Jackson Hunsicker..

Jackson gave me a bunch of free books and I would be happy to mail you one..just send me a PM with your mailing address...Promise not to hassle you.. or you can order via Amazon..

Hopefully the chemo will do its thing and your wife’s hair will grow back like my daughter’s did...very curly and grey but it’s back.

welcome to our family,

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


Posted By: snugltz
Date Posted: Feb 22 2011 at 1:39pm
I do not know your financial situation.  If you can use any help the American Cancer Society will give you a wig of your choice from their office, or give you a credit of $75 to TLC wig and hat shop online.  I actually got my best wig from the cancer society and paid for more from TLC along with some sleep caps etc.  I have gotten many compliments on the wig.  Strangers ask me where I got my hair done and what color I used on it (it is a tiny bit frosted). 

-------------
1 cm, 0/2 neg nodes, lumpectomy 6/16/10, cytoxin/taxotere 4x every three weeks, rad start 11/8 33X


Posted By: dmwolf
Date Posted: Mar 30 2011 at 1:56pm
bump

-------------
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: 123Donna
Date Posted: Mar 31 2011 at 2:28pm
bump



-------------
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: robinpich
Date Posted: Apr 12 2011 at 8:05am

http://www.uab.edu/news/latest/item/1053-uab-launches-drug-trial-aimed-at-triple-negative-breast-cancers - http://www.uab.edu/news/latest/item/1053-uab-launches-drug-trial-aimed-at-triple-negative-breast-cancers

 

I lost my Sister-in-law to this dreaded disease in August 2010.  She was 45 yrs old, had 8 children (ages 19-4).  When she was looking for any and all treatment, UAB was one of the places she visited.  Since we live in Alabama, it was convenient.  The Dr she saw told her a clinical trial was in the works for triple neg but it wasn't available yet. 

It's too late for her, she lost the battle, but I hope this might help others.

Robin

 



Posted By: Lillie
Date Posted: Apr 12 2011 at 10:36am
Hello All,
I want to climb on the Soapbox with Donna. I would like to see a database with information broken down into "particulars" also. I, for one, would not mind having my information used to help us ALL. I for one would not mind using my computer skills to help load the database. It seems so many things are not done due to lack of funds these days. I'm retired, let me key in the information to help us ALL.....

Robin, I'm so sorry about the death of your sister-in-law.

Also, I see the newbies at the oncology center where I volunteer. A lot of times they don't know what they're taking, or why; and strangly enough, they don't want to know. The oncologist recommended it, and that's good enough.

I'm off the soapbox now...

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: SagePatientAdvocates
Date Posted: Apr 12 2011 at 11:10am
Dear Robin,

I am very sorry about your loss....those words seem so inadequate but I hope you know my feelings are genuine...I am so sorry...I am so used to seeing young ages with this awful disease but each time I do, I feel a shudder...45...it seems so unfair. But my mom was 46 when she passed. Never saw her six grandchildren and two great-grandchildren...A woman who adored children...this is just so unjust..but at least scientists are trying and some day, I believe with all my heart, there will be meaningful help for our community..there is already, at times, but other times it is just tragic.

Thank you for posting information about this trial...TNBC Foundation and Komen both supported the original research for this drug...and now all we can do is pray that it will help..

The process is often a slow one as the drug, hopefully, moves through the various Phases mandated by the FDA. So it will probably take years, if all goes well....but again, hopefully, it will help.

all the best,

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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