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single vs. combined agents in metastatic TNBC

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Parker View Drop Down
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    Posted: Feb 08 2016 at 12:41pm
I am noticing that a lot of you on this forum have received combination chemotherapy even though you are Stage IV. I was diagnosed de novo triple negative (liver met) in September and had a good initial response to Taxol (90% response), but a scan last week showed 20+ small new mets to liver. I'm also having some abdominal pain and coughing, so need to have some scans today and tomorrow to see what that's about. 

I'm trying to figure out what to do next. My local oncologist and my Dana Farber second opinion both suggest Carboplatin only. But I have seen other friends and people here who have been given more aggressive treatment plans (for example, Carbo/Gem). My goal right now is to get my liver enzymes down into the range where I can qualify for a clinical trial. Right now I qualify for some phase 1 trials but I would need to be off treatment for three more weeks which is terrifying. Especially since I don't know if it's the liver mets or the Taxol that is causing the liver enzyme elevation.

Have any of you had good responses to Carbo only? Do you think I should push for a more aggressive treatment? I've only had Taxol so far, and tolerated it well. 

9/15 Dx age 46, IDC-TNBC
1cm,BRCA-
Stage IV - 1 liver met, 1 cm
10/15 Taxol
12/15 90% response
2/16 Abdominal scan; 20+ liver mets



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gordon15 View Drop Down
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Post Options Post Options   Thanks (1) Thanks(1)   Quote gordon15 Quote  Post ReplyReply Direct Link To This Post Posted: Feb 08 2016 at 9:21pm
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Post Options Post Options   Thanks (1) Thanks(1)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Feb 09 2016 at 7:43am
Hi Parker,

Could you ask if combination therapy has a better chance to get you into remission or NED vs single agent chemo?  

I found this study:

Combination versus sequential single agent chemotherapy for metastatic breast cancer.

AUTHORS' CONCLUSIONS:

Sequential single agent chemotherapy has a positive effect on progression-free survival, whereas combination chemotherapy has a higher response rate and a higher risk of febrile neutropenia in metastatic breast cancer. There is no difference in overall survival time between these treatment strategies, both overall and in the subgroups analysed. In particular, there was no difference in survival according to the schema of chemotherapy (giving chemotherapy on disease progression or after a set number of cycles) or according to the line of chemotherapy (first-line versus second- or third-line).

http://www.ncbi.nlm.nih.gov/pubmed/24347031



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

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Post Options Post Options   Thanks (1) Thanks(1)   Quote gordon15 Quote  Post ReplyReply Direct Link To This Post Posted: Feb 09 2016 at 10:00am
Parker: here's a case of successful liver mets chemotherapy, it also says surgery is an option afterwards.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4620831/
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: Feb 10 2016 at 10:11pm
Hi Parker. I have stage 3 hi grade tnbc and they saw spots on my liver bit werent sure if they were mets or not. This is my first try at treatment but they said evenif they found mets the treatment would still be the sameAC plus T. The T is taxol. My Dr and I could feel the tumor before i started chemo and now we cant. I have double mastectomy coming up on March 8 so they will test every thing o see if it is all dead.
Any way the point is that chemo can kill tnbc. So keep researching and trying.
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Parker View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Parker Quote  Post ReplyReply Direct Link To This Post Posted: Feb 11 2016 at 7:56am
Thanks for your reply. Taxol was my first agent and we saw an almost complete response in December in the liver and lymph nodes. Unfortunately, my scan last week showed it was no longer effective so I'm now on to carboplatin. I don't think that A/C is typlically given to Stage IV patients because it's too harsh and the goal is palliative rather than curative. If carboplatin doesn't work I will need to have a next line of treatment and perhaps A/C or something more aggressive might be an option.

I hope your surgery goes well and that you tolerate the chemo. Where are you being treated? 
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Post Options Post Options   Thanks (1) Thanks(1)   Quote CindyRose Quote  Post ReplyReply Direct Link To This Post Posted: Feb 12 2016 at 1:54am
Hi Parker,

I was on Carbo last year only 4 rounds. This was the plan to treat my local reoccurrence and it was recommended by Dr Melinda Telli who is one of the top specialist in TNBC. I had a PET scan done after fourth treatment and nothing lit up, so I didn't have to continue the last two treatments. I am not sure the outcome, I also felt like there should have been more to the treatment but I trust Dr Telli and I believe her when she says TNBC BRCA carries respond well to Carbo. Only time will tell. I had taxotere in 2010, dr did say if it didn't work once it won't work again. Something about the cancer cells becoming immune.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Parker Quote  Post ReplyReply Direct Link To This Post Posted: Feb 12 2016 at 7:51am
Thanks CindyRose - I ended up feeling more comfortable with the carbo. I don't have a germ-line BRCA mutation but I do have a somatic one (as well as a few others), so maybe it will respond. Good to know you got a complete response!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Parker Quote  Post ReplyReply Direct Link To This Post Posted: Feb 12 2016 at 7:53am
123Donna, 

That article was very helpful!

Thanks for finding it!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Parker Quote  Post ReplyReply Direct Link To This Post Posted: Feb 12 2016 at 7:54am
gordon15

Thanks for all the helpful links!

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Post Options Post Options   Thanks (0) Thanks(0)   Quote petersdraggon Quote  Post ReplyReply Direct Link To This Post Posted: Feb 12 2016 at 10:02pm
Kind of off-topic but I wanted to pass this along in case no one else has.
I follow a couple of posts in "Inspire" in regards to TNBC.  The lady being treated stated she started the trial in December (2015) and in layman's terms what they do is harvest cells, take a part of your tumor, monitor which one's are aggressive against the cancer and grow literally millions more like them.  They then administer chemo to knock-down your immune system, then reintroduce the fighters back in to your system.  She had multiple tumors throughout and said they were are drastically reducing in size.  You have to stay at the hospital for one month as I recall.  It doesn't work for everyone but it sounds like they're on to something. My wife was diagnosed with TNBC in 2013, did the chemo & radiation and had been great for 18 months since finishing treatment and sadly we just this week we found it is back, so we are just getting geared-up for another fight.

https://clinicaltrials.gov/ct2/show/NCT01174121?term=%22TIL%22+and+%22NCI%22&recr=Open&rank=2

All the best you all of you,
Greg.
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Post Options Post Options   Thanks (1) Thanks(1)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Feb 13 2016 at 12:03am
Greg,

I'm so sorry your wife received this news.  Is it a local or distal recurrence?  Does she go to Siteman?  Is she considering clinical trials?  

Here's your link made hot:


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

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Post Options Post Options   Thanks (0) Thanks(0)   Quote kellly Quote  Post ReplyReply Direct Link To This Post Posted: Feb 14 2016 at 9:52am
i was on carbo solo for 10 months and was NED. Took a 6 weeks pause and after started a Nivolumab trial, which failed. I am now on Carbo /gemzar but having trouble with Carbo, i m having allergic reactions to the carbo.
 

DX '08,34yr, TN-IBC, gr3, 4 FEC, 3 Taxotere, biMST ->3/9 nodes+, 23rad's, BRCA-, bi DIEP '09. '12 son born!
Dx2 feb'14 mets subcl. & mediast. lymph nodes.CHEK2-. Olaparib, Carboplatin. Now: Nivolumab
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Post Options Post Options   Thanks (0) Thanks(0)   Quote hydeskate Quote  Post ReplyReply Direct Link To This Post Posted: May 27 2016 at 2:20am
I was originally suppose to have combo Taxol & A/C but due to a severe allergic reaction to Taxol, my regiment was changed to stand alone treatment.  First up was Abraxane, which knocked almost all my liver mets, and cleared my lungs, I was than given A/C as a stand alone which did the unexpected and knocked out the last remaining liver spot. They had planned on using the cyberknife on that spot but canceled that plan as my scans came back NED for the first time at the end of 2008.   

I had a 3rd round of chemo Abraxane as a standalone in 2009 after a BMX and Radiation.  My scans have all been NED (no evidence of disease) since and I am on a long break from chemo for my breast cancer. I am also Brac 1+ and apparently according to this latest study they did the genetic makeup of my tumor I am screwed when it comes back due to crap inherited genes.

I was dx out of the gate with Stage IV mets to liver, lungs and lymph nodes in early 2008, (lump was found at the end of 07 but was thought to be a hematoma due to my age (29).





Edited by hydeskate - May 28 2016 at 12:13am
IDC, 1cm, Stage IV, Grade 3, 2/20 nodes, mets, ER-/PR-, HER-
Mets Liver & Lungs
Sjogren's Syndrome
http://heidiy13.blogspot.com/
http://heidyplayscalediorama.blogspot.com/
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