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All TopicsForum: HER2/neu Positive Breast Cancer → Topic: Did you have chemo before surgery?

Topic: Did you have chemo before surgery?

Forum: HER2/neu Positive Breast Cancer — Testing, Herceptin (trastuzumab) treatment, side effects, and more.

Posted on: Jun 4, 2010 01:47PM, edited Oct 9, 2013 12:31AM by kayb

kayb wrote:

Just curious - my cousin tells me that she knows several people being treated at MD Anderson who had chemo before surgery. None have advanced cancers, all were DX'd in the past year, but I don't know any other details like type of BC or if they had lumpectomy or mastectomy. She thinks neoadjuvant therapy is being done more often there and wants me to ask my breast surgeon about it before my bi-lateral mastectomy. She wants to be sure I'm getting the latest and greatest care - bless her heart.

Has anyone heard of this is becoming more common? Does anyone know how to find current protocols for this? I've read it's sometimes done before lumpectomies to try to shrink a tumor so they can remove less tissue or if the cancer is very large but that's all I've found.

I'll post what I learn from my surgeon.

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Jun 4, 2010 01:53PM fightinhrd123 wrote:

I did, Im so glad i did, because i know the chemo worked!  At surgery i had no cancer left... I have a friend who wasnt responding to the chemo (her tumor wasnt shrinking) and they were able to switch the chemo so she had a better response at surgery. Good luck with you decission :)

Laura

Dx 5/29/2008, IDC, 2cm, Stage IIb, Grade 2, 2/14 nodes, ER-/PR-, HER2+
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Jun 4, 2010 02:05PM, edited Oct 9, 2013 12:32AM by kayb

Laura,

That must have been a wonderful feeling! May I ask what chemo you had? Feel free to PM me if you prefer. I'd like to have some examples to share with my BS. I think I'll call my nurse coordinator to set up a meeting with my oncologist. I was told I wouldn't meet him until 3 or 4 weeks after surgery.

DX May/2010, synchronous bilateral cancer, triple positive

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Jun 4, 2010 02:07PM, edited Oct 9, 2013 12:32AM by kayb

P.S. Laura -

Are you being treated at a major cancer center?

DX May/2010, synchronous bilateral cancer, triple positive

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Jun 4, 2010 04:18PM mke wrote:

I had chemo before surgery (dose dense AC and taxol ).  The tumour shrunk and that allowed for a lumpectomy rather than mastectomy.  Also the it showed excellent response to the chemo.  I was treated at a major cancer center.

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Jun 4, 2010 04:24PM Gettinpastthis wrote:

Hey there!  I am stage III and had chemo first.  Just finished in May and having bilateral Monday.  I took Taxotere, Carboplatin and Herceptin.  I chose it first because I would know without a doubt if chemo was working.  If it didn't they could change the cocktail.  Hope that helps and good luck!

Dx 12/31/2009, IDC, 6cm+, Stage IIIc, Grade 3, 23/23 nodes, ER+/PR+, HER2+Targeted Therapy 01/22/2010 HerceptinChemotherapy 01/22/2010 carboplatin, TaxotereSurgery 06/06/2010 Mastectomy (Right); Lymph Node Removal: Sentinel Lymph Node Dissection, Axillary Lymph Node Dissection (Right); Prophylactic Mastectomy (Left)Radiation Therapy 07/05/2010 ExternalHormonal Therapy 09/16/2010 TamoxifenHormonal Therapy 07/15/2011 Arimidex
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Jun 4, 2010 04:36PM fightinhrd123 wrote:

I was just at a regular oncologist, and i had AC and  then Taxol, surgery, then a year of herceptin, which i think is the "old" way of doing it.  Now i believe i would get the herceptin with the taxol, and then continue on w just the H after surgery.  I didnt really research enough when i was first diagnosed, i was just scared to death, and did everything the dr said.  What chemos are they recomending for you? 

Dx 5/29/2008, IDC, 2cm, Stage IIb, Grade 2, 2/14 nodes, ER-/PR-, HER2+
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Jun 4, 2010 04:38PM fightinhrd123 wrote:

Forgot to add I had at least two probably four positive nodes that were wiped out by chemo too!  Im really glad i did chemo first!

Dx 5/29/2008, IDC, 2cm, Stage IIb, Grade 2, 2/14 nodes, ER-/PR-, HER2+
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Jun 4, 2010 06:34PM, edited Oct 9, 2013 12:33AM by kayb

"Gettinpastthis wrote: I chose it first because I would know without a doubt if chemo was working."

Thank you. That's exactly what I'm thinking! Only problem is I haven't been offered that option because I wasn't supposed to see the oncologist until after my surgery.

I found an abstract today (published 4/1/10) that says the "National Comprehensive Cancer Network now recommends treating patients who have operable, locally advanced, HER2-positive breast cancer with neoadjuvant paclitaxel plus trastuzumab followed by 5-fluorouracil, epirubicin, and cyclophosphamide plus trastuzumab." Here's the link if anyone wants it:

www3.interscience.wiley.com/jo...

I don't know if I qualify as having locally advanced cancer (not until sentinal node biopsy which they plan to do during mastectomy) but it is IDC and HER2+. I called and made an appointment to see the local oncologist on Monday. I think I'm all ready getting a rep as a pain in the butt because I've asked lots of questions! I just want to be proactive. I feel like I need to be my own advocate.

I also plan to travel to Houston and MDA for oncology so I have a new call into them. Their new patient scheduler had also told me to call back after my surgery to schedule my first appt.

Thanks for responding. It's a big help!


DX May/2010, synchronous bilateral cancer, triple positive

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Jun 4, 2010 09:44PM Twinmom77 wrote:

I, too, had chemo before surgery and was told it was both to make sure the tumor shrunk and to make a lumpectomy possible.  I had both happen and I had no IDC left after surgery, just a little DCIS.  I was on taxotere, carboplatin, and herceptin.  At first I just wanted the darn thing out of me so I was so ready for surgery, but in the end I was glad I did chemo first.

And good for you for being your own advocate - that's exactly right!  I fired my first onc because she seemed to get annoyed with my questions and would blow me off and I was miserable during treatment.  Once I switched oncs to one who patiently listened to my questions and concerns I was much happier.

1st dx 6/09 IDC, Stage I, HER2/ER/PR+, 0/2 nodes

Dx 6/12/2009, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2+Dx 12/23/2011, IDC, <1cm, Stage I, Grade 2, 0/4 nodes, ER+/PR+, HER2-Surgery Reconstruction: Breast implants (permanent) (Both)Targeted Therapy 07/21/2009 HerceptinChemotherapy 07/21/2009 carboplatin, TaxotereSurgery 12/08/2009 Lumpectomy (Left); Lymph Node Removal: Sentinel Lymph Node Dissection (Left)Radiation Therapy 01/30/2010 ExternalSurgery 01/30/2012 Reconstruction: Tissue expander placement (Both)Surgery 01/30/2012 Mastectomy (Both); Lymph Node Removal: Sentinel Lymph Node Dissection (Right)Hormonal Therapy 02/09/2012 Tamoxifen
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Jun 4, 2010 10:36PM Gettinpastthis wrote:

hillck - I did have locally advanced with four tumors and significant axillary node involvement.  One onco told me to do surgery.  My second opinion said either surgery or chemo.  In my case chemo was not do to shrink for a lumpectomy - I always knew it would be a mastectomy.  BUT if they remove the tumors and then do chemo... how will they know for sure chemo worked?? the second onco said they don't exactly know if it is working...  That wasn't good enough for me... I wanted to see and know it was working.  I went back to the first onco because he is closer to my town and he agreed to do chemo first. Boy am I glad I did!! I felt the tumor shrinking after teh first treatment.  I cannot feel any tumors now and surgery is Monday.  Good luck and you must be your own best advocate!  Demand to see the onco first, at least to see why he wants surgery first.  hugs and hang tough!

Dx 12/31/2009, IDC, 6cm+, Stage IIIc, Grade 3, 23/23 nodes, ER+/PR+, HER2+Targeted Therapy 01/22/2010 HerceptinChemotherapy 01/22/2010 carboplatin, TaxotereSurgery 06/06/2010 Mastectomy (Right); Lymph Node Removal: Sentinel Lymph Node Dissection, Axillary Lymph Node Dissection (Right); Prophylactic Mastectomy (Left)Radiation Therapy 07/05/2010 ExternalHormonal Therapy 09/16/2010 TamoxifenHormonal Therapy 07/15/2011 Arimidex
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Jun 5, 2010 12:19AM Ca1Ripken wrote:

Hi all.  I am doing neoadjuvant chemo now....  have 2 tumors in my right breast... MRI estimates them at 7.4 cm and 2.6 cm.  And, have had one node test positive.  The large tumor is IDC, and I did not have the 2nd tumor biopsied b/c I am definitely having a mastectomy.  I opted (and was given the option for surgery or chemo) for chemo first, because I didn't want any possible cancer cells hanging out in my body before, during, and after surgery... I mean with locally advanced
BC, they can't get it all or know that they did - so, I wanted to do what was aimed at getting it all now!  I've had 4 weekly treatments of taxol (paclitaxel) and herceptin and can't say that I have felt my tumor responding yet.  I don't know when it is suppose to start feeling smaller or softer? (anyone else do taxol and herceptin know??).  I will continue this for 12 weeks, and then move on to adrimycin (sp?) and cytoxan, dose dense every 2 weeks for 4 treatments, then surgery, then rads... then herceptin every 3 weeks to complete a year, then 5 years of tamoxifen. 

If anyone has an answer on the tumor response time, please let me know!!  ((HUGS)) sisters!!!!!

Dx 4/23/2010, IDC, Stage IIIa, Grade 2, 1/10 nodes, ER+/PR+, HER2+Dx 3/13/2013, IDC, Stage IV, mets, ER+/PR-, HER2+
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Jun 5, 2010 06:17AM anna4969 wrote:

HI Everyone, This is actually my first public post as I have "lingered" for several months and have read many encouraging and informative posts.  I am in this exact situation now.  I was diagnosed Jan 11, 2010 with IDC, 6+ cm, stage 3a, Grade 2, ER-/ PR-, HER2+, with at least 2 lymph nodes involved(that is how I realized something was wrong).  I am at a large hospital, not a major medical center, in the midwest.  It was comforting to read, Cindy, your post.  I have trusted my onc from the very first day.  He was very upfront with us, looking back, hard to swallow at that overwhelming time, but I knew he had the experience behind him.  He came from MD Anderson and has told me I am getting their regiment of treatment.  That being said, I am getting neoadjuvant chemo which started 2 weeks after my diagnosis.  I got 4 treatments once every three weeks of 5FU(twice a week), Adriamyacin and Cytoxan.  They classified this as "the big guns" and said I couldn't have gotten anything stronger. I then had a 3 week recoup time, whereby they redid an MRI and Muga.  My Mri showed major shrinkage, to the point of barely being seen on the MRI.  My onc was absolutely delighted with the response I had to the 4 treatments. Especially being that I was only half way through chemo.  I then started Taxol and Herceptin for 12 weeks.  I have just completed my 7th treatment of that.  I will end with Taxol on July 7 and continue Herceptin until next April.  Was told that if the studies show that Herceptin is advantageous past a year, we will continue that. I will then have 4 weeks to recover and surgery will be the first week of August.  I am committed to mastectomy and want that and will meet again with the breast surgeon on June 21st to get that ball rolling. 

So, my understanding is that, yes they want to see how the tumors respond to the chemo and as my onc told me get the chemo "systemic".  So that if there were any cells that have traveled to other parts of the body, we have had the 6 months of chemo to kill it.  Also, to shrink the tumor before surgery.  Though the systemic part was really the huge focus here.  That really makes sense to me.  Like others here, I just wanted this thing off of me, however being that the lymph nodes were already involved, it all made even more sense to get the chemo bodywide before surgery.  Kind of like an insurance policy if you ask me.  I don't care about the breast but certainly fear that the cancer has traveled to the liver, lung or brain and the neoadjuvant addresses this situation.

Cindy, I would most definitely talk to the onc first.  This is your body and your life and you have to know you are doing everything possible to keep it.  I myself, am so grateful that my medical team took me by the hand and made the aggressive decisions for me.  I was not in a good situation in Jan as my sweet mother had passed away only 2 months before and so I was grieving heavily and relied on my medical team immensely.  Thankfully after lingering, and reading many posts, it appears that they did/are doing all they can for my diagnosis.  In your situation, If I had any questions and they were not addressed appropriately, I would be concerned about putting my treatment decisions in someone else's hands that couldn't give me the 10 minutes to answer my questions.  You are doing the very best thing for yourself by educating yourself and asking questions.   Keep your inquisitive attitude and aggressive attitude, it will certainly help you get through this situation!!!

Dx 1/13/2010, IDC, 6cm+, Stage IIIa, Grade 2, 9/18 nodes, ER-/PR-, HER2+
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Jun 5, 2010 10:25AM gsg wrote:

Stage IIa and I had chemo first.  4 DD A/C and 4 DD Taxol.  I was able to feel my lump shrinking and by the time of surgery, the lump was completely gone.  My surgeon said they basically did a "ghostectomy."  It did a lot for me mentally...I knew the chemo was working.  Figured if there were any stray cells in other parts of my body they must have been obliterated as well.  Being ER/PR+ this meant a lot, as ER/PR+ cancers don't *always* respond as well to chemo as the negatives do.

Pardon me if I repeat myself. Can't remember jack.

Dx 3/2006, IDC, 3cm, Stage IIa, Grade 2, 0/2 nodes, ER+/PR+, HER2-
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Jun 5, 2010 10:38AM, edited Jun 5, 2010 10:41AM by negirly

I also had chemo first. I was diagnosed mixed ILC and IDC stage 3 with some lymph involvement. I did it a little backwards and did taxol/herceptin first for 12 weeks then AC after surgery.  My onc at Dana Farber wanted me to get on Herceptin ASAP.  My tumor shrunk a lot - it was big to start with (over 10 cm) and all the nodes were clear at surgery - but I still needed them removed.  As others have said - I'm glad bc I know it worked and it does give me confidence going forward. 

Best of luck.

Karyn

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Jun 5, 2010 12:32PM RebzAmy wrote:

I also had chemo before surgery due to size of lump, spread to lymph nodes, being HER2++ and grade 3 (very aggressive). Chemo first was to shrink the lumps and make sure the cancer didn't spread any further.

I had 3 x FEC and 3 x Taxotere and started Herceptin when I started the Taxotere. I could feel the lumps shrinking almost immediately and when I had my mastectomy and lymph nodes removed 4 months later, there was practically nothing left of the cancer.

 RebzAmy

Diagnosed June 2007, IDC, Grade 3, 4-5cm lump, several lymph nodes involved, HER2+++, 4 months of high strength chemo, mastectomy and lymph node removal, radiotherapy & a year of herceptin and recently had preventative surgery to other breast.

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Jun 5, 2010 03:38PM fg2000 wrote:

Hi Leanna

 I just finished my first DD cycle (4 rounds) of Adriamycin and Cytoxan. After just the first treatment I felt a VERY noticeable difference in tthe size of the 5 cm tumor in my right axilla as well as the tumor in my right breast. By the second treatment it had shrunk to half size. Now, after the 4th treatment, I cannot feel the lump at all. I have responded very well to this regimen and I hope you do too! Now I have 4 cycles (two weeks apart) of DD Taxol then surgery sometime mid August (lumpectomy and total node disection  in right axilla) then aramatose inhibitor for 5 years. I feel very good about my progress. My team of doctors at Moffit has been excellent!

Good luck to you!

 Kathie

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Jun 5, 2010 04:11PM stlcardsfan wrote:

I also had Chemo first - TCH (taxotere, carboplatin and Herceptin). I was checked by manual exam before each Chemo cycle (had 6 total) after #1, it was down about 1 cm, started at 4.4 cm. After #2 was down to about the size of an acorn. After #3 could not find it anymore. 

Due to BRCA status - BRCA 2+, will be having BMX, but if I was BRCA negative, then definitely would be having lump.

Chemo was done first to # 1 get it to stop growing, and # 2 get it to shrink to a manageable size for surgery. Both objectives accomplished!  

TCH, Herceptin, BMX, Exchange all Done!

Dx 12/16/2009, IDC, 4cm, Stage IIa, Grade 3, 0/2 nodes, ER-/PR-, HER2+
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Jun 5, 2010 05:05PM MiracleMileM wrote:

I had chemo first - taxotere, carboplatin & herceptin six sessions - beginning in December of 07 and then a lumpectomy and IMRT radiation.  I was told that chemo first was standard protocol for stage IVs like me and locally advanced.  Research showed that these protocols at least for HER2+++ were reported on at the 06 San Antonio conference.  A PET scan after the 4th chemo showed a remarkably positive result though there was something still there at the time of surgery.   I am happy with the sequencing.

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Jun 6, 2010 12:14AM afpb wrote:

Hi there. This is my first post and I hope I'm on the correct board. I am helping a friend navigate her way through neoadjuvent chemo. She is HER2+++. She had a 7.3 cm tumor that shrank to 2.3cm after 6 rounds of TCH which ended on May 13. She had her first follow up herceptin on June 3rd. She was going to have a lumpectomey on June 11 but decided to have a right side mast with expanders. before rads. The change in plans pushed her surgey to June 30th. She is concerned that 6 weeks is too long to wait and that the tumor might regrow or spread if it doesn't come out sooner. Can anyone offer an informed opinion about whether or not that is too long to wait between chemo and surgery? If I'm on the wrong board, please point me in the right direction.

Thanks

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Jun 6, 2010 12:25AM 2z54 wrote:

Hi afpb,

By no means am I an expert, but I don't think 6 weeks is too long to wait. I had my last chemo on Dec. 10 and then BLM on Jan. 25 '08 (longer than 6 weeks, now that you've made me count!). I think one of the reasons it's good to wait is to rebuild your healing strength after the chemo, in preparation for the surgery.  I think that the minimum they'll wait is four weeks before doing a mastectomy. 

Sue

Dx 7/23/2008, IDC, 3cm, Stage II, Grade 3, 0/3 nodes, ER-/PR-, HER2-
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Jun 6, 2010 12:35AM afpb wrote:

Thank you Sue. That's reassuring. I hope you are doing well.

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Jun 6, 2010 12:55AM afpb wrote:

Sue. My finger counting was wrong! My friend's surgery will actually be 7 weeks after chemo as was yours. Thanks again.

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Jun 6, 2010 10:48AM 2z54 wrote:

You're very welcome!  I am doing fine, and very glad most of this is behind me.  Next week I will probably be getting my last reconstrution revision, to get nips.  Not sure I want them, but my PS almost insists!  (I think she wants the practice????)  Anyway, wishing your friend the best!  She's lucky to have such a good friend in you!

sue

Dx 7/23/2008, IDC, 3cm, Stage II, Grade 3, 0/3 nodes, ER-/PR-, HER2-
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Jun 6, 2010 12:38PM, edited Oct 9, 2013 12:35AM by kayb

Hi all. I started this thread and truly appreciate your responding. It's a tremendous help.

I'll meet the onc tomorrow to ask some questions. I've realized my tumor size (2cm) doesn't fall into the definition of locally advanced cancer and it's that category of HER2+++ that is recommended to have pre-op chemo. HOWEVER - here's my big question:

What is the downside of giving someone like me pre-op chemo? It seems that either the tumor will respond to the herceptin and shrink or (fingers crossed) possibly disappear. That's a good thing! OR, the tumor won't respond to herceptin and that might change the course of my adjuvant therapy. I don't see a downside. Either my cancer starts getting better right away or the onc has more knowledge about how best to treat me.

BS says sentinel biopsy will tell us if my cancer has spread to lymph nodes but she won't do that until I'm on the table for BMX. If it has spread to nodes, doesn't it seem like pre-op chemo could be advantageous? I realize I'm not a doctor and I don't play one on TV so maybe there's more to this than meets the eye, but I feel like my thought process is pretty logical here.

So - we'll see what he says and I'll post it.

BTW - anybody here have a smallish tumor and receive pre-op chemo? If so, were you treated at an NCI designated cancer center?

DX May/2010, synchronous bilateral cancer, triple positive

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Jun 6, 2010 01:00PM lovetosail wrote:

Hi Cindy,

My tumor was ~2cM, not locally advanced, and I did neoadjuvant chemo as part of a clinical trial.  I had taxotere, carboplatin and herceptin plus tykerb, 6 cycles. The tykerb was the clinical trial drug, it's FDA approved for stage IV and may get approved for earlier stages depending on this trial.  A lot of clinical trials do neoadjuvant as they can directly see how the new treatment affects the tumor, compared to standard treatment.  The tumor starting shrinking after the first treatment.  By the time of my mx, the only thing they found were a few isolated pockets of cancer about 4mm in size, and those cells were so damaged by chemo that they weren't sure they were entirely functional anymore.

I am at an NCI designated cancer center

My oncologist and surgeon were adamant, however, about doing the SNB BEFORE chemo.  They wanted me to be correctly staged - if I did have node involvement and nodes were assessed only after chemo then it's possible I would be classified as node-negative when in fact I had been node positive but chemo cleared it up.  I was node-negative with the pre-chemo SNB.  Had I been positive they would have investigated more nodes in my mx, post-chemo.  

Knowing the correct stage of disease may or may not impact treatment decisions - for example if I had positive nodes pre-chemo they would have done radiation post-chemo, regardless of how the nodes responded to chemo.  I guess knowing the correct stage of disease also allows them to give a more accurate prognosis - but that's all probability anyway (I am a statistician by training and actually enjoy the numbers, but I know a lot of women here don't care to know if their probability of 5 year survival is 87% vs 93%). 

I bring up the idea of pre-chemo SNB  just b/c you might want to discuss it with your onc.

Like you, I don't see the downside to neo-adjuvant chemo.

Good luck with your treatment!

Sue

Dx 10/19/2009, IDC, 2cm, Stage IIa, Grade 3, 0/5 nodes, ER+/PR-, HER2+
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Jun 6, 2010 02:01PM, edited Jun 6, 2010 02:07PM by 2z54

Cindy,

I think your doctor may be considering neo adjuvant chemo, not only because you're HER2+, but also ER-, PR-.  I'm triple negative (ER-, PR-, HER-), and know that it is a very agressive cancer and chemo worksvery well on it.   I was given neo adjuvant chemo not so much to shrink the fairly large 4cm tumor, but to also make sure it was not floating around my bloodstream, etc. As it turns out, the tumor shrank in half (not total response, but enough to satisfy me!), which proved that my dose dense AC and Taxol treatments worked.

And, my doctors all insisted on a SNB BEFORE the start of chemo in order to get an accurate read on the lymph nodes. Fortunately, they were all clear. I think SNB before chemo is the standard of care, and it really makes sense.  If you decide to go with neo-adjuvant chemo, insist on the doing the SNB for staging, BEFORE starting chemo.  (In fact, I wouldn't totally trust a BS who didn't insist on that!!!!  It may be time for a second opinion???)

Hope that helps! 

Sue

Dx 7/23/2008, IDC, 3cm, Stage II, Grade 3, 0/3 nodes, ER-/PR-, HER2-
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Jun 6, 2010 08:42PM, edited Oct 9, 2013 12:38AM by kayb

Thank you Sue and Sue!

I'm definitely bringing up pre-op SNB and pre-op chemo with the onc. and I may be putting the breaks on everything depending on what he says. My original plan was to have an onc at MD Anderson in Houston work with a local onc in Albuquerque to oversee my chemo, but I planned to have surgery locally for comfort's sake.

My doctors were NOT considering neo adjuvant treatment for me, in fact, I wasn't to meet my local onc until 3 or 4 weeks post surgery. The only reason I have an appointment with the onc tomorrow is because I requested it after I read about pre-op chemo.

BS here is planning SNB as first thing she does once I'm under anesthesia in OR immediately before BMX. I have read that general anesthesia makes the process easier on the doc because it's pain free for the patient.

MDA new patient coordinator said they'd schedule my first onc visit there also post surgery as soon as they had all of my test results and pathology report from the surgery. Of course the coordinator doesn't know anything about my cancer so she's just following procedure. I think I'll call there tomorrow to set up a surgical consult if that will get me to MDA sooner.

I'll see where my conversation leads tomorrow, but I suspect I'll be heading to MDA sooner rather than later.

Thanks again for sharing your info with me.

DX May/2010, synchronous bilateral cancer, triple positive

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Jun 7, 2010 10:58PM, edited Jun 7, 2010 10:59PM by CMT

Cindy,

My oncologist team did my chemo a little differently. I had 4 cycles of AC to shrink the tumor for a lumpectomy and while I waited for my BRAC results to come back. Then I had surgery and when they went in the cancer had evaporated (only dead cells were left). God is awesome! After surgery, I completed 12 more weeks of chemo (Taxol and Herceptin) and I'm currently in my 3rd week of radiation and continuing with Herceptin for one year. I go to a cancer center. God bless!!

CMT

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Jun 9, 2010 02:01PM, edited Oct 9, 2013 12:40AM by kayb

Hi all. Here's an update if anyone's interested.

I met my oncologist on Monday. I had requested an appointment through my Cancer Care Nurse Coordinator. The onc's office hours begin at 8 but he offered to see me at 7 because he had no openings. I thought that was nice. I told him I knew that a lot of HER2/neu+ patients were getting neoadjuvant treatment. I knew that the size of my tumor was smaller than those usually recommended for having the pre-op chemo but I wanted to talk about whether there were any advantages or downsides to neoadjuvant as opposed to adjuvant treatment.

We talked for an hour but what it came down to was this:

He said that currently there is a theoretical advantage to pre-op chemo with herceptin for those who achieve pCR. There hasn't been enough clinical data to say there's an advantage with certainty because we're still in the early years of widespread use of herceptin. Officially, survival rates are the same overall for pre-op or post-op treatment. If someone has a very large tumor, pr-op chemo may cause it to shrink enough for lumpectomy instead of MX. I'll be having BMX.

I asked if it would be helpful in choosing my future chemo if we discovered that my tumor didn't respond to the herceptin now. He said "maybe". He said that the commonly used chemo drugs for other types of BC are also used on us who are HER2+ but it is the addition of herceptin that makes our treatment different. When a HER2+ tumor doesn't respond to herceptin, they just use more of the other standard drugs. The difference would be knowing for sure that herceptin isn't working - once your tumor has been removed they have no way of knowing if you're responding to herceptin but they add it to your treatment anyway based on your positive status.

So - for someone in my situation with a 1.8 - 2.0 cm tumor, possibly no node involvement (based on the biopsy of one node, but not SNB) - there may be a theoretical advantage if I reach pCR but there's really no downside for me either. I'm going for neoadjuvant mostly for my peace of mind. It will give ME more info about my cancer and that's important to me.

Now - what I will choose for neoadjuvant treatment is still to be decided. There are 2 trails nearby I might take part in, or I could go with what would normally be used after surgery. We still have several things to talk about and I may still getting a second opinion at MDA depending on how long it takes to get in.

I must say, I really liked this onc. I appreciated the time he took to answer all of my questions and to discuss the clinical trials I asked about. He's perfectly happy doing the neoadjuvant treatment since I asked for it.

BTW - the current issue of the Annals of Oncology has a study about how most BC patients want greater participation in making decisions about their care LOL!

DX May/2010, synchronous bilateral cancer, triple positive

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Jun 9, 2010 05:15PM lovetosail wrote:

Cindy, glad you liked your onco and that there are trials you might be able to partake it.  Good luck with forming your treatment plans!

Dx 10/19/2009, IDC, 2cm, Stage IIa, Grade 3, 0/5 nodes, ER+/PR-, HER2+

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