TRIPLE POSITIVE GROUP
Comments
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LizA - They are discussing radiation this long after surgery? After a year it seems unusual, especially with ALND already done.0 -
LizA - I had a right mastectomy and had 2/27 nodes positive for macrometastases. Due to newer research our province had just updated their guidelines to recommend radiation if 1 - 3 nodes positive with macrometastases. I finished my radiation end of March 2013 and, as Girlstrong indicated it included regional node irradiation.0 -
Special K and team, one of my close friends just had an outpatient procedure and she is in living hell from the adhesive bandages and steri strips. Can you remind me of the name of the products she should ask for in the future? I remember seeing those posts awhile back on the boards. Danke Schon (with an o-umlaut).0 -
I just had my annual skin cancer checkup. No spraying this time. He thout all looked well. You guys got me motivated!
Flavia, wow, you had it rough. My pain pump was inserted from the front . One baseball size thing in a bag that I wore in a fanny pack. The tiny tubes that delivered the meds were like three feet long! They went in and then circled around my breast area. When it had worn off, they told me I could pull the tubes out. Ummmm....no. At my checkup, which ended up being at 5 days, I had the nurse in my BS office take them out. Good thing I didn't try as I had no idea they were so long!
Lago...love the link...I am going to order a couple of the fans!
All...I thought this was really cool. Probably should post it on the recon site, but I thought it was a nices story.
http://www.nydailynews.com/life-style/health/twin-sisters-discover-breast-cancer-article-1.15181370 -
pbrain - here are a couple, I am more familiar with the third one, Medipore. Also, here is a link to a thread regarding allergies to tape:
http://community.breastcancer.org/topic_post?forum_id=91&id=767669&page=10 -
Fluff - glad all was well at the derm! I go for the third and final excision on Monday morning. I get the stitches out from #2, and have #3, then wait two more weeks and get those stitches out. After that I won't know what to do with myself!0 -
Pbrain. I was going to start the closet cleaning/treadmill program last w/end but I slept most of Saturday. Which meant Sunday I had to prep for Monday. And classes. And get dog food. Usual. So. This w/end I am at least going to do a couple of drawers in the kitchen and move the drycleaning from the treadmill to the bedroom. Years and years ago a volunteer group I was part of had a workshop called Messy's something or other. Got a "lesson plan" on how to Mount Vernonize a room. Work in a circle with 3 boxes. 1 to be put away in another room, 1 to give away, 1 to throw away. It actually works if you do it-drawers, cupboards, under beds and couches, etc. Of course I will NEVER get that far Am hoping for a couple drawers and a closet or 2. My office at work is horrid. I almost need to torch it.
One of the side winding trails I am on is the ECHO/MUGA trail due to falling EF. Mine went from 66 to a low of 35%. Apparently I will have ECHOs every 3 months for 3 years or so then every 6 months. I plan to argue that if I am feeling well and not short of breath, pale as a ghost, or panting. A bit of a waste of money that can be used elsewhere. Am taking cardiac drugs and do feel better.0 -
Susan...I would have that echo! That is really low.
I had echos every three months until the end of herceptin, and then six months out. Haven't had one since, although he mentioned that when I see him in March, which will be my three year date from surgeries, he would probably order one just to make sure it is all stable.
SpecialK-I'll bet you won't be heading for the tanning bed, lol. You have been through the ringer!
Kayb....I still don't like to think about that. Yick. I had an issue with one of my drains after my second surgery to remove my expanders. Somehow it pulled or something (can't remember), but it was like 9at night. I texted my PS. he called from emergency surgery at the hospital. My DH talked to him and he said no worries, it is in there a long way and we would have to see a black dot. DH said, yeah that dot is showing. PS told him we could pull it out. No, no, no. My husband said he wasn't going to be responsible if something went wrong and I was bleeding to death or screaming in pain. So, he had us come in and bypass the emergency room. He sent out a nurse who got everything all set up, had me lay back, and the tube fell out in her hand. We all started laughing. But I felt much better knowing I was someplace sterile!
I had no problem looking at my incisions, etc, but show me gooey, gunky stuff, and give me some time to form a picture in my mind of what it looks like, and I'm out. Taking out stitches can send me into an anxiety attack, lol.0 -
Hello to all , need help . Chemo # 9 was last thursday the 7th felt the usual se then started feeling ill on sunday nausea lack of appetite lethargy. Tuesday developed fever chills and the breast with the ca got swollen and tender to touch achey went to onc the following day cbc within normal limits had fever was tachycardic very lethargic . They sent me home with script for ABT and canceled my taxol / herceptin for this week, said might be mastitis been on abt day 3 today fever gone but i dont notice swelling reduce and still tender . Had 3 surgeries in may 7th was 1st lumpectomy , dirty margins went in 2 more times got three clean margins but one is very close to comsider clean 1mm shy . Nervous and scared dont know what to think no u/s or ct ordered . Help........0 -
fluff - I feel like a Thanksgiving turkey! I have had so many skin cancers - my first one was when I was 35 so I have not been out in the sun much! I think that is one of the reasons my Vit D was so low - I have avoided the sun like it was the plague. My back was clear at my check six months ago - hard to believe that these developed so quickly. By Monday I will have three 2" incision lines in the middle of my back! Between all the BC scars, the scars from C-sections, abdominal hyst/ooph, knee surgery, tumor removal from my right calf, reflux surgery with five small incisions, and all the other skin cancers I look like I have been in a helluva knife fight! You and kayb have funny stories about the JP drains. I had reflux surgery in '95 and prior to the surgery they needed to do a diagnostic Ph probe which involved wearing a thin nasogastric tube that was in my esophagus and came out my nose, was taped to my cheek and then the tube was connected to a 24-hour monitor about the size of a deck of cards. I had to wear it overnight and the little monitor thing recorded the Ph levels. The hospital was about 45 minutes away, got stuck in a road block on my freeway exit - the trooper was a bit shocked when he looked into my car - he looked like he thought I had escaped from the hospital and should not be driving a car, but I was not who he was looking for so he let me go! I had to do a scholarship presentation on behalf of the Officers' Wives' Club early the next morning with a bunch of military folks and scholarship winners, no time to drive to the hospital and back, so they told me how to disconnect the monitor and get this thing out - OMG! They just said to pull it really fast, like kayb's it was really long! My eyes were watering like crazy and I couldn't catch my breath for about a minute, but it all worked out. I showed up at the scholarship breakfast in my suit and cute heels and thought to myself that I should get an award for having the craziest effing morning!!!0 -
SpecialK: Yes, it will be a year on Dec.7 that I had my surgery. Finished TC in May and have 2 Herceptin left. I am seeing the RO on Nov.25, I guess I'll see what he has to say about this year thing. All I know was my Oncologist said at my appt. on Thursday that it was past practice for him with anyone w/less than 4 pos nodes and a BMX = no radiation. In recent studies, he said that view had changed and that in my case of 2 nodes, rads would provide a 3% advantage to the cure rate. I've been pondering this year thing since he said this. Needless to say, I will have plenty of questions for the RO.0 -
To add to the above: I've read about the rads that Girlstrong is talking about and I'm sure that's what he's suggesting be done. Just seems odd to just now decide it. I know the study I read about was just recently published, maybe that's why. I'll let you know what RO says.0 -
Liz - I was curious because our dx is very similar. Please let us know what your RO says.0 -
pbrain. I had to use Mepilex so my skin didn't pull off. I don't have too many issues with sterile strip and tagaderm is ok for an hour or so. I nearly pulled my skin off from itching when I had it on for a week at a time for three weeks. The nurse gave me some lotion to put on under the tagederm that helped. I an not sure just what that was.
SpecialK I am glad you are getting to the end of that skin stuff! I bet you are too.0 -
LisaA - here is a link to the Updated guidelines for radiotherapy that was the basis of my RO's recommendation - it might be helpful -
http://www.albertahealthservices.ca/hp/if-hp-cancer-guide-br005-adjuvant-rt-invasive-breast.pdf0 -
websister - I just read the guidelines you posted - they were consistent with the treatment I received if I was reading them correctly. Also looked at your blog for the first time - I just wanted to say how sorry I am about your mom, your posts about her were tender, it sounds like she was a strong and generous woman, my condolences to you and your family.0 -
Re cardio toxicity ... New BC protocols on the way... Sequential v concurrent treatments!
A potentially more heart-friendly sequential chemotherapy regimen for breast cancer proved as effective as the standard concurrent approach but with less cardiotoxicity, a randomized trial showed.Action Points
- Note that this randomized trial of women with HER2-positive breast cancer demonstrated that sequential treatment with trastuzumab was as effective as concurrent trastuzumab when added to conventional therapy.
- Be aware that the rate of cardiotoxicity was very low -- it remains unclear whether the sequential dosing regimen will improve cardiac outcomes in these patients.
Sequential delivery of an anthracycline and trastuzumab (Herceptin) resulted in a pathologic complete response (pCR) rate of 56.5% compared with 54.2% for concurrent administration protocols.
Clinically significant declines in left ventricular ejection fraction occurred infrequently, and the rates did not differ significantly between treatment groups,Aman U. Buzdar, MD, of the University of Texas MD Anderson Cancer Center in Houston, and co-authors reported online in The Lancet Oncology.
"We have shown that anthracycline and taxane neoadjuvant chemotherapy with trastuzumab results in a complete pathological response in many patients with HER2-positive breast cancer," the authors concluded. "Pathological complete responses with concurrent versus sequential administration in combination with [fluorouracil, epirubicin, and cyclophosphamide (FEC)] were similar.
"Thus, concurrent administration of trastuzumab with anthracyclines offers no additional benefit and is not warranted."
In many instances, neoadjuvant chemotherapy for breast cancer can downstage the primary tumor and regional lymph nodes, extending the potential for breast-conserving surgery to more patients. Pathologic CR to neoadjuvant chemotherapy is associated with more favorable outcomes, the authors noted in their introduction.
For tumors with HER2 overexpression, the addition of trastuzumab to conventional adjuvant chemotherapy has been shown to reduce the risk of recurrence and death. Many standard adjuvant regimens include a member of the anthracycline drug class, which carries a risk of cardiotoxicity. The toxicity might be increased by concurrent administratilon of trastuzumab.
The efficacy of trastuzumab-containing adjuvant regimens has led to investigation of neoadjuvant therapy for patients withHER2-positive breast cancer. A phase III randomized trial showed that the addition of trastuzumab to paclitaxel, followed by anthracycline-containing therapy, more than doubled the rate of pCR and improved disease-free survival.
In the same trial, concurrent administration of trastuzumab and chemotherapy was associated with a lower pCR rate. No safety problems emerged, regardless of whether therapy was given concurrently or sequentially.
In follow-up to the previous study, Buzdar and colleagues performed a randomized trial to compare FEC followed by paclitaxel-trastuzumab (sequential) with paclitaxel-trastuzumab followed by FEC-trastuzumab (concurrent).
Investigators at 36 centers in the U.S. enrolled and randomized patients withHER2-positive invasive breast cancer to the two regimens. Eligibility criteria included a baseline LVEF ≥55%, assessed within 90 days prior to enrollment. The primary endpoint was pCR, defined as no histologic evidence of invasive tumor in the breast and axillary nodes at surgery.
Concurrent therapy continued for 12 weeks and sequential therapy for 24 weeks. LVEF was assessed at 12 and 24 weeks, and clinically relevant cardiotoxicity was defined according to
standards at the treating institution.
The final analysis included 280 patients. The results showed that 78 of 138 patients randomized to sequential therapy had a pCR, as did 77 of 142 in the concurrent-therapy arm. The 2.3% absolute difference in pCR rates did not achieve statistical significance.
No treatment-related deaths occurred during the trial. The most common severe toxicities were neutropenia (25% with sequential therapy versus 31.7% with concurrent administration) and fatigue (4.3% versus 8.5%).
At week 12, LVEF had declined below the lower limit of the institutional definition of normal in 0.8% of patients in the sequential arm and 2.9% of those who received concurrent therapy. By week 24 the rates were 7.1% for the sequential group and 4.6% in the concurrent group. Rates did not differ significantly between groups at either point in time.
The authors noted that the trial did not address the potential cardiotoxicity of 12 versus 24 weeks of neoadjuvant therapy, followed by an additional 28 to 48 weeks of trastuzumab after surgery, which is standard for HER2-positive breast cancer.
The study was supported by the National Cancer Institute.0 -
Special K - thank you re: condolences re: Mom.
Yes, I think you were reading the guidelines correctly, the reason I received radiotherapy post-mastectomy was due to macrometastases in my positive nodes, otherwise it would not have been indicated.
Ashla - thank you for the article - from reading it I think I understand that this was similar to the treatment I received, mine was adjuvant - FEC followed DH, then finishing up with H every three weeks for 14 cycles. Good to read about the PCR0 -
writer, thanks for the reply. They also removed and replaced my nipple on the cancer side, glad to hear the feeling might come back. at the time of surgery the plastic surgeon said "it might fall off, don't worry." yikes. I will be going down form a "G" cup to a "C" cup, can't wait to be able to shop for a normal, hopefully comfortable bra (they are usually instruments of torture), or be able to go out in public braless....0 -
Thought I would check in since I finally finished my weekly taxol on Thursday! My CT came back with no new mets, however my tumor is the same as are the two nodes. BMX scheduled for Jan 13,the and I am not looking forward to the surgery, but am looking forward to it being done as if I get to check another thing off my list. Going to three week Herceptin infusions starting next week. Not looking forward to the SE's . Question: with the higher dose are the SE's really intense at first and then ease off or do they just linger? Any information will be most appreciated!0 -
Kayb
Fascinating that you were in this trial. I could never quite wrap my chemo brain around your regimen!
Good for you that you will likely have less chance of cardio risk! Your gift for being courageous in participating in the trial!
Thank you !0 -
Kayb
I'm in a clinical trial as well but mine is observational. It's thru Agendia....
Mammaprint. All of us has neo adjuvant chemo. They have our DNA/RNA and are following us for at least 5 years . Hopefully it will lead to more personalized treatments down the line.0 -
very interesting Kayb..... Thx!0 -
Happy Saturday Girls; take a look at the link. It was posted on the ER/PR- HER+ thread. Great news for us with that darn HER+ status.
If the link doesn't work, I apologize. The article basically gives kudos to Dr. Slamon (invented Herceptin) and goes on to say that Dr Slamon will be presenting updated info at the 2013 Breast Cancer symposium. The new data says that the survival for HER has increased from 84 to 92percent
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wow lots of info there. Thanks Ashley and KB. SpecialK, please accept the thanks for being in a trial. Even if it was a little thing to you. I have come to realize in my life that NOT everyone thinks like that. Even giving blood such a simple thing is not done very much. I am ac tally upset that I can't give anymore. It was my little giveback. My DH is somewhere around 12 gallons. Between kids and breastfeeding and diabetes I was about 2. Oh well. 3 of my 4 kids do it as well. Just our little thing. I did give permission for them to use tissue in testing so I guess that counts too. LOL. I am surprised when they said a lot of patients don't do that either. Especially when it's something you have no use for! LOL. I guess if it's a religious thing that's one thing but otherwise.. Much love to all.0 -
Great news that survival for HER2 is increasing
Not sure I believe everything in that article - journalists sometime get things rather garbled. Before Herceptin the survival rate was 26% at 2 to 5 years???
Rubbish!
Herceptin has certainly improved the prognosis for HER2 patients - nearly halved the risk but it certainly hasn't increased the survival from 26% to 84%...0 -
Had my bmx yesterday! It really wasn't as bad as I expected, and I am already home. I do have pain, but nothing I can't manage. Just hoping that there are no bad surprises during pathology! The PS already put 350ccs in my TEs, does that seem crazy?
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Thanks for the links to all the interesting articles ladies.
SGC - congrats on finishing up the taxol. Another milestone down. Happy dance!
Twinmama, glad you are home and managing the pain well. Hopefully there will be NO surprises on the path report.0 -
Miss Twin....very glad you are home resting!
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Moonflwr you can give blood after a certain time linky and your corneas linky can still be donated.
TwinMamaHeather Yay TMH! You made it. 350ccs a lot? well that depends. I would think for someone in my case that had really small breasts there there just wasnt' enough skin to stretch for 350cc to start… especially since I had 10 expansion and my implants are only 397ccs. You must be a big gal.
Thanks for all the articles everyone!0
