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Neoadjuvant TCHP - Post Results Here

agness
agness Member Posts: 406

I completed my course of neoadjuvant Taxotere-Carboplatin-Herceptin-Perjeta (TCHP) at the beginning of July 2014. Since this is the first year of having this treatment option available to general breast cancer patients I thought it would be helpful if we could track outcomes.

Please summarize your clinical and pathological reports, also any imaging you had along the way. If you can describe any modifications to this treatment, as well as any other complementary therapies, that would be helpful. Maybe include a few tips or personal experiences with this particular drug regime?

Hopefully as time rolls on we can also track longterm results as well.

Looking forward to reading your stories.

-Ann


Ann - PCR 8/15/14


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Comments

  • agness
    agness Member Posts: 406

    [Feel free to post fewer details, I just wanted to be more detailed in case it makes a difference to someone else's care choices]

    Treatment:  

    Six doses of TCHP, every three weeks, no delays

    Modifications:  

    Had a Zoladex 30-day injection before round 5 to try to protect my ovaries

    Had 7th dose of Perjeta three weeks PFC

    I declined Neulasta treatment and used Chinese medicine to treat neutropenia.

    Complementary Therapy:

    Weekly acupuncture, daily prescribed Chinese herbs (pausing the week of infusions)

    Nutritional supplementation (iron, zinc, vit D, magnesium, probiotics, powdered greens) under guidance with naturopathic oncologist based on additional blood labs.

    Energetic bodywork (based on a recommendation of a friend)

    Qigong

    Fasting (water only) during round 5 (18 hours before, ending after 25 hours total)

    Clinical Results:

    Tumor no longer palpable after round 3

    Imaging the day after round 6 dose (so demonstrating response through round 5) showed no tumor but residual calcifications; lymph nodes in axilla no longer light up, sentinal node and internal node still light up.

    Pathology Results:

    No residual carcinoma in breast, fibrosis, adenosis and microcalcifications remain as evidence of treated tumor

    3 Lymph nodes removed - fibrosis suggestive of treated tumor in one

    Imaging:

    MRI and ultrasound after round 6

    Notes:

    I tracked what I ate carefully, focused on probiotic and prebiotic foods to help heal my gut and improve nutritional absorption after each round. I also supplemented extra magnesium and potassium to counteract the muscle cramping caused by the cytotoxic agents. My magnesium tested low throughout treatment and afterwards (still working on it 8 weeks PFC).

  • samiamaham
    samiamaham Member Posts: 3

    I would love to hear from more people who are doing this neoadjuvant therapy.  My MO wants me to start this asap.  ER+ (93%) PR- (0%) HER2+++

    I was hoping to just do surgery and rad... since just dx'd 8/21/14, I'm trying to learn as much as I can about all of this.  It's crazy and scary...

    Thanks, Sam

  • agness
    agness Member Posts: 406

    bump

  • ben50
    ben50 Member Posts: 13

    We started TCHP December of 2013. The lump, quite tangible at first, melted away before the second infusion. We had no imaging during chemotherapy. At the time of BMX, achieved a pCR. Because of our good results and with evidence of only one positive lymph node beforehand, we decided to pass on radiation (a difficult decision) with the support of our medical team. We have been on Herceptin and Perjeta for the last 5-6 months in the adjuvant setting. We'll be on Tamoxifen for the next 10 years with OS for the foreseeable future. Side effects from the hormonal therapy have been mild but quite unpleasant at times. We will also try to get on neratinib or maybe the GP2 trails after our one year of H and P.

  • specialk
    specialk Member Posts: 9,211

    ben50 - the GP2 (and AE37) trial is sorted by histological type (tissue typing like for an organ transplant) and for GP2 you have to be A2+, so you have a 50/50 shot as the population is about evenly split.  A2- folks are sorted into the AE37 arm of the trial.

  • Fionascottie
    Fionascottie Member Posts: 56

    I completed  a series of 6 TCHP treatments . The inverted nipple that got my attention back in April and led to my diagnosis is  has dramatically changed.......the tumor (1.3cm ) is no longer palpable. I'm scheduled for a mammogram this week to get confirmation that it has shrunk. I will then have surgery to remove anything that may be left with clean margins.

  • CassieCat
    CassieCat Member Posts: 863

    I'm still very much in the midst of treatment, but so far my story sounds like Fionascottie's.  The goal is to shrink the tumors so surgery can have clean margins.  I've had 2 of 6 TCHP treatments and the tumor that I originally found has shrunk greatly to my touch.  Originally they found two lesions in my left breast (one that I found and another smaller one) and one lymph node affected.  I had diagnostic mammogram and ultrasounds done, along with a breast MRI, CT scan and PET scan.  I will come back to this thread with some updates as I have them.

  • linzer
    linzer Member Posts: 50

    I did THP, no C for ER/PR- Her2+ 2 cm with lymph node involvement. Finished my 12 weeks on August 27th. Had my lx and axillary dissection on 9/17. No evidence of cancer - ZERO! 3 of my 9 nodes removed showed that there had been cancer but not present any longer. This protocol is amazingly effective, at least in my case. and hopefully in many, many more!

  • Lovemysons
    Lovemysons Member Posts: 2

    Started out receiving THP in March 2014. MRI after two treatments didn't show any changes in size so they added carboplatin to treatments 3 through 6. Surgery was 9/10/14 and what was a 4.5 cm tumor was reduced to 1.1 mm. Had at least one positive node which was biopsied prior to chemo and at the time of surgery they removed 7 nodes and all were negative. Only the 6th treatment was delayed by 2 weeks due to low platelets. 

  • agness
    agness Member Posts: 406

    bump 

  • blownoffcourse
    blownoffcourse Member Posts: 27

    I finished 6 rounds of TCHP on June 3, with UMX on July 9. My tumor started at 6 cm, with 3-4 positive nodes. My path report showed the tumor to be reduced to less than 1 mm, and only 1 positive node at .4 mm. 

    No imaging done since initial diagnosis, I did have 33 radiation treatments and have started Femara.

    Hopefully it is enough :).

  • Fionascottie
    Fionascottie Member Posts: 56

    I posted in late September that I had completed 6 rounds of TCHP.....and was taking a break before surgery which took place on October 23, 2014. I had a partial mastectomy with a surprising lab report. Last May Imaging and a biopsy had measured my tumor at around 1.4 cm. I began neoadjuvant TCHP in June. There WAS a physical response to chemo....the inverted nipple that had alerted me to the fact something was wrong came back to almost normal and an ultrasound and mammogram showed NO tumor. But surgery removed a 2.4 cm tumor with clean margins. Surprise, surprise. So, as my surgeon said all along, pathology will have the final word. I'm still just a bit stunned !

    In the meantime my echocardiogram shows some effects from drugs on my heart ejection %age so I'm to see a cardiologist on Monday. My oncologist is not resuming Herceptin for the remainder of the year until I'm cleared by the cardiologist. Radiation was scheduled to begin about now, but that, too, is on hold because my surgical wound developed a seroma situation and the wound did not heal. I'm packing it at home and checking in regularly with the surgeon. So, a few bumps in the road, but I feel confidence in my medical team and trust things will get back on track soon!

  • agness
    agness Member Posts: 406

    Im sorry that treatment has been so rough on your body. My naturopathic oncologist has me taking CoQ10 to help with protecting my heart from the Herceptin, just not during radiation treatment.

    From what I have read, those who are HER2-positive and hormone receptor negative have the greatest pathologically complete rate to neoadjuvant therapy. The ER+ seems to allow the dancer cells a way out, a secondary fuel source of sorts. Recent studies are underway looking at the use of GnRH-agonists in premenopausal women such a Zoladex (Goserelin) to help protect the ovaries from chemo damage; they alter levels of estrogen in the body. I requested and received a Zoladex injection last Spring which covered two cycles at the end of chemo. I think it made my magesium depletion worse as I had about two months of serious muscle aches, and it made recovery from chemo harder.

    Just things to be aware of.

  • CassieCat
    CassieCat Member Posts: 863

    I will share an update, since I last posted in September. I had another ultrasound done in October, and both breast tumors were completely undetectable, and the lymph node tumor cannot be found manually either. I have had another ecg and echo done and my heart function remains unchanged in terms of EF. I have now had 5 of 6 TCHP infusions, with my last one scheduled for December 15th. I meet with my surgeon again on the 9th to discuss plans.

  • april25
    april25 Member Posts: 367

    I just talked with an oncologist about taking Perjeta

    He recommended neoadjuvant TCH, 6 cycles. Then surgery (lx-more my choice, but was open to mx if that was better). Then Herceptin every three weeks for a year with Radiation, then Femara for 5 years after that.

    He said Perjeta is usually done with Adriamycin and he didn't like the SE of cardiotoxicity and rare risk of Leukemogenesis. Said, since I was 58 and in pretty good shape aside from controlled Type 2 Diabetes, he didn't think the extra risks were worth it and the TCH should work as well.

    Is that correct?

  • specialk
    specialk Member Posts: 9,211

    april - I responded to your other thread - no your doc is incorrect - here is the info from Perjeta's site - it is given with the regimen he is already recommending.  That is the combination these ladies are doing.

    http://www.perjeta.com/patient/neoadjuvant


     

  • Skoolgirljen
    Skoolgirljen Member Posts: 14

    April-I did 6 cycles of neoadjuvant TCH with perjeta. I will finish Herceptin in February. Perjeta is a targeted therapy that works with Herceptin. My onc felt it was my best defense against recurrance to have the perjeta in conjunction withTCH. He felt the benefits outweighed the risks. You may want to revisit this option with your onc.

    Good luck with your upcoming treatment. Wishing you minimal side effects :)

  • april25
    april25 Member Posts: 367

    Another thing to consider with neoadjuvent chemo-- SNB. Some of you have it after chemo and during the surgery, but it's said this isn't great for staging. Anyone have the SNB before chemo and surgery??? DUring Chemo? My BS suggested this might be done during Chemo. My MO wasn't keen on it because ultrasound showed normal r. axcilla... but who knows about the micro-sized stuff? and the true pathology???


    SpecialK -- I read your other posts. Thanks so much! I really appreciate the help.

  • specialk
    specialk Member Posts: 9,211

    april - you can't really do a SNB during chemo - these drugs inhibit healing and have an impact on your infection fighting WBC (white blood cells), so invasive procedures during chemo are minimized.  For the SNB to truly be accurate, if doing neoadjuvent chemo, it would need to be done prior to starting chemo.  If you are having port placement you can do it then - I have a friend who did neoadjuvent chemo for Triple Negative and she did this - her breast surgeon did both the port placement and the SNB at the same time.  Those who do neo chemo and don't do the SNB ahead of time have to live with some degree of unclear staging.

  • april25
    april25 Member Posts: 367

    Thanks, SpecialK. I don't know if I'm getting a Port or not! That's another thing I need to ask about, I guess.

    I'm feeling worn out by all this without even starting chemo.. *sigh*


    ... I'm due to start chemotherapy in a week or so... It seems there's not enough time to do an SNB...???

  • specialk
    specialk Member Posts: 9,211

    You would have to press for it. Also, it would be pretty unusual not to have a port when you will have infusions for a year. You run the risk of damaging your veins without a port but it is a personal choice.

  • larod825
    larod825 Member Posts: 6

    My wife will start this treatment (TCH+p) on December 9th, 2014. She was diagnosed on her 37th b-day with IDC (we have 3 kids, 2 (girl), 4 (girl) & 6 (boy), she found 2-lumps and the MRI showed some extensive heterogeneous stuff in the right quadrant so the MO went off of the largest tumor at 6+cm, hence the IIIa. The extensive stuff was not biopsied but the two tumors were (each about 1.2 cm) We just finished a sentinel lymph node biopsy (which came back negative for 2-nodes) and the port placement. This forum for me, has been great. We just finished a long month of figuring out what to do, everyone here in Denver has been very helpful. A couple of things we learned from some great MOs, is to get some eye drops to drain the taxotere out of your eyes. Its been a long haul already but we will push through as all of you have and I'll check up on everyone from time to time.

  • specialk
    specialk Member Posts: 9,211

    larod - make sure that the eye drop you get are lubricating - not the type to "get the red out" as many experience "Taxo-tears" which is spontaneous watering of the eyes.  It is actually a result of dry eyes - even though that sounds contradictory.  Keeping the eyes lubricated may cut down on the tearing.  Glad your wife got a port and SNB - good to know the nodal status prior to chemo.  Good luck!

  • agness
    agness Member Posts: 406

    larod - sorry to learn of your wife's disease, she's just like mine. I have a 4yo and HER2+/HR- disease and my tumor was around 6cm also. I was even breadtfeeding (in the process of child-led weaning) when I was diagnosed. HER2 disease can be aggressive like that -- but it also has the highest pathologically complete rate to neoadjuvant treatment.

    I found it a but tough to find reports that fit my situation or showed liver term outcomes for similar protocols as Herceptin and especially Perjeta are still relatively new. More data should come out in the next few years and it looks so far like it is going to be promising.

  • agness
    agness Member Posts: 406

    That is great news Cassie. Good luck with your upcoming appointment.

    I felt pretty poorly for about 5 weeks post final TCHP and so I didn't have my surgery until I was 6 weeks out. I'm glad I was feeling a bit restored before having to recover from surgery.

  • april25
    april25 Member Posts: 367

    I think my surgeon mentioned getting an SNB when getting a port for the Chemo... Is that a whole separate surgical thing??? I've just sent like 3 emails to my BS yesterday--I guess I'm sending another!

    So far I've got MUGI and chemo scheduled in a few weeks-- but no Port & SNB surgery... and no Perjeta! This doesn't sound good!

  • april25
    april25 Member Posts: 367

    How unusual is this Neoadjuvent TCHP? Doesn't seem like a lot of people posting here...

    ===

    and does being ER+/PR- make any difference as far as this treatment goes?

  • ShepherdB
    ShepherdB Member Posts: 2

    After 6 rounds of TCHP that started in January 2014, I received a pCR at BMX surgery in June 2014. What a great feeling that the chemo and Herceptin and Perjeta did their jobs well!

  • moderators
    moderators Posts: 7,670

    ShepherdB,

    Thanks for sharing that experience. How are you feeling now?

    Best,

    The Mods

  • april25
    april25 Member Posts: 367

    I've asked elsewhere, but just in case, I'll post here, too...

    My MO has me down for TCH. I asked about Perjeta and he says the FDA protocol says that after Neoadjuvent TCHP and surgery, (spelling will not be correct as I took notes over phone) -- etirudicina, herbicin and cytoxan (anthrocyclene/adriamycin) is called for and he doesn't like the SE of that.

    IS that the protocol??? Have you heard of that? Can protocols be ignored? Do you think adding Perjeta to TCH would be better even if protocol isn't followed after surgery???

    --I have an outside KP 2nd Op with a MO tomorrow. I will ask him about it... all! But your input is really, really appreciated!