neoadjuvant chemotherapy for IDC ER+/PR+, HER2- and 19 oncotype
I have a 4cm tumor up against my skin. I will need a mastectomy but I have differing opinions from two excellent teams on the next steps for treatment.
Opinion 1: Complete neoadjuvant chemotherapy to improve the margins and get it off my skin.
Opinion 2: Move forward with surgery first and remove the skin. The team believes the tumor will not shrink with chemo. Decide after what kind of systemic treatment is needed.
Was anyone successful in reducing their tumor with neoadjuvant chemotherapy given low/intermediate Oncotype score and ER+/PR+, HER-?
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ogopa - you need to confirm your HER2 status. Have they done a FISH test yet? With HER2+ I believe the standard of care is still chemo first. Not only might that shrink the tumor, but it should catch any micro cells that are moving around.
Looking back on all I've read here, it seems that tumors usually do shrink with neo-adjuvant chemo, even it they don't totally go away (pCR).
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I never got an oncotype score, but I had a 5.5 cm IDC tumor that was ER/PR+ and HER-, grade 2. It had affected my skin and was stuck to my chest wall. I did neoadjuvant chemo and it did shrink down noticeably. There was still more of the tumor there than not at the time of surgery, but things went better then, because of the neoadjuvant chemo. AC-T.
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I have also read about people using neoadjuvant hormonal therapy.
I believe the oncotype studies were based on the impact of chemo on recurrence. It's not obvious to me that a low impact on recurrence (the implication of a low oncotype score) necessarily correlates with a low impact on the size of the original tumor. I definitely do not know enough about it either way, and I would want to better understand from both teams of doctors how they are interpreting and parsing the evidence and why they are coming to different conclusions.
I wonder if a third opinion is in order? Or at least, pushing for more explanation from both of the first opinions.
I'm sorry you're having to deal with this!
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ogopa,
I had a 5+cm tumor, oncotype 20,ER/PR+, HER2-. Ask about chemo effectiveness for ER+ cancers. I did have chemo and during mastectomy, there was still cancer present from original lumpectomy. But the good news is that all the lymph nodes were negative for cancer, and I know 2 had micromets. Surgeon told me I had partial response to chemo. A third opinion isn't a bad idea.... good luck.
Julie
Jujuscancerjouney.Wordpress.com
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Thanks everyone for your responses.
I was able to get another opinion and plan to move forward with the surgery.
I think the option of the neoadjuvant chemotherapy was presented because I'm 37 years old and the surgeon perhaps was concerned about providing me a skin-sparing mastectomy or possibly a nipple-sparing mastectomy.
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ogpa - I’m late in responding but but I have IDC with skin edema and tethering. Tumor was just under 3cm back in January. I’m scheduled for mastectomy Mar 11with no reconstruction. ER+ PR + HER2 -, Oncotype was 6. Given no reconstruction BS did not have to worry about preserving skin - same as you. I’m 66 so I didn’t care about recon. I hope your surgery went well if you had it already.
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