New to the Group: Navigating TNAC and Neoadjuvant Chemo
Hi, I’m new here and honestly not thrilled to be in this group…this is a plot twist indeed for my life. I went in for a routine mammogram in early December. The imaging, pathology, etc., is complete. I'm currently navigating a diagnosis of triple-negative apocrine-type invasive carcinoma (TNAC), Stage 2, Grade 2. The tumor is ER-, PR-, HER2-, the Ki-67 is 10%, and PD-L1 negative. Thus, the cells divide slowly, and immunotherapy such as Keytruda is not feasible as there isn't a "target." Genetic testing was all negative- so no "targets" there, either.
I’m starting my second of three months of weekly neoadjuvant chemo with paclitaxel and carboplatin. The side effects are hitting hard—hair loss (starting day 18 after 1st infusion) and bone pain each time around days 3-4 post-chemo. I'm using hand and foot ice packs to minimize the chance of neuropathy and elected not to cold-cap.
I would love any insights or advice from others in similar situations, particularly around taste changes, food suggestions, packing meals, and working, as I try to make sense of this rare tumor type (0.5-4% of BC) and the road ahead. Currently, I'm using intermittent FMLA in combination with my PTO, plus working 35+ hours each week. Surgery, etc., is in the future.
Comments
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Hi,
Sorry to hear you are dealing with this type of breast cancer. I have TNBC and get carbo/paxol with Keytruda every 3rd week. I had 7 of 12 last week and mostly deal with fatigue and slight nausea. My interest in complex food has decreased each week and I usually have protein smoothies or healthy soup now. I try to do a walk a few days after chemo when I have energy.
I think your mindset is also important and I view chemo as a positive thing as it is healing me. It doesn’t mean healing feels good all the time.
Sending positive thoughts and healing your way.1 -
My apologies for the delayed response, and thank you for your kind thoughts.
I do want to gently add some context, not to disagree but to clarify for others reading. While support is appreciated, not all triple-negative breast cancers behave the same biologically, and it isn’t really something where mindset meaningfully changes the clinical reality.
My diagnosis is apocrine-type TNBC (TNAC). It is quite rare and has a distinct receptor profile compared with the more typical TNBC. In my case, it is also PD-L1 negative, which rules out immunotherapy options like Keytruda.
Because TNAC is so uncommon, the data are limited and largely based on small retrospective studies. Going into treatment, I was aware of the published “numbers,” which generally suggest that neoadjuvant chemotherapy has less than a 50/50 chance of producing a meaningful response in this subtype, and that pathologic complete response (pCR) is uncommon compared with other TNBCs. I’m about done with weekly carboplatin/paclitaxel and waiting to have the imaging to see if/how my tumor responds before the surgical planning stage.
Appreciate the support, and wish you well as you continue treatment.
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