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Topic: Mastectomy for metastasis breast cancer.

Forum: Stage IV/Metastatic Breast Cancer, Open to All To Contribute —

Topics here are started by members with a Stage IV/Metastatic Breast Cancer diagnosis, but open to all members to contribute to discussions. Please note that there is a separate forum, Stage IV/Metastatic Breast Cancer ONLY, where topics are open only to those members.

Posted on: Jun 7, 2021 08:22AM - edited Jun 7, 2021 02:04PM by Koushik

Koushik wrote:

Hi All,

After my mother's initial diagnosis of metastasis breast cancer(Lungs alone) in March, she had undergone 4 chemo cycles (Paclitaxel and trastuzumab)so far and she in due to PET-CT scan this week to evaluate the response of the so far treatment. Our MO mentioned if there is good response and tumors in lungs were disappeared they will perform breast surgery (mastectomy).Also, they mentioned if there was no complete response (i.e tumors left in lungs but pretty good response) they will continue with the 4 chemo as curative intent but with different chemo drug and perform PET and decide on the mastectomy after.

I wanted to know from you all about possibility of mastectomy in metastasis stage,

In general, after how many cycles of chemo(after 3 months or 6 months) from initial diagnosis of mastectomy can be done?I agree this will be performed only after finding good response during her chemo treatment..

Your experiences pleaseeeeee

Thanks All

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Jun 8, 2021 01:44AM SondraF wrote:

Surgery at Stage IV is not a simple decision as it is with earlier stage cancer. Many women don't actually receive it - I still have a breast tumor and axillary tumor and despite a strong response to the hormonal treatments, MO will not consider putting me forward for breast surgery unless the breast tumor starts to grow. The cancer in the breast is not the concern ad stage IV because that is not what will kill the patient, its the external mets and escaped cells and those need to be managed ahead of the breast.

The studies on the potential of surgery to have survival benefit are not clear one way or another, so its just not a standardized approach. It also is something that depends on the patient (overall health and ability to handle surgery), type of cancer (triple negative or HER2+ seem to get surgery but they leave ER+ women alone), and in some cases the grade, type, location, and number of the mets before treatment.

There are also risks involved, which include being off treatment in order to heal and in case of infection. If your mom was on chemo to clear the lungs that is different from having to take ongoing pills which would need to be stopped for surgery.

I guess what I am getting at is this is a highly personalized decision by care teams and the patient depending on a lot of factors and it may be difficult to find ladies with similar experiences because its such a unique situation. If your mother's team want her to have the mastectomy pending good results then I would want to be absolutely clear and on the same page of potential risks from the surgery and how the expected benefits outweigh those risks.

"The closer we come to the negative, to death, the more we blossom" - Montgomery Clift Dx 9/27/2019, IDC, Right, 5cm, Stage IV, metastasized to bone, Grade 3, ER+/PR+, HER2- Targeted Therapy 11/29/2019 Ibrance (palbociclib) Hormonal Therapy 11/29/2019 Femara (letrozole) Surgery Prophylactic ovary removal
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Jun 8, 2021 03:55AM jensgotthis wrote:

I echo Sondra that there isn’t one clear path. I was dx with MBC (bones) and did 6 rounds of chemo then had a mastectomy followed by radiation. My MO chose this as I had just met and had a complete response to chemo. The evidence base isn’t strong enough to suggest one way over the other

Dx 12/3/2015, IDC: Tubular, Left, 2cm, Stage IV, metastasized to bone, Grade 1, 0/12 nodes, ER+/PR+, HER2- Chemotherapy 1/4/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 5/1/2016 External: Bone Hormonal Therapy 5/23/2016 Surgery 5/25/2016 Lymph node removal: Left; Mastectomy: Left Targeted Therapy 9/14/2016 Ibrance (palbociclib) Hormonal Therapy 9/14/2016 Femara (letrozole) Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall Targeted Therapy
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Jun 8, 2021 11:06AM NineTwelve wrote:

Third this. I got my MBC diagnosis almost 7 years ago, and was told that mastectomy is not recommended. I still have not had any surgery.

There are risks with surgery, and no clear evidence that it will increase overall survival time for those with multiple mets.

12/15/20 - Progression to liver. Tx changed to Xeloda. 2021 - Tx changed to weekly Taxol. Dx 9/12/2014, IDC, 4cm, Stage IV, Grade 2, mets, ER+/PR+, HER2- Hormonal Therapy 9/15/2014 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone), Zoladex (goserelin) Hormonal Therapy 9/30/2014 Dx 7/2016, IDC, Stage IV, metastasized to bone/lungs Hormonal Therapy 8/15/2016 Faslodex (fulvestrant), Zoladex (goserelin) Targeted Therapy 8/15/2016 Ibrance (palbociclib)
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Jun 8, 2021 01:45PM moth wrote:

Breast surgery is not standard of care in metastatic setting. There are some clinical trials investigating whether it confers advantage. If it was within a trial, I would consider it but otherwise, there would have to be really compelling other reasons.

Where is your mother receiving treatment? I know there are some drs pursing very aggressive treatment for de novo HER2+ like your mom's

Is she feeling well, I hope?

I take weekends off

Initial dx at 50. Seriously?? “Sometimes the future changes quickly and completely and we’re left with only the choice of what to do next." blog: Never Tell Me the Odds

Dx 12/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- (IHC) Surgery 12/12/2017 Lumpectomy: Left; Lymph node removal: Sentinel Chemotherapy 2/14/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole-breast: Breast Dx 2/2020, IDC, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/19/2020 Tecentriq (atezolizumab) Chemotherapy 11/26/2020 Abraxane (albumin-bound or nab-paclitaxel) Dx 12/9/2020, IDC, Right, Stage IV, metastasized to lungs, Grade 3, ER+/PR-, HER2- (IHC) Radiation Therapy 12/9/2020 External Hormonal Therapy 12/16/2020 Femara (letrozole) Dx 1/28/2021, IDC, Left, Stage IV, metastasized to bone Radiation Therapy 3/3/2021 External: Bone
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Jun 8, 2021 05:31PM illimae wrote:

Currently, studies and trials are not conclusive on the benefits of surgery or not but it is more common in stage IV patients with good overall health and minimal cancer spread.

Also, she may not have to be off treatment. If surgery is done after her initial chemo, she may continue on Herceptin while recovering. In my case, I had surgery following chemo with no treatment for 1 month but since Herceptin is given every 3 weeks, the delay was really only 1 week. After that, I had breast radiation and continued on with maintenance therapy. I found it all pretty tolerable but I was only 41 and pretty active. Each situation is different but I have no regrets.

Diagnosed at 41 Stage IV De Novo Dx 11/16/2016, IDC, Left, 5cm, Stage IV, metastasized to bone, Grade 3, 3/13 nodes, ER+/PR-, HER2+ (IHC) Chemotherapy 1/1/2017 Abraxane (albumin-bound or nab-paclitaxel) Targeted Therapy 1/1/2017 Herceptin (trastuzumab) Targeted Therapy 1/1/2017 Perjeta (pertuzumab) Surgery 6/26/2017 Lumpectomy: Left; Lymph node removal: Underarm/Axillary Radiation Therapy 8/10/2017 Breast, Lymph nodes Dx 10/5/2017, IDC, Left, 5cm, Stage IV, metastasized to brain, Grade 3, 3/13 nodes, ER+, HER2+ (IHC) Radiation Therapy 10/19/2017 External: Brain Radiation Therapy 4/18/2018 External: Brain Radiation Therapy 5/22/2019 External: Brain Surgery 1/21/2020 Radiation Therapy 2/16/2020 External: Brain Radiation Therapy 7/20/2020 External: Bone Radiation Therapy 12/4/2020 External: Brain Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Targeted Therapy Tukysa (tucatinib) Chemotherapy Xeloda (capecitabine)
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Jun 14, 2021 11:43AM Koushik wrote:

Hi All, Thanks very much for sharing your experiences and thoughts,

I wanted to give an Update that, Her follow-up PET-CT was done Yesterday, and the report showed complete response to the ongoing therapy.

Due to this, her Med Onco wants to give her the complete benefit and opted for mastectomy, he also mentioned it not is definitive that it is going to completely cure here, he said he does not want to miss the benefit out of surgery.

For now, I asked them couple of days of time and meanwhile looking for expert as 2nd opinion.

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Jun 14, 2021 11:48AM Koushik wrote:

Hi Moth,

Thanks for sharing your experience.

We are from India, as of now, my mother is doing okay. she is having some SE's like diarrhea, especially after including pertuzumab in her treatment.

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