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Topic: 2nd TNBC, not enough chemo? Lifetime limit of Adriamycin reached

Forum: Triple-Negative Breast Cancer —

Share with others who have ER-/PR-/HER2- breast cancer.

Posted on: May 19, 2020 01:50PM

Camama2 wrote:

I was recently diagnosed with TNBC in right breast. In 2005 went through the same thing, same breast. I had TAC the first time around but have been told that I have hit the lifetime limit of Adriamycin and will "only" be getting TC for 4 rounds if no lymph node involvement and 6 if lymph nodes. I had a double mastectomy last week and will be meeting with oncologist tomorrow. Won't start chemo until I'm healed, probably 3-4 more weeks. On another thread several ladies suggested that I ask about Carboplatin being added to TC, which I will ask about when I see my oncologist tomorrow. But is there anything else I should be asking for or about? Do I ask for TC and Carboplatin or the Carboplatin instead of one of them? Just met with the surgeon today and he said that there were no lymph nodes removed because most were removed 15 years ago and he said he wasn't going looking for lymph nodes. But last week when I met with oncologist she told me that they usually take out some lymph nodes anyway and if there is cancer in the lymph nodes I will have 6 rounds. So now that the surgeon didn't go looking for them but the oncologist is relying on treatment choice based on lack of lymph node involvement I'm worried I may not get enough chemo. Must say never did I ever think I would be asking for more chemo, but it's more important to eradicate this cancer now than worry about having more chemo.

Laurie

Laurie Dx 6/24/2005, IDC, Right, 5cm, Stage IIIB, Grade 3, 2/17 nodes, ER-/PR-, HER2- Surgery 7/21/2005 Lumpectomy; Lymph node removal Dx 4/29/2020, IDC, Right, 3cm, Stage IIB, Grade 3, ER-/PR-, HER2- (IHC) Surgery 5/13/2020 Mastectomy: Left, Right; Prophylactic mastectomy: Left Chemotherapy 6/3/2020 Carboplatin (Paraplatin), Taxotere (docetaxel) Chemotherapy TAC Radiation Therapy
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May 19, 2020 04:51PM moth wrote:

did you already have a torso CT scan? Lymph involvement usually shows up. I'd ask for 1 esp if the bs didn't take any samples.

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 2/13/2018 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 3/18/2020 Tecentriq (atezolizumab) Chemotherapy 11/25/2020 Abraxane (albumin-bound or nab-paclitaxel) Radiation Therapy 12/8/2020 External Dx 12/9/2020, IDC, Right, Stage IV, metastasized to lungs, Grade 3, ER+/PR-, HER2- (IHC) Hormonal Therapy 12/15/2020 Femara (letrozole) Dx 1/28/2021, IDC, Left, Stage IV, metastasized to bone Radiation Therapy 3/2/2021 External: Bone
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May 19, 2020 05:07PM ShetlandPony wrote:

If no lymph nodes could be checked, I would think you would be treated as if positive nodes were found, especially as the tumor was a large (as I see from another post). Also, I think you should have a PET-CT, or CT with Contrast plus bone scan, and possibly a brain MRI, to rule out mets before you begin treatment, as the results could change your treatment plan. Your situation is complex and calls for a second opinion. UC San Diego Moore’s Cancer Center in La Jolla is an NCCN Center. Or are you already there?

2011 Stage I ITCs sn, premenopausal, Oncotype 16. 2014 Stage IV mets breast,liver. TaxolNEAD. Ibrance+letrozole 2yrs. Fas+afinitor nope. XelodaNEAD 2yrs. Eribulin,Doxil nope. SUMMIT FaslodexHerceptinNeratinib for Her2mut NEAD Dx 2011, ILC, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- Dx 2014, ILC, 2cm, Stage IV, metastasized to liver/other, Grade 2, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy Whole-breast: Breast Surgery Lumpectomy
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May 19, 2020 09:16PM Camama2 wrote:

Thanks for your response. I did have a CT scan and bone scan. Both were clear. Does lymph involvement show up in these type of scans? The oncologist says that triple negative shows up better in CT/bone scans than a pet scan so they weren't ordering one. Since everything else was clear and I'm not having any headaches they're not doing a brain scan, as that's usually a secondary mets location. I'm okay with that. No I'm not at UCSD Moore's, I'm at Kaiser. I was also with Kaiser on my last go around and LOVED my oncologist. Unfortunately he retired last year (I cried when I saw that). I'll be discussing with my oncologist tomorrow about the lymph nodes. If I don't have confidence in what I'm hearing I may decide on a second opinion.

Laurie

Laurie Dx 6/24/2005, IDC, Right, 5cm, Stage IIIB, Grade 3, 2/17 nodes, ER-/PR-, HER2- Surgery 7/21/2005 Lumpectomy; Lymph node removal Dx 4/29/2020, IDC, Right, 3cm, Stage IIB, Grade 3, ER-/PR-, HER2- (IHC) Surgery 5/13/2020 Mastectomy: Left, Right; Prophylactic mastectomy: Left Chemotherapy 6/3/2020 Carboplatin (Paraplatin), Taxotere (docetaxel) Chemotherapy TAC Radiation Therapy
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May 19, 2020 10:25PM ShetlandPony wrote:

Ok, Laurie, it’s good you got scans and really good they were clear.

As far as axillary nodes, I understand you may not have many left after the first surgery. When you first found the recurrence, they probably did a physical exam and an ultrasound to see if any were enlarged. That’s probably all you can do. They will just have to proceed with the information available. For my relative with early bc, they attempted a sentinel node biopsy but the tracer did not work. So no information and the oncologist was not happy. But what it means for her is that they proceed with treatment and do not consider skipping radiation or hormone therapy, as they might have otherwise done because of her age and low-risk profile. The details of your situation are different, but my point is, they are proceeding as if there was a positive node, which I agree with.

2011 Stage I ITCs sn, premenopausal, Oncotype 16. 2014 Stage IV mets breast,liver. TaxolNEAD. Ibrance+letrozole 2yrs. Fas+afinitor nope. XelodaNEAD 2yrs. Eribulin,Doxil nope. SUMMIT FaslodexHerceptinNeratinib for Her2mut NEAD Dx 2011, ILC, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- Dx 2014, ILC, 2cm, Stage IV, metastasized to liver/other, Grade 2, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy Whole-breast: Breast Surgery Lumpectomy
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May 20, 2020 06:26AM lifeb4me wrote:

I’ve also had a recurrence of TN and also had reached my life limit of the A of the ACT chemo I had.

My oncologist decided on 6 rounds of taxotere plus carboplatin. I also got approved for including keytruda, as in the keynote 522 trial. They said taxotere is stronger than taxol and carboplatin very effective on TN. I had neoadjuvant chemo and surgery on April 28th. I had an almost complete pathological response. They only found viable cells in 4mm of the tumor. So I would ask about carbo and getting into keynote 522 trial

Dx 8/29/2016, IDC, Left, 6cm+, Stage IIIA, Grade 3, 0/6 nodes, ER-/PR-, HER2+ (FISH) Chemotherapy 9/16/2016 AC + T (Taxol) Targeted Therapy 12/5/2016 Herceptin (trastuzumab) Targeted Therapy 12/5/2016 Perjeta (pertuzumab) Surgery 3/8/2017 Lumpectomy: Left; Lymph node removal: Sentinel Dx 12/5/2019, IDC, Left, 5cm, Stage IIIA, Grade 3, ER-/PR-, HER2- (IHC) Chemotherapy 12/16/2019 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 3DCRT: Breast, Chest wall Chemotherapy Chemotherapy Xeloda (capecitabine) Chemotherapy
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May 20, 2020 07:06AM santabarbarian wrote:

I had taxotere and caeboplatin too. Not a picnic but a doable chemo-- and effective.

pCR after neoadjuvant chemo w/ integrative practices; Proton rads. Dx 7/13/2018, IDC, Left, 3cm, Stage IIB, Grade 3, ER-/PR-, HER2- (FISH) Chemotherapy 8/12/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 12/27/2018 Lumpectomy: Left Radiation Therapy 2/10/2019 Whole-breast: Breast, Lymph nodes
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May 20, 2020 05:49PM Cowgirl13 wrote:

I had taxotere and carboplatin (along with herceptin). They were both doable. One thing I did for myself was to drink at lease 8-10 cups of water every day for a year. My oncologist wasn't for drinking great, great amount of water, I think because of losing the electrolytes.

Be the kind of woman that when your feet hit the floor each morning the Devil says: 'Oh crap! She's up! Dx 5/28/2009, IDC, Left, 2cm, Stage IIA, Grade 3, 0/4 nodes, ER+/PR+, HER2+ Surgery 6/17/2009 Chemotherapy 8/3/2009 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 12/21/2009 Hormonal Therapy 2/23/2010 Arimidex (anastrozole)
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May 21, 2020 06:25AM Camama2 wrote:

Thank you everyone for your input. My concern about her choosing treatment based on lymph nodes was incorrect. My oncologist is giving me the same treatment regardless. The decision is 6 rounds of Taxotere and Carboplatin. She said that I am an unusual case because she wanted to go neoadjuvant chemo but because I had already reached the lifetime limit of Adriamycin with my first round of TNBC 15 years ago she wanted the aggressive tumor removed immediately, hence surgery first. Had I had neoadjuvant chemo I would be eligible for FDA approved meds after surgery and chemo. There are currently clinical trials for drugs that are not currently approved for me and will most likely be approved too long after my treatment is complete as whatever I would be taking would need to be administered within a short time after completion of my chemo. She has said that if I am successful in handling all 6 rounds of the treatment she would consider allowing me to have Xeloda but I would have to sign off on it acknowledging that there are not specific studies that support the use of it for my situation. I'm happy that she is open to it and have decided that we will look into that as things proceed. My first chemo (for my second time of BC) is June 3rd. Strangely I'm excited, can't move to the other side until I get started. I'm not looking forward to chemo again but I know it's what I have to do to live.

Laurie

Laurie Dx 6/24/2005, IDC, Right, 5cm, Stage IIIB, Grade 3, 2/17 nodes, ER-/PR-, HER2- Surgery 7/21/2005 Lumpectomy; Lymph node removal Dx 4/29/2020, IDC, Right, 3cm, Stage IIB, Grade 3, ER-/PR-, HER2- (IHC) Surgery 5/13/2020 Mastectomy: Left, Right; Prophylactic mastectomy: Left Chemotherapy 6/3/2020 Carboplatin (Paraplatin), Taxotere (docetaxel) Chemotherapy TAC Radiation Therapy

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