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Dec 4, 2020 10:47AM
for all with staging questions - keep in mind that the studies for most of the drugs early stagers now receive are based on original studies for stage IV patients, that then are looked at for early stage patients, but that these studies are often older information because of the length of time involved with studies and follow up. While we will soon see COVID vaccines with very fast trial times, most drugs go through a lengthy FDA approval process. It is an 11 year average for first approval, with some drugs used in original populations having a shorter approval process for use in other populations, i.e. the same drug used for advanced stage to use for early stage. For example, Perjeta was first approved for metastatic patients in 2012 after five years of study - so initial study commenced in 2007 - for early stage neoadjuvent use only (6 infusions) in 2013, but now for both neo and adjuvent use in 2017. So much has changed with the order of treatment for triple positives with the advent of newer drugs that staging has become a slippery slope due to neoadjuvent treatment recommendations for those with tumors greater than 2cm, or those with smaller tumors but positive nodes. For those who image really well, and/or who know they have positive nodes proven by biopsy prior to neoadjuvent treatment, clinical staging is more clear. Those who are thought to be node negative with smaller tumors still have the option of surgery first, so staging is pathological, and systemic treatment then takes place with the possibility of single agent chemo and Herceptin only. The decisions hinge on treatment order, regimen choice, and additional adjuvent treatment options based on post-surgery pathology. For triple positives we know that we will receive chemo, with targeted therapies, and anti-hormonals pretty much regardless of staging info. Regimens, recommendation for radiation, and type of surgery seem to be the decisions points. For me, even though I had surgery first because I was treated prior to the approval of Perjeta and the advent of neoadjuvent treatment for larger or node positives, my clinical staging was not accurate. Tumor size was pretty close, but my positives nodes were a total surprise - never palpated despite larger size, and didn't show in the MRI at all even though the imaging size threshold was met.
noelle - I experienced dizziness as well, and of course my initial thought was brain mets. After a stat head CT it turned out to be SSHL - Sudden Sensorineural Hearing Loss, but I was actually kind of unaware of the hearing loss part initially. This is something that needs to be treated with speed to try to reverse the hearing loss, so if you feel any kind of diminished hearing - usually on one side only - see a doc pronto. I had episodes of dizziness, but they didn't last more than a couple of weeks so I didn't pursue getting it checked until I experienced what felt like water in my ear after a shower. I now wish I had had it checked earlier because I have one-sided deafness to human voice that did not respond to large doses of steroids and anti-viral meds. This is related to chicken pox and shingles, so it can happen to anyone.
BMX w/ TE 11/1/10, ALND 12/6/10. 15 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present.
9/27/2010, DCIS, Stage 0, Grade 3
9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ (IHC)