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Nov 18, 2015 11:52AM
What I do think is relevant to mention (and that explains the "synergy" of chemo added to trastuzumab) is the benefit that occurs with treatments that bring about ovarian suppression/menopause. Chemo does this for most (since the majority of bc patients are over the age of 40).
The issue there is, since ovarian suppression can be done through other, far less toxic and expensive methods that don't tinker with the immune system, it doesn't make sense to use chemo to do it.
Ovarian suppression/menopause affects the rate of metabolism, slowing it down. That is what brings about weight gain. Weight gain then gradually contributes to recurrences by increasing the amount of body fat, since body fat is a source of more estrogen. However, when the metabolism is slower, there is more time for abnormal cells as well as normal cells to proceed through the normal process of dying instead of the process of cancer cells multiplying rapidly.
The points here are:
1) that we probably aren't going to be able to avoid the sexual slowdown involved with either chemo or ovarian ablation, but of the two, OA may be preferable as a natural process that allows the immune system to continue to function -- especially if one chooses to use a form of ovarian suppression that one can choose to stop at a point in time, rather than choosing permanent removal of the ovaries.
2) that younger patients, who have a higher recurrence rate, likely should make sure they do add some form of OA to the trastuzumab, and not just dump the chemo and rely on trastuzumab.
3) and weight management through diet and exercise also are likely to make a real difference in terms of recurrence.
12/3/2001, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2+ (IHC)
1/3/2002 Lumpectomy: Left; Lymph node removal: Left, Sentinel
3/12/2002 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Fluorouracil (5-fluorouracil, 5-FU, Adrucil)
11/15/2002 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)