Chemo/Radiation

MaryB36

My Mom has HER2 metastatic breast cancer which we recently found out that it has metastisized to her bone and lymph. I'm confused about some things and have some questions maybe you all could help us with (my sister, Mom and I and other friends are looking into treatment now-QUICKLY). She has difficulty getting up and down due to the cancer being in her sacrum. Between the Oncologist and the Radiologist I'm a little confused.

1. Is it true that you shouldn't do chemo and radiation at the same time?
2. If she gets say 3-5 radiation treatments then goes to chemo will that be detrimental if she stops the radiation at that point?
3. What benefits are there to being in a clinical trial for new drugs, is there a downside?
4. What is the life expectancy for this diagnosis (I'm sure that its variable)?
5. Should we get a second opinion?

Thanks so much!

Mary

TammyLou

I think that the "normal" thing is to have radiation first.

 Radiation affects your bone marrow and it kills the white blood cells that happen to be in the beam when radiation is delivered.  Usually, the more lymph nodes being radiated, the more white blood cells that are killed.

It is not usual to have chemotherapy at the same time you are having radiation...because chemotherapy also kills white blood cells.  There are a few exceptions because there are a few agents that are used as "sensitizers"  like xeloda.

More likely, your mother will be having (possibly Herceptin = a targeted biological but probably) bone enhancers like zometa (bionophosphate) concurrent with her radiation.

A key objective of the radiation is to get your mother out of pain.  The cancer cells press on nerves, etc., Killing the tumors makes them shrink and reduces pain.

Your mother's prognosis is dependent on a number of variables...one of them is the pathology of the cancer...is it ER+ / sensitive to hormone blockers?

If it is, then her prognosis is likely improved because the hormone blockers (like Tamoxifen) tend to have less harsh side effects than chemotherapy.  Chemotherapy is poison, and it has a cumulative toxicity so it tends to be held in reserve for visceral mets.  (visceral...liver, lung, etc.)

It is possible that the doctor will want to give her chemo for the lymph nodes, but it would surprise me if he did. 

Another variable in your mother's prognosis is how well the cancer responds to treatment.  Herceptin tends to improve HER2 amplified cancer response to chemo.

If the doctor can get her stable, there is every reason to believe that your mother has several years.  At this particular point, the focus of her treatment should be to get her out of pain and give her the best possible quality of life.

If you are near a major cancer treatment center, there are some ongoing trials that could be of benefit to your mother...a second opinion is not a bad option.

However, THE major breakthrough in recent years for HER2 amplified cancers is Herceptin...and that is probably readily available at most centers across the country.

Tammy Lou