starting chemo

prv

I have just had my port put in two days ago and will be starting chemo very shortly. I'm wondering what kind is effective for lobular ca? I am er/pr positive, and her2-neu negative with two positive nodes. they asked me if I wanted to be in a clinical trial for avastin. What has everybody else gotten?

Rabbit_fan

I didn't do chemo because of my Oncotype, but while I was waiting for that score the onc said that he would put me on 4 rounds of TC if it came back that I needed chemo.  The first onc I saw said she was going to put me on either CA, CMF or FEC, but I don't know how she was going to choose.  It seems to me like they don't agree on a 'right answer' on what they use. 

I never heard anything from any of my doctors regarding treating ILC differently from IDC.  I think some of that information may be still too much in the research stage and the practicing doctors haven't adopted it yet. 

Gitane

Hi prv,  

I don't know if one kind of chemo is more effective than another in lobular.  I have never read that anywhere, nor heard anyone mention it.  What chemos is your onc suggesting for you?  Here are some things I've noticed that you could ask the oncologists to discuss.

1.   Taxanes (taxotere, taxol, docetaxel, etc.), in some studies, have been shown to be less effective in ER+Her2- breast cancers.  However, I have also read posts on this site from people who had ILC and got a good response to neoadjuvant TC.  

2.   In some studies, AC was more effective if the ER level was not high but rather in the moderate to lowish range.  When ER is measured by IHC it may not give you accurate information about high because most ER+ are rated as high even if they are only moderate (mine was).  I found out that mine was moderate by getting the OncotypeDX test.  I also found that my tumor was IHC negative for PgR, but slightly positive according to OncotypeDX.  

I had dose dense AC, 4 before surgery and 2 after surgery.  I had a good response, but it was not a pathologic complete response.  MRI after 4 infusions said 95% reduction.  Pathology said that there were some viable cells left.  Chemosensitivity testing on those residual cells showed that the AC still would work on those cells, so I had 2 more rounds of AC. (Note: chemosensitivity also showed that the taxanes wouldn't work on them)

There seems to be consensus among researchers right now that one thing Avastin does is stabilize the blood vessels around the tumor so that the chemo is more effective in getting to it.  Therefore, in some metastatic BC trials there was improved response when chemo was given with Avastin.  On medscape and on some other sites that have info about BC trials being discussed by doctors, the topic comes up that Avastin may have a "rebound" effect.  Officially the response is that this hasn't been proven, but it comes up often enough that I question if it is happening.  (rebound effect means initially it works, but later the tumor comes back and is more aggressive someway)

Needless to say, I'm sharing stuff here that needs to be talked over with an oncologist, probably more than one oncologist would be better, because I'm no doctor.  I do want to share what I have learned, however, because it may help.

I hope you are getting your strength back now.  It sounds like you are back at work and doing O.K.  Please let us know when you get your test results, and what you are learning about your possible treatments.  

Holding you in my thoughts until I hear back from you,

Giant HUGS!   G. 

Survivor07

I have heard of a new "study" that showed how Avastin, used in conjunction with Herceptin (I think that's the one) seems to kick butt.  My doc put me on the Adrimyacin/Taxol route which worked just fine for me.  Had my surgery and recent scans show I have "no detectable cancer." Finishing up radiation, on Herceptin until start of '10 and then will take Femera for the next 5+ years.

Good luck to you . Keep us posted on your progress!!