Partial response to chemo-what next?

Carol456

I had 2.9 cm , grade 3 tumor (triple neg) that shrank to 2.1 during AC portion of chemo (little or no shrinkage during T). Margins and lymphs were clear after lumpectomy. I just finished radiation. Doctors do not seem to agree on whether I should stop or pursue more therapy. Some say that i am in good shape and should not take any more harmful drugs; others suggest chemo in a trial I have a meeting set up to discuss clinical trials at a research hopital in another state but this seems to all be Phase I trials - toxicity studies with no known benefits.



Any advice or information to help in this decision?

christina1961

Hi Carol, I had neoadjuvant chemo and my 2.5 cm tumor shrank to 2.0 following chemo but I still had two positive nodes. I did go into a clinical trial for additional chemo, a Phase II trial for eribulin.  I think the protocol has now changed and you cannot have rads before this trial but I could be mistaken.  There are several phase II trials out there for those with residual disease following chemo - one has carboplatin and a parp inhibitor (Hoosier Group) - another is the ABCDE trial (Dana Farber), but it is randomized. Also check out tnbcfoundation.org website - there are a couple of topics posted on this issue, and other participants of some of these trials have posted messages on the residual disease topics.

Personally, I'm glad I did it.  I didn't have as hard a time with the six cycles of eribulin as I did with the original TAC.  I was originally diagnosed triple negative, then after the chemo my tumor was retested and showed 5-10% ER receptors.  I also had my residual tumor analyzed for the "residual cancer burden index" as developed by MD Anderson.  I had an RCBII - the cellularity of the remaining tumor bed, its size, and any nodes are all factors that determine this index.  There are several studies in which patients have been classified according to this index and followed - so there are some studies that show the recurrence risk for different levels of residual disease. I had this done in order to guide me as to whether or not to do more chemo. Since my risk was high (50%), I decided to do it.  The positive nodes were a big factor in my case that tipped me into the RCBII category-they are weighted more heavily that the size of the remaining tumor- so it is good that your nodes are negative.

njprn

Carol, I am enrolled in a clinical trial at Dana Faber and received Cisplatin with T and  random for RAD001. I didn't care as much about the RAD but wanted the Cisplatin which is an older chemo drug that has shown promising results against TNBC and can only be gotten in a trial. Ultrasound last week showed good tumor response. LX is June 12 so fingers crossed for a good path report. Have you done a search on clinicaltrials.gov or national cancer Institute for trials with your specs?. Check out the use of platinum drugs or ask your MO. The PARP inhibitors and Tyrosine Kinase Inhibitors have good studies as well. Hope this helps, good luck!! Nance