Incomplete pathological response to neoadjuvant chemotherapy

BRCA2girl

My daughter, who is BRCA2 +, had her bilateral mastectomy a month ago. She had level 1 and 2 of axillary lymph nodes removed, which for her ended up being 6 lymph nodes. The cancer in her left breast shrunk from 6cm (60mm) to 9 mm and she had cancer (not sure of size, but it, too had shrunk) remaining in 1 of the 6 removed lymph nodes. She is HER2 negative and both ER+ and progesterone +. She starts radiation therapy next week. The surgeon was able to get 2mm clear margins!

My worry: because she did not achieve a complete pathological response, does this give her a greater chance for a recurrence?

By the way her diagnosis was stage 3A invasive ductal carcinoma.

Are there others doing well with this kind of result following neoadjuvant chemo?

Thank you!
Pat

ziggypop

Wow, I think that's a great response. I had neoadjuvant and went from 9cm to 4cm and my docs were very pleased with that - I'm only about a year and 1/2 from diagnosis so I can't speak to the long term. Most people do not have a complete response. Presumably the rads will clear up any little cancer cells that may have been left behind locally. Chemo is a systemic treatment & in most cases the primary reason to have it is to hit any tiny micro mets that may be in distal locations. It would seem that if it worked that well on the primary tumor that it would also have been effective elsewhere. Also, given that your daughter is er/pr+, she'll have the additional systemic hormone treatment. One of the 'good' things about neoadjuvant is that you know whether the chemo 'worked' or not (people who have chemo after surgery don't know if it worked at all). I'm not a doc, but I'd say that your daughter actually probably has lower risk for recurrence than general stats for her specific type of cancer would imply (if she also does the hormonal treatment). 

BRCA2girl

ziggypop,

Thank you for your encouraging response! I am BRCA2+, which was discovered when both my sister and I were diagnosed 3 weeks apart of ovarian cancer in May of 2010. I am still in remission, (so incredibly lucky). My sister died in just under 3 months. My daughter waited to test for BRCA2 until she had and finished nursing her second child. She found out her positive BRCA2 status in December of 2012. She chose surveillance while she figured out which of the body-altering surgeries she would do to protect herself. She had a clear mammogram that December, and the follow-up breast MRI in June of 2013 found 6cm of tumor in her left breast. We were stunned!

Watching my child face an advanced cancer diagnosis with all the treatment it entails is far worse than battling my own cancer.

I tell you all this, so that you will know how much your positive response has meant to me! Bless you!

Pat

encyclias

Pat, I didn't have a complete response either, but my doctors were pleased; the A/C chemo found a reduction in the size of my two tumors (totaling 5cm) down to one with 3mm, the other gone completely, and wide clear margins.  It's now a year from my last chemo infusion, and I had a second PET scan just a month or so ago, "eyes to thighs", and it was negative for cancer.

I had asked my MO, surgeon and RO what they thought about my prognosis since I didn't have a complete response.  They all said they didn't feel that it changed it in a negative way.  However, being triple-negative, I can't use any of the follow-up hormonals, etc., so this has to do for me.

Sending prayers and good vibes to you, Ziggypop, and to Pat and Pat's daughter.  We can beat this.

Carol

BRCA2girl

encyclias,

Thank you, too, for your response. My daughter had 12 weekly taxol treatments in addition to 4 every other week A/C treatments. She is now dealing with peripheral neuropathy from the Taxol. (Hers is more severe in her hands, whereas mine is more severe in my feet.) Mine is considered permanent, at this point. I pray that her youth will help hers to eventually go away.

Did you take Herceptin?

Great news on your clear PET scan!

Pat

Anonymous

BRCA2girl,

I also had neoadjuvant chemo. I was also concerned about a complete response because you read so much
about it now, but my MO seemed very happy with the results.

I had two tumors - one triple negative - one HER2+. My triple negative went from 1.4cm to 3mm and my HER2+ tumor shrunk from 1.5cm to 1.4cm. The triple negative responded very well to chemo after only 4 treatments. Hopefully the Herceptin for a year will take care of the HER2+ tumor residuals. I only had four rounds of chemo due to other health complications. I got wide, clear margins on both tumors.

I can't speak to long term results because I'm still in treatment, but it sounds like your daughter had a great response! Ziggypop made a good point - at least she knows the chemo worked - not everyone gets that info. I'm so sorry to hear about your sister. Sending good thoughts to you and your daughter. I have a daughter and I feel your pain. We would take on anything if we could to keep them safe and healthy. It's sound like you've been through a lot.

Edited for Typos