Is there a 'standard' chemo protocol for triple positive?

rleepac

I'm supposed to see the MO on Tue 2/17 for neoadjuvent chemo and I'm sure he'll be telling me all about the fabulous things he has in store for me but I'm just curious if there seems to be a standard 'cocktail' for triple positives? I know you're not my MO and every case is evaluated individually and all that...just sort of taking a poll. If you don't mind sharing..What was the cocktail you got and the frequency? Also, how many cycles did you do?

SpecialK

rleepac - There are several chemo regimens used for early stage triple positive BC. I assume the reason for neoadjuvent chemo is so that you may have the addition of Perjeta.  Is that correct?  If so, there is a standard regimen that is approved by the FDA for this - TCHP (Taxotere/Carboplatin/Herceptin/Perjeta).  There are three other regimens that are often used for Her2+ breast cancer, with reasons and MO preference for each.  You will see geographic trends, age and experience of MO trends, and other reasons that influence why a specific regimen is chosen - to include possible co-morbidities of the patient.  Adjuvent AC-TH (Adriamycin/Cytoxan followed by Taxol/Herceptin)  the Herceptin is combined with the taxane drug Taxol and is separated from the Adriamycin due to the concern over damage to the heart since both drugs can be cardiotoxic.  The adjuvent regimen TCH (Taxotere/Carboplatin/Herceptin) is given by MOs who like this combo since the chemo agents are not known to be cardiotoxic.  Also used, most often for smaller masses, is Taxol and Herceptin.  All of these regimens have a somewhat standard dosing schedule, but sometimes have to be altered, dose reduced or changed.  The AC-TH, TCH or Taxol/Herceptin can be given neoadjuvently either to make sure it is working, or shrink a mass for possible lumpectomy - or they can be given adjuvently.  Some MOs have been able to add Perjeta to regimens other than TCHP, but I believe that it takes some convincing of insurance companies to cover it since it is not the FDA approved regimen for early stage.  My MO does not like Adriamycin and Herceptin combined - even with a separation of drug administration, so I received 6 cycles of TCH.  I received chemo prior to the Sept. 2013 approval of neoadjuvent TCHP.

ElaineTherese

Hi rleepac!

There's not a standard protocol. Many ladies get Taxotere-Carboplatin-Herceptin; depending on tumor size and nodal involvement, they might also get Perjeta. I got dose dense Adriamycin-Cytoxan (once every two weeks, four infusions total) and then twelve weekly infusions of Taxol-Herceptin, with Perjeta every three weeks. My MO isn't a big fan of TC because it is associated with gastrointestinal issues and some of her patients don't make it through the entire regimen. But, AC can be tough on the heart, so ladies with pre-existing heart issues might be steered away from that as well.

rleepac

SpecialK - I think they are doing the neoadjuvant chemo because the first surgeon who did my excisional biopsy didn't check for a sentinel node first (only took out the palpable node adjacent to the tumor) so they aren't comfortable with the nodal status. Also, hopefully to add the Perjeta. I won't know for sure until I see him on 2/17 but that's my guess. This was a unanimous recommendation from the Tumor Board so I have to think there is good reason for neoadjuvant chemo? Then last night his office called me and wants a PET scan too. Again, I'm guessing to assess the node status since a SNB is probably not possible to get now. It's a little frustrating that the SNB wasn't done and it's put a 'kink' in my treatment plan but I'm trying to just roll with it. Thanks for the breakdown on the different regimens...at least I have an idea of what to expect.

ElaineThere - thanks for the info. I know I should just be patient and the MO will answer all my questions but I'm impatient and curious!

SpecialK

rleepac - always a good idea to have a foundational understanding, less time spent trying to absorb info and more spent fully understanding the recommendation and reasons for it - good for you for trying to understand in advance!  I would totally take the advantage that Perjeta potentially adds, and try not to worry too much about missing out on the SNB.  If it is something that doesn't necessarily change the treatment plan it carries less consequence in the long run.  With a triple pos 2cm mass this is what would standardly be offered, and most likely why the unanimous agreement among the members of the tumor board.  With a node positive, Her2+ mass, I would also want a PET in advance, so don't let that throw you.  It sounds like to me that all bases are being covered and a good plan set up for you!

rleepac

Awesome! thanks for the reassurance!!!

Mommato3

I agree with Specialk about learning as much as you can before your appointments. My MO told me he appreciated the fact that I did so much research before I came in. It allowed him to get straight to the discussion without needing to explain every little detail. I did AC every three weeks followed by Taxol weekly for twelve weeks along with Herceptin/Perjeta every three weeks. I went to an MO that worked for IU. They have a computer system where they put your specifics in and it pops out a treatment plan. That's what they came up with for me. My MO didn't like TCH either. He said it was hard on them system. Although I could end up with heart problems down the road. I received Perjeta adjuvantly. My insurance never questioned it but I understand that isn't the case with all of them. Perjeta would be a good thing to add

fightergirl711

Had my first appointment today with the oncologist, and she recommended TCHP x 6. But her concern was that Perjuta was NOT covered because I already had a lumpectomy. I see a few people here already had surgery, did insurance cover it for you? did you have to appeal? I have a second opinion scheduled Monday, so it will be interesting to hear a different approach.

rleepac

I had an excisional biopsy (which could also be considered a lumpectomy) and my insurance covered the Perjeta. But thenafter my BMX they wouldn't cover it anymore.