Chemotherapy and hormone positive bc

zayb

I am scheduled to start chemotherapy this Friday. I previously had dose dense AC +T over six years ago for triple negative breast cancer on my left side. I had a mastectomy prior to chemtherapy.

I then had a right "prophylactic" mastectomy the year after my first mastectomy. It turned out I had microscopic dcis, various grades and types. Recently, I had surgery to remove a 3 cm lymph node on my right side that was cancerous. I had a revision of my right mastectomy and had an additional 20 lymph nodes removed. There was only cancer in the one node, and there was no extra capsular extension. This cancer was 95%er and 50%pr, her2 neg.

I guess because the cancer was in the node, chemotherapy was recommended (there was no primary/local tumor). I am scheduled to have 4 cycles of TC, but it is unclear to me whether this has any benefits for hormone positive BC. I seem to find conflicting information on this. Of course, I will be doing anti-hormonals as well.

Are other people with highly hormone receptive BC doing chemotherapy?

ShetlandPony

Yes, my ILC recurrence was highly ER and PR positive, grade 2. Taxol got me to NED. Permanent chemopause probably helped, too, but I think taxol gets a lot of the credit for my complete response.

zayb

I am going to bump this up to see if there are more responses. I noticed that many hormone positive, her2- diagnoses are getting g the TC combo. What have you all heard about the efficacy of this regimen for hormone positive. I don't think i had oncotype testing done, it is not on the path report. I only had cancer in one lymph node, a big tumor, but no extra capsular extension so I am not sure exactly how they are classifying it. I had various types and grades of dcis on the right, but still very very small, some high grade with comedo. Clearly what I had going on in my lymph node wasn't high grade even if it was big, so we are not sure where it came from. I would appreciate any feedback on the use of chemo in early hormone positive her2 neg cancer. Thanks.

Thanks for your reply, ShetlandPony. I am glad taxol worked so well for you. The information is all over the place. It seems clear that some hormone positive cancers really do respond well to chemo and some do not. It is hard to tell what the best treatment route is. My previous cancer was triple negative, high grade. Chemo wasma pretty obvious choice for that one!

ShetlandPony

Also there has been recent discussion of genetic differences between early and metastatic tumors, and that could possibly influence the effectiveness of chemo. Advice from an experienced oncologist is valuable. Advice from someone who has seen a lot and has a good feel for what would be best for you.

Racy

Have you got second and third doctors' opinions? I think you should.

Opt4Life

I am also very interested in this topic as I am ER+ (70%) but PR + only (10%) and HER2- with a KI-67 of 5% and an apparent low score on my genomics test (I was just told that I have a low recurrence risk). However, I have one positive lymph node (biopsied) and another noted as suspicious on the ultrasound. Neoadjuvant chemo was recommended because of my pre-menopausal state and the positive node. They also plan to put me on Tamoxifen for 5 years.

When I noticed that I was doing Taxol first instead of dose dense AC, I questioned my MO who basically said said 'she will see how I do on that'. So far, so good on the Taxol with few SEs outside of constipation. But I am now questioning whether I should even do AC if I don't get any response from the Taxol. So my question for my MO at my next infusion is whether it would be appropriate to finish Taxol, do the surgery (I'm getting a mastectomy because they found DCIS and small segment of LCIS too)and make a determination about AC and its necessity after surgery.

Thoughts?

Jinx27

Great thread! Thanks Zayb!

@zayb

I also am highly ER/PR positive (both breasts) and had my surgery first and then will be having chemo (AC+T) twice a month for four months starting the first week of Jan 2016.

Before deciding on doctors, I had one oncologist who thought neoadjuvant chemo would be good for me but the second oncologist was not too sure she preferred surgery first in order to study my tumor.

With the first oncologist , I asked her about the efficacy of using chemo on hormone receptive cancer and what data and experience have they had with it. She really could not give me a solid answer only because they only had biopsy results and imaging to look at. She also stated that data is more abundant for her+ and triple negative patients but chemo is stanard regardless.

My second oncologist (who was a mentee of the first oncologist) is at a different facility but also stated that chemo for hormone receptive cancer can work but she was more excited about the SOFT regimen ( ovarian suppression and aromatase inhibitors) for me instead of Tamoxifen.

My overall impression is that chemo is given to hormone receptive patients like us because the efficacy of chemo in our cases doesn't have a low enough percentage rate of not working enough for doctors NOT to suggest it. It's become a standard. I really want to do more research on this because it should be out there for us to read. Making a decision about chemo should include info and percentages of responses to chemo regardless of hormone status.

This thread is the first time I have heard about Taxol really helping out us hormone positive cancer patients, l'll ask about that.

In my case,

The final path report after surgery found in the left breast was a large tumor 4cm with some satellite lesions and only one positive node, no extra capsular extension. The right breast was DCIS with some comedo and two nodes with super microscopic amounts of cancer that's not considered mets. There were no axillary nodes. Great margins on both sides.

My tumor was also close to my pectoralis major muscle but there were great margins on that side, so maybe that's why they want to do chemo....

I have an appointment today with my oncologist to discuss this in more detail before beginning chemo, I l'll be sure to ask questions until I fully understand everything. I hope you all do the same!!

I'll keep you guys updated and will write what my oncologist says about my questions.