Oral chemo for breast cancer

Mariangel43

Hi, BC Community;

I am a 66 yr. old woman who still have to make a living (works full time) and was dx on May, 2016 after initial biopsy with BC Invasive ductal carcinoma with cribiform and papillary features. I had my mx on June 2, and the first phase of recon on August 4. My BS sent me to a MO and RO. Initially my MO said that I didn't need chemo because of Oncotype and later he changed opinion. He wanted the conventional type of chemo (A+C) followed by (T). I said no. I still have to work to make a living and I am in charge of a program. I am the only employee in that area and need to be functional. Besides, with all three surgeries and the next to come, I have used many of my sickness and regular license days.

Well, the RO also went for the conventional type RT that consists of 28 sessions of 180Gy. At least she spared me the boosts that the first RO who evaluated me included in the tx. She is very nice and I really like her but I can't negotiate such a long full lifetime dosage to my right mx breast (or what has been left of it). I do understand her position; however, I cannot accept her premises.

I want to be free of cancer and I don't want to live with the expectancy of a new lung cancer or recurrence of bc due to RT. I have read a lot of oncology journals and trials. The research indicates that a low dose of 40 Gy in 15 sessions is as good as 50 Gy in 25 sessions. I worked as a health physicist for a time but I had the problem of being overly sensitive to radiation. As a student and later as a worker I overdosed easily. So I changed career to avoid developing cancer in the future.

I want to reduce the probability of recurrence. I am on hormone therapy, antioxidants, and change of style of living. The only negative factor is stress. Yes, I will need a psychologist. But in the meantime, is anyone of you in oral chemo for breast cancer? What drugs do you use? I will see my MO next Friday and he will not be very happy when I tell him I am not going after RT either. Thanks in advance for the information.

Meow13

Do you have any positive lymph nodes? You are hormone positive and the oncodx was not suggesting chemo, why did your mo change his mind? You've had a mastectomy and they still want you to do radiation?

My oncodx was 34 and I refused chemo. I went 4 years on AI drugs, still NED.

Meow13

I have heard of oral chemo but that was for a woman in her 90s.

muska

Hi Maria, you didn't include the details of your diagnosis, so it is hard to make any suggestions. However, judging by the treatment you were recommended, your diagnosis might be close to mine. You probably had no more than 3 affected lymph nodes. If you provide more details the women here might be able to advise better.

Speaking of the 'oral chemo' your MO probably was referring to Ibrance (palbociclib) - that's a rather new drug showing some promise when used in combination with AI drugs in ER+ cases. But this is just a guess.

You say work is the main reason why you don't want to do chemo. It is not easy to do the regimen you were recommended while working full time but it is possible. I had 4 AC sessions with 3 week intervals in between. Family and Medical Leave Act has special provisions for people undergoing chemo so that chemo patients be allowed to take covered sick/disability days intermittently or even several hours per day as needed for infusions and recovery. I had 4 AC infusions on Thursdays (4 sick days) and worked from home on Fridays after. By Monday, I was mostly recovered and fully functional. Taxol is usually easier tolerated and doesn't require as much time for infusions as AC, so my 12 taxol infusions were on Fridays. I took those 12 Fridays off but could have worked at least half day if there were a need for that.

Have you gotten a second MO opinion? Have you considered other chemo regimens - less difficult or shorter?

Mariangel43

Meow amd Muska, When I first saw the MO, I gave him my histopathology report from the biopsy. It was invasive papillary carcinoma. It was E+, Pr-, Her-. My onco score was and is 26 (intermediate region). When the mx was done, my BS sent it to a lab and it was later identified as invasive ductal carcinoma with cribiform and papillary features. No skin involvement, no nipple involvement, wide clean margins. Originally in my right breast there was a big capsule with many (almost 10) small and round cysts, only one of them was positive. In the sentinel biopsy, one positive node of three was found. According to the MRI, petscan, and the sentinel biopsy, no other nodes were involved. The new RO checked me and told me that no nodes in the cervical, supraclavicular or IMN were involved and has not grown.

I live alone and I have to work. I have not much license now since I had to stay home because of the fracture. Also I have to be coordinator, secretary, messenger, and accountant for this program. That's why I am resisting to strong cytotoxic treatments. But doctors here only apply standard, conventional protocols.

Tell me if you need more information. Thanks. What I have found in the Internet is that MOs are using oral chemo but they do not say the name of the pills.

Meow13

Mariangel43, I have a similar dx at 53 yrs old but I had 2 tumors each 1cm ILC and IDC, no node or skin involved also er+ pr- and her2 -, I did mx and my oncodx was 34. I didn't do the recommended chemo. But I did do anastrozole and exemestane which really effected my ability to do 40 hours a week. I retired early because of the side effects. Now I'm off meds and feel better.

I know several woman that were able to work through their treatment including chemo and radiation.

Mariangel43

Meow, those are beautiful cats. I will retire on June 30 next year. I will try to do my best until that date comes. I talked to my MO last Friday and I was happy to hear from him that I was covered with anastrozole when I asked him for an oral chemo drug because I won't be taking the RT. The thing is that the new RO also wants to use full lifetime dosage with me (28 sessions 1.8 Gy, no boosts like the former). So I told her I was very sensitive to radiation and that full dosage could make me develop other serious health problems; told her that I had to leave the health physics job because of rad overdose. (I could deal with 40 Gy in 16 sessions).

Anyway, I had worked since last week of Sept. Some days I was fully tired and I only thought of my bed. This last week I had had the exercise of the whole month. I literally walked more than five miles. So, this week mean I will rest a lot.

Good night. Sweet dreams.

Kessala

Mariangel, I've been taking oral chemotherapy for over three years.

The brand name of the drug is Xeloda (pronounced Zah-LOW-da). It is now available in its generic form (capecitabine).

It's taken at home in tablet form, twice a day. It's usually prescribed to be taken for 14 days in a row then stopped for 7 days. Then the cycle starts over.

Because it's an oral chemo the doctor can easily lower the dosage or adjust the cycles if the side effects become too severe.

Kessala

Mariangel43

Kessala, thanks for commenting. Are the side effects severe as the IV chemo or are they quite tolerable? Have a good night. Thanks.