tamoxifen not for ILC???

My mom had ILC, took tamox after lumpectomy and radiation, and is now a survivor of 22 years without a recurrence--so obviously there are those with ILC who take tamox and do very well.

Anne

Well, hell, first they tell us chemo won't work on ILC, now they tell us Tamoxifen won't work. Seems like if nothing worked, we'll all be dead. But that is a very interesting article, wallycat, thanks for posting it. It's exciting that the research is becoming so specific.

Thanks for sharing this.

Is there a way for us to find out the amount of gamma/alpha receptors our tissue had? I don't think it's in our path reports...Is this what the new Tamoxifen resistant test is all about?

My Onc is of the opinion that if I'm experiencing s/e's (hot flashes, joint pain) that the Tamoxifen is "doing it's job". But my argument is that how does he know that I wouldn't be experiencing these same s/e's if I was just naturally going through menopause or simply due to the aging process.

And, do any of you know if there are stats showing which types of bc have the highest mortality rate? Or which types have a tendancy to recur more often than others?

I think that triple negs have a higher mortality rate, but wonder if it's ever been broken down by type.

When I was first dx'd I (naively) thought that my Dr's would be asking me tons of questions. What foods I ate regularly, what viruses if any I had had, what symptoms - if any - I had over the years. If I was exposed to chemicals. I'm curious to know what info doctors report to who ever compiles statistics relating to cancer dx's. I was so naive tha I even thought that the CDC would have a lengthy questionnaire for me to complete. After all, that's what's done when there's an outbreak/epidemic. ISN'T BC/CA AN EPIDEMIC? I really wish/feel it should be considered an epidemic. If 50,000 women died in one year from a virus or a flu...NO DOUBT a vaccine would be found very quickly!  There would be public outcry and the media would be all over it. But instead, cancer is simply expected to be viewed as a "part of life". We have become complacent and brainwashed into accepting its destruction, and making the best of it, to be strong, and to just fight the battle like little soldiers and to keep a positive attitude and to bravely accept the wrath of it and to keep a smile on our faces to spare our loved ones the sadness and grief. It is so upsetting that so many people, women, children and men are suffering/dying from this disease. I'm getting really impatient. Sorry...I am just so disgusted with the whole Cancer Industry, and that's precisely what it is...an INDUSTRY: an extremely PROFITABLE one. It's all about money: and the age old question has yet to be addressed in an honest and open way: what's more profitable...a cure/vaccine or the incredible amount of profits generated from medications, chemo, and all other treatments relating to it. I just had to vent.

This is an interesting article & I am glad that research continues to work toward more answers about our tx's, but it is perplexing, too, since it is only an "observation".  I think that once we have been dx'd with bc we spend the rest of our lives wondering/worrying if tx did/is working. We can make ourselves totally crazy asking questions that have no answers. Articles like this can give us the willies, but no course of action!

It is a fallacy to think that se's or lack of them indicate effecacy of ANY tx---BELIEVE me---I know first hand. Our individual physiology is paramount in the success or failure of tx. Our bodies uniqueness is what this article seems to address. Only more research will give us the knowledge we need to know whether or not tamox is going to be effective for one person over another---that kind of info could crack open so many secrets about cancer!

I don't think ANYONE has become complacent! More research = more answers!!  Researchers constantly present new finds. But it is a long process! Meanwhile we need to be our own best advocates; stay informed on the latest or find ppl who are, so we can trust their help in tx decisions.

Of course, there is no cure yet due to the fact that medicine is NOT far enough advanced to solve this problem.  In 50 years medicine will look on today's tx for cancer in the same way we currently view blood letting in previous centuries! It is NOT in our control & that sux, but it is what it is. More studies are being done & giving us tx that extend life longer & longer--not just for cancer patients, but for ppl of many walks. Scientists keep working & we keep hoping...........Try to use articles like this as a tool to discuss tx with your onc. Mine seems 'up' on almost EVERY one I have ever taken him & can always put my mind at ease with insight I don't have when I find this kind of release.

Be well & stay strong 

Thank you, Tender. Very interesting.

This is an interesting article, and as far as I can see from my research, which I've been pursuing since I was diagnosed, it is part of a trend toward testing the effectiveness of drugs which have gained wide acceptance and finding that they do not work equally well for all varieties of breast cancer.

For several years, research has been chipping away at adriamycin, not only because it is cardiotoxic, but also because it was becoming increasingly apparent that it is most effective on HER-2 positive cancer, while most breast cancer is HER-2 negative. See http://www.cancer.gov/clinicaltrials/results/HER2-anthrycycline0108

Nevertheless, it was being used to treat both types indiscriminently. Lobular carcinoma has also been increasingly recognized as less responsive to existing chemotherapies than ductal, but in spite of that, its prognosis seems to be more favorable.  In one study, lobular patients enjoyed a significantly longer disease-free survival than ductal patients, in spite of their lack of response to chemotherapy.

One  possible reason for this is that cancer research has understandably concentrated on advanced cases, which will tend to involve the most aggressive forms of cancer with the fastest rate of growth, and therapies have consequently been developed to target cells that divide rapidly. Lobular seems to progress more slowly, which may be why it is not affected, or is less affected, by therapies that attack rapid cell divison.Taxol is another drug which is now recognized as being effective for HER + but not for HER-.

Taxotere seems to be more generally effective than adriamycin, and  also lacks its cardiotoxic side effects, but if there is any study of its relative effect on HER+/- or ductal/lobular, I haven't found it. Nevertheless, the TC regimen seems to be replacing AC since Dr. Stephen Jones, who first promoted AC, has declared TC superior.

What is clear to me is that chemotherapy is still in an experimental stage, and that breast cancer consists of a number of subtypes which are sufficiently different that they cannot all be treated with the same chemical agents. The result will be increasing diversity of treatment as the distinctions among the subtypes of breast cancer are better understood.

What this means, I suppose, is that we're all guinea pigs, but the good news is that  2/3 of breast cancer patients will survive without having either chemo or hormonal therapy. Chemo supposedly increases survival by 11%, hormonal therapy by 9%. Still, there is a good chance that we will survive *in spite of* adjuvant therapy rather than because of it.

To answer your first question, if, out of 100 patients, 11 more survive becasue of chemo, and nine more because of hormonal therapy, that is an advantage, especially if you are one of the 11 or 9. However, 66 patients will be taking the chemo and harmonal therapy who will survive anyhow.  The trouble is, we don't know which ones are which. These firgures came from an oncologist, by the way, so I don't know their source.

And yes, Taxotere is equally effective on patients with positive nodes.

 The source linked above covers some of this information. For the superiority of the TC regimen try http://www.medpagetoday.com/Hematology/Oncology/BreastCancer/2308. For the ineffectiveness of some chemo on lobular, see http://www.news-medical.net/print_article.asp?id=7087. This may also be at www.mdanderson.org. I have a recent Italian study which does not have the address on the printed version entititled "Anthracyclines of no benefit in HER-2 negative breast cancer" (That means both adriamycin and Ellence.)  You can find this by entering key  words in your browser. I found it in Medscape Medical News.

Curetoday.com has a very helpful feature article called "Finding Your Compass" currently online.I don't see your full diagnosis, but the Oncotype Dx test might be useful to you.  It is now regarded as reliable for some Stage IIB patients as well, rathert than just node-negative cases.

I am now looking for an oncologist who will do the TC regimen. The first one I talked to tried to sell me on AC. No "red death" for me, thank you. I don't relish the idea of chemo, but if it seems to be effective on my type of bc and isn't cardiotoxic or worse, I'll try it. I just might be one of the 11 who benefit. 

These researchers would probably say that it worked for you because you are HER-2 +. Many chemo regimens work for HER-2 +. I found another study in which the authors suggested that for the HER-2 - subjects, the anthracycline chemo may have appeared to work because the second round using Taxotere salvaged the results. In that case there was apparently no testing for effectiveness between the rounds.

I agree that there must be more factors involved in response or non-response to chemo than we know about. HER-2 is just one marker that has some significance. The fact that not all individuals get the same side effects could be taken as a hint that there are great individual variations in response to chemo.

One of the MD Anderson Center studies suggested that if a woman was hypothyroid, she had a lower risk of getting breast cancer, and if she did get it, it would most likely be less aggressive, homone positive, and have a low mitotic rate--all of which happen to be true of me, but I'm not sure exactly where this leads.

OK, I haven't encountered that version of the grading system yet.  So in your case some other factor caused Ellence to work for you.  Of course Ellence is not idenitical to Adriamycin, though they are both classified as anthracyclines. They have somewhat different side effects, and people who respond to one may not respond to the other. The same is true of Taxol and Taxotere, which are derived from the same plant source.

 I read somewhere that they are developing a way of testing resistance to chemotherapy.  That could be a great help in identifying a treatment that will work for the individual.

You might want to look at a study by Christofanilli et al. of 1,035 patients with IDC and ILC. The patients with ILC were older, had more advanced and lower-grade carcinoma, and had a relatively poor response to chemotherapy compared to patients with IDC. However, the five-year survival rate of those with ILC was better. I cited one report of this study in an earlier post in this thread, but it can be found at other sites as well. Another study comparing patients with IDC and ILC fourd that the patients with ILC tended to be E+ and HER2-, had lower-grade tumors and survived longer. The same findings show up in a number of studies. Just put "invasive ductal and lobular carcinoma" in your browser and you'll find them.

It's true that these studies involve interpretation and theorizing, but when a number of studies produce  the same or similar findings, I tend to think that there must be some truth to them.

I was pre menapausal when dx'd so after chemo was put on tamoxifen.  a year and a half later, mets to the femur.  My  last period was 2 weeks before my first chemo then nothing.  I have now been switched to Femara as obviously the tamox wasn't working for me.  Marsha