curious about chemo....

PineHouse · January 2009

Just my two cents of this subject:

There was some article a couple years ago from a UCLA study by dr. Slamon that said Adriamycin (or Epirubicin) only benefited 8% of the population receiving it, and they found that ONLY HER2+ people benefited from it. Because of that, some trials popped up in an attempt to eliminate the "A" from ACT, and therefore some people may get Taxotere+Cytoxan, the CT part of ACT. It seemed prudent then to eliminate Adriamycin since it carries a potential serious cardio-toxicity.

But since then, the myth has been debunked. Not just HER2+ people responded well to Adriamycin. Many Triple Negatives did too!! So the ACT that has been a standard treatment for 10 years is effective anyway.

So I'm just inferring that when people say that TN's respond well to chemo, they're looking at the ACT, TAC, FAC treatments that are mostly able to shrink breast tumors prior to surgery. With that said, bear in mind that NOT all TN's are the same and not all TN's respond to standard treatment. Once you find that the "standard" doesn't work for you, it is hard to find and "guess" which chemo will work for you. This is probably what FlaLady refered to as "chemoresistant". Chemoresistance is usually not an issue for early stage breast cancer, since the tumors are generally removed by surgery anyway. But it IS a HUGE issue for those with recurrences. Even those that originally respond to Taxol for example, they will eventually become resistant to Taxol. Again, this acquired resistance is more apparent if you have to be on the same drug for a long time, so it's hard to tell on early stage patients.

So, my suggestion to those with early stage: just be as aggressive with your treatment as you can tolerate. Yes, basically you want to aim at that 3 year mark! (by the way, I never know at what point we're supposed to start that 3 year clock ticking)

FloridaLady · January 2009

As noted before I'm discussing people who have not met the two to three year mark. Even though we have people with recurrence after this time frame who are TN. If you don't know what Basal tumors are they are the most aggressive of tumors. Again not all TN are basal because we may not all have the same disease. This is by the doctor many say is the most knowledgeable about TN. I post this not to scare anyone but to know that you must understand your bc and know that you must be aggressive with treatment.

Understanding And Treating Triple-Negative Breast Cancer

07 Jan 2009

Triple-negative breast cancer is a subtype of breast cancer that is clinically negative for expression of estrogen and progesterone receptors (ER/PR) and HER2 protein. It is characterized by its unique molecular profile, aggressive behavior, distinct patterns of metastasis, and lack of targeted therapies.

Although not synonymous, the majority of triple-negative breast cancers carry the "basal-like" molecular profile on gene expression arrays. The majority of BRCA1-associated breast cancers are triple-negative and basal-like; the extent to which the BRCA1 pathway contributes to the behavior of sporadic basal-like breast cancers is an area of active research.

Epidemiologic studies illustrate a high prevalence of triple-negative breast cancers among younger women and those of African descent. Increasing evidence suggests that the risk factor profile differs between this subtype and the more common luminal subtypes.

Although sensitive to chemotherapy, early relapse is common and a predilection for visceral metastasis, including brain metastasis, is seen.Targeted agents, including epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), and poly (ADP-ribose) polymerase (PARP) inhibitors, are currently in clinical trials and hold promise in the treatment of this aggressive disease.

In 2008, it is estimated that over 1 million women worldwide will be diagnosed with breast cancer, of which 172,695 will be classified as "triple-negative." The triple-negative phenotype encompasses a breast tumor subtype that is clinically negative for expression of the estrogen and progesterone receptors (ER and PR) and lacks overexpression of the HER2 protein, with unique prognostic and therapeutic implications.

Over the past decade, our understanding and treatment of breast cancer has undergone a metamorphosis, shifting from a generally homogeneous approach to a more sophisticated view as guided by gene expression analysis.

Multiple studies have reproducibly identified the intrinsic breast cancer subtypes, which include several luminal subtypes characterized by expression of hormone receptor-related genes, and two hormone receptor-negative subtypes - the HER2-positive/ER-negative subtype and the "basal-like" subtype. Contrary to the luminal subtypes, the basal-like subtype is characterized by low expression of ER- and HER2-related genes and clinically is usually, but not always, ER/PR-negative and lack HER2 overexpression, thereby constituting the "triple-negative" phenotype.

Multiple studies have demonstrated that the intrinsic subtypes vary by prognosis, with inferior outcomes illustrated among the two hormone receptor-negative subgroups as compared to the luminal subtypes.[3,4] They may also differ in other important ways. Recent studies suggest that patients with triple-negative breast cancer have a high incidence of visceral metastasis, including brain metastasis. This clinically challenging scenario is an area of fertile research.

Carey Anders, MD, Lisa A. Carey, MD

tibet · January 2009

With ER+ patients, if they have a recurrence with mets then they have to take hormone medicine for ever and they also eventual grow resistances to the medicine so they can switch from one type to another hormone medince. For TN, it is switing around chemo medicine. But the difference is that TN has high risks of distant mets during the first years and after passing a certain time line (4 years for example), the risk of distant recurrences drops to nearly zero which is not the case for ER+ patients.

tibet · January 2009

I am scared when I read this article. I don't know if mine was basel like, not tested per doc.

I am having dd bi-weekly EC and weekly taxol with carboplantin. Is it aggressive enough for early stage?

FloridaLady · January 2009

newalex,

From what I understand this Dr Carey is at Univ of North Carolina. If you look around you maybe able to find her email address. I know some people have gotten through to her. Hopefully she can make you feel comfortable with your treatment.

As for your treatment...I do believe you are getting the same treatment a lot of early stage ladies are receiving. Only difference is the E they may be getting A. But these drug are very similar but your's is less toxic. Remember you are ahead of the game with early stage disease. The biggest plus you can have with bc is finding it early. You have done that!

If I see her email...I'll send it your way.

Flalady

tibet · January 2009

Floridalady

I don't see on the board many early stage ladies are also getting the carboplantin.

g94u67 · January 2009

Hello all,

Yesterday I read some recent unfavorable 2008 reports (On Dr. Susan Love's site) how we TN's do have higher risk to get reoccurance for brain mets and a low mortality rate. This especially related to minorities and regardless of early stage and good recovery (like myself). That sent me in a frenzy and right back into depression.

I respect Floladie's research and experience with reocurrance. No question you've been through the mill with this disease and TX'! AND you have a wealth of knowledge with TN. BUT... It is so encouraging to know the positives of being TN too. My oncologist told me being HER+ was far worse than my TN.

I have a question for anyone who can knows, does the reoccurance (2 year mark) include the risk if we have our ovaries removed within that time frame?

Newalex: I may have stated my TX incorrectly. I did 4 rounds of AC and now I'm doing 4 rounds of Taxotere. Only 2 more to go!

Jeannine

tibet · January 2009

Why the unfavorable relates especially to minorities and regardless of early stage?

If early stage, i,e, possibly the surgery had removed all tumor and cells if the cell did not spread that much. So I think stage matters, right?

FloridaLady · January 2009

Newalex,

New finding show minorities have issues with how their liver processes chemo.
Research is showing they may need different chemo's or different dose protocols. They now "think" this is why minorities have unfavorable out comes. But...minorities do have TN more often and they are not sure why yet.

Your right STAGE is very important for 90%(?) of bc ladies. There are a few that they still have a recurrence even with early disease. This could be again the whole "chemo-resistance" thing.

g94g67- Jeannine

Her2 is a very aggressive bc also...but many women are responding very well to Hercepton. I can't remember how many lives this drug a saved. It a lovely number what ever it is. But after going to two different research clinic...the bottom-line is many of the bc research dollar are being spent here. Triple neg is still the least study kind of bc. I do believe things are changing as Dr Carey noted this is a tough group that acts differently to treatment. Here is the note again we may have different disease not yet identified. I just hope each of you get the one's that respond well to chemo. I know they are on the right track if after eight chemo's the ninth one still worked is a miracle in itself. The more chemo's you do and fail the more powerful your disease becomes. So if they can kill my "super tumors" they should be able to kill and cure early disease. There is hope for all TN's. I hope the soon they well be able to truly know our receptors.

Flalady

SoapMaker · January 2009

I read a clinical research study where they tested 1,600+ women, and what they found was that distant mets peaked at three years, for TNs. They stated that after 5 years, there was no recurrence in any of the patients, with TN; however, with women who were positive, the risk of recurrence was present throughout the entire study period.

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Where is the cure Cry

www.truefacesofbreastcancer.org

g94u67 · January 2009

Thanks Flalady. I truly hope & pray researchers can make a breakthrough with our TN disease soon and give more attention to us. When I mentioned to my onc. @ DX that "I'm a TN" she wasn't familiar w/the term!

You are a trooper Flalady. I wish you all the best and am keeping you in prayer.

Here's to wishing us all, the next 3 yrs. of NED!

God Bless,

Jeannine

kekoa · January 2009

Newalex,

Thank God for you saying something positive about TN! I have been going out of my mind for the past 24 hours trying to decide if it's even worth it to take chemo as the side effects are so bad. I have been studying 3 different trials to join and have decided on the TC/TAC trial. My oncologist said the same thing yesterday, if I can make it past those first few years, my rate of survivial is so much better than ER/PR+. That is the hope that I will hold on to.

SoapMaker · January 2009

Kekoa, thank you. That is what I was trying to say and thus my personal reasoning for saying that I rather have TN than positive anyday. I was happy that that is what my very own daughter had, as well. I know her risk of recurrence is high, but I know that once she hits that 3 and 5 year period...she will be much better of than if she had positive receptors. My heart would have sunk if her receptors turned out positive. I would have been worried sick. Have hope and focus on getting to that goal.

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Where is the cure Cry

www.truefacesofbreastcancer.org

HollyHopes · January 2009

I, too, was offered FEC-D, but having done a lot a reserach and having a dear friend who is a medical onoclogist I opted for dose dense AC/T. Whatever course of treatment you decide to follow - don't look back and second guess yourself after embarking on the treatment.

Laura-Vic · January 2009

I had FECD - exactly the same regime you are saying ... 3 x FEC and 3 X Doxetaxol. Never look back ... it did the result for me. I am now one year out from my dx and have been given the all clear ... go for it hun ... FECD is much more common in Canada and parallels much of the same (although with different jargon) in other countries.

tibet · January 2009

Hi Laura-vic

What is Doxetaxol? Is it taxol? What was your dx? Thanks.

tibet · February 2009

Hollyhope

Was your dd ACT meaning bi weekly AC and weekly taxol?

curious about chemo....

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