Neoadjuvant Chemo - If the Chemo Works, Why Not Take More!!!

Hi Meg! 

Thanks for the post.  I just passed the halfway mark of the chemo portion of my treatment and I needed a little reminder.  I am participating in a clinical trial and the plan is 4x taxotere (done!) and 4x A/C.  My tumor is shrinking with each treatment and I hope that it will be gone by the time I have my bilateral mastectomy. 

When we get neoadjuvant, it gives us and our doctors an opportunity to see how our cancer responds to chemo.  Not only wonderful information as you pointed out, but I know that my outlook improves with each report from my oncologist that my tumor is shrinking.  We KNOW that the chemo is working!  That is good news in tough times.

I am getting neoadjuvant TC and my onc scheduled me up front for 6 cycles instead of the 4 many women get, but then I have both multifocal diseease and a very large primary tumor.  I'm 6 days into my second cycle and am tolerating the chemo reasonably well.  I will be getting an MRI next week to see if there has been appreciable shrinkage of the tumors, but I can already tell that my primary tumor seems a bit smaller.

Neoadjuvant chemo seems to make so much sense and is delievered through an in-tact vascular system.  It surprises me that it isn't used more often.  I suspect it could eventually become the standard of care in more situations.

Meg--our chemo regimens are very similar.  I had dose densing neoadjuvant AC/T. 4 cycles of AC every 2 weeks followed by 4 cycles of Taxotere every 2 weeks.  After 2 of the AC we could no longer feel my primary tumor (it was large). At the end of chemo I was clinically (the Dr could feel nothing) and radiographically (PET/CT scan was negative) responsive to chemo.  I then had a bilateral mastectomy and did have some residual at the time of surgery....it was less than 1cm (PET/CT's only see to 1cm).  So what to do now?  A 2009 May ASCO article says that after neoadjuvant chemo with residual cancer at the time of surgery, the recommendation is to do NOTHING.  WHAT?!!  Believe it or not that is the recommendation.  I didn't agree with this....just sitting around waiting for the cancer to pop up somewhere else.  My Dr was going to do Xeloda (pill form) with rads but I didn't like that answer...I felt that it only hit the cells at one phase of their cycle and I wanted combination therapy and to go back to IV. After battling insurance, i was approved this week to now do carboplat and taxatere with rads (starting in the next few weeks....I need another chest port--they took mine out with my mastectomy in June, ugh!).  Gemzar and avastin are miracle drugs for triple negatives but are only approved for stage IV which I am not....so I have to wait for those drugs. I am very surprised Meg that they did more AC because of the toxicities.  I know my Dr talked to me about toxicities and I told her I would rather be ALIVE than worry now about possible renal or heart failure in the future.....there is always dialysis or a mechanical heart but what is the option to LIFE?  Thankfully my oncologist was on my side but that isn't always the case.  I just had to come to the point where I know that if this recurs in the future that I did EVERYTHING in my power NOW to kick it!  I want no regrets....

My mom appears to be HER2+ and estrogen-, Stage 3 IDC, and it might have spread to her liver. There was a spot in the ultrasound so they're going to look at it. What is this "A/C" you're referring to? I've been doing research on all the types of chemo drugs she may have to use, and her oncologist said that she'd need about a year's worth of treatment: 6 rounds of taxotere and carboplatin, and herceptin throughout. She didn't mention any other neoadjuvant chemotherapy treatments or the A/C, but it seems that the A/C is working well for everyone in this thread.

 Is AC = Adriamycin cytoxan? If so, her oncologist recommend AC only if the Her2 was negative. Does that make sense?

How much did it cost for each treatment? My mom doesn't have health insurance other than the AARP plan, so we're going to have to pay out of pocket or find some financial assistance.

Hello all!   My mom was diagnosed with BC (Stage 3B, Triple Neg) in April.  Because of the size of her tumor and chest wall invasion, it was determined that she would do neo-adjuvant chemotherapy to try to shrink the tumor prior to surgery.  She was selected to participate in a clinical trial of a new drug (Sutent) along with weekly chemo which started in May.  She did 12 weekly treatments of Taxol along with daily Sutent for those 12 weeks.  The tumor responded very well to the Taxol and shrunk from the approximate size of a golf ball to  practically undetectable to the touch.  Then about 6 weeks ago my mom began phase 2 of the trial and switched from Taxol and Sutent to weekly Adriomycin and daily, oral tablet dosage Cytoxan.  She was scheduled to do 15 weeks of that, instead at last week’s chemo we learned that her monthly ultrasound showed that she is failing to respond to this chemo and the cancer has restarted growth.  It is now detectable to touch again and approximately the size of a marble.  She has been removed from the clinical trial and we meet with the oncologist tomorrow to see what our next course of treatment is.  Most likely the next step is surgery and then radiation.  However, what is really scaring me is that, based on whatever the onc saw on the MRI he ordered to confirm the ultrasound results, he has now ordered a PT scan which makes me question whether the cancer has spread.  I am very scared for my mom, since she is triple negative, if 12 weeks of Taxol didn’t stop it and Adriomycin and Cytoxan are ineffective, what else is there?  Also, my mom is unlikely to do any more chemo after six months already that haven’t been successful.  Please, any thoughts/advice would be appreciated.  Thank you.

I had AC and Herceptin both and did not have heart problems.