neoadjuvant before surgery

I'm going with neo.. my tumor is a little bigger so the surgeon is also recommending it to improve surgical options - assuming it shrinks during chemo- but I also like the idea of knowing how effective the chemo is.  I get my first infusion next week.  My surgeon said she has seen one case in 13yrs where the patient chose neo and the cancer advanced.  So her opinion is either way you need both chemo and surgery - and for us TN the neo seems to have some added benefits..  BUT it is your choice and if you feel that strongly about surgery and it will help your mental state of mind that is worth a lot as well.  I was where you are a few weeks ago, I've since talked myself into the benefits of neo and am very comfortable with that choice.  The stats still show (from what I understand) equivalent outcomes for either order of events. 

 Sorry to be so wishy washy!  I have been struggling with this myself for a few weeks so I know how you feel.

I am doing neoadjuvant as well - although my tumor is bigger.

I agree the response to chemo is so important for us TNs.  I only had a 50% response to the AC, so my doctor added Carboplatin to my Taxol, and after three weeks,  I can no longer feel the tumor.  When I asked my doctor if the cancer could have spread during the AC, she said no, I responded enough to prevent that.

For my doctor, particularly with node-positive patients, she uses neo-adjuvant as a way of improving outcomes by trying to get her patients a complete response. 

I feel comfortable with this decision - but if you don't, please get a second opinion.  This is your body and you should be completely on board with your treatment plan.

HI Grac - I am a newly diagnosed TNBC with a larger tumor than you and positive nodes (they think 4 from the MRI).  I read studies obessively for about the first 2 weeks and went to the oncologist prearped to do neoadjuvant - she agreed as did my second opinion onc.  What appealed to me about the neoadjuvant approach was that you'll KNOW if the chemo is working on the tumor - with pre-chemo surgery you lose that info.  I was also reassured by both docs that if it doesn't appear to be working they'll switch quickly to a different cocktail and that the likelihood of metastes happening whiel on chemo is really low.

 I think you have to be comfortable that you are making a decision you can live with.  For me, I wanted to go all out hard the  first time as I know me and if it comes back I'd be consumed with regrets that I didn't throw everything at it that was available.  Having said that however, I also know I have a really crappy year ahead of me and there's no guarantee either way.  I think that's what's been so hard about his for me - there's no black and white answer...you just have to find docs you trust and make a decision that feels right to you.  If you are anywhere near the Bay Area, PM me and I can give you some info on a trial I'm doing if you are interested - it's for neoadjuvant chemo with the new PARP inhibitor.

Best of luck in reaching a decision - I think there's a tremendous sense of relief when you HAVE a decision and are ready to move forward (at least there was for me).

Best - Donna

I will offer the counter point on this.  I was offered neo adjuvant chemo but decided against it when my onco told me the risk is that the cancer could spread while in chemo (i did not ask her to quantify the risk).  I was also told by my surgeon that approximately 25% do not respond to chemo.  The combo of those was all I needed to hear.

My tumor was a fast grower (Ki67 of 98%).  I have heard through others that some oncos recommend immediate surgery with such tumors.  I know that once I communicated to my onco that I wanted surgery first, they had me scheduled within one week.  So, clearly they too felt it was urgent to get it out.

What we did not know at the time, but learned after surgery is that my tumor was metaplastic.  Apparently not a true metaplastic, but had metaplastic characteristics (which I understand basically means it was partly metaplastic).  I have since learned that metaplastic tumors do not typically respond well to chemo, are extremely fast growing, and are very metastic (is that a word?). Having learned that, I was very glad I decided against the chemo first.  

There are risks either way.  Of course, there are time where I look back and think it would be nice to know if my chemo was the right one.  But mostly I am just glad to have gotten that thing out of me sooner rather than later. 

Riley is correct - everyone is different.  And really, you may never know if your decision was the correct one.  Maybe it comes back, but would have come back no matter what your choice.  And maybe it never comes back, but wouldn't have irrespective.  

I have decided that most of this oncology stuff is just a crap shoot.  With chemo and rads (which I start after the new year), I have basically been told we don't know if you need this, we don't know if you will benefit from it if you do, but you are young and have an aggressive cancer, so do it is best to do it.  WTF?!  I sometimes wonder how this passes for science, although I realize it is just the nature of the disease. 

Good luck, Grac, I believe you've made the right decision.  I know the feeling of wishing to just get the tumor removed, but it is reassuring to know that your chemo works on the tumor which is something you can tell with neoadjuvant.  That means that if cancer has spread on a microscopic level then the chemo will get those cells too.