Anyone do Neoadjuvant AND Adjuvant chemo?

I had a situation somewhat similar to yours, but had a large mass in the axillary area, plus the PET scan showed positive nodes in the subclavical and pectoral area.   I had a pretty good, but not complete response to neo-adjuvant chemo, followed by surgery and rads.   Now I am on Arimidex. 

I asked my onc whether I should have more chemo to ensure that cancer in the nodes that could not be radiated/removed was knocked out.  He said no, so I would also be very interested in hearing whether someone else got adjuvant chemo as well as neo-adjuvant without any finding of new disease.

My treatment was identical to Sherri's, but my tumor was smaller and I had fewer involved nodes. However, I did have at least one encapsulated node, which means they had broken open and the cancer was growing on the outside. I have a gnawing suspicion that that node was the one they core biopsied. I think that created a hole that allowed the cancer cells to spill out. My surgery was five months after the biopsy.

My Mom is in a similar situation. She was DX in July Stage 2B/3A- Triple Negative. Her tumor was 4.5cm and she had lymph nodes measuring 2.5cm. She did neo-adjuvent AC x4, T X 4 DD. It did not out a lot of the cancer, the tumor was all gone but some residual cancer remained in 3 of her lymph nodes as per her path report after her BMX. She is now going to get some additional chemo due to her high risk of recurrence since the lymph nodes had residual cancer. Her Onc recommended either gem/carbo or Ixempra with possible carbo. Due to heavy duty side effects of Ixempra we are leaning towards the gem/carbo and that will probably be what she does and she will prob start next wee. Her BMX was Dec. 10th. 

 If you didn't have node involvement you may not want to do more chemo as yes it is toxic and will reck some havoc on the body again. If my mom didn't have residual in the nodes we wouldn't have pushed for add'l chemo and she could have just gotten radiation. But given her stage and triple negative status, her risk is high for recurrence and the nodes still having some cancer is a chance that we rather not take. It seems as though there isn't much out there on studies of women getting adjuvent chemo after neo-adjuvent fails to produce a complete response. Some Onc's definitely do it but more of on a case by case basis rather than as a protocol. There should be more studies to see if it does make a difference especially in women who are triple negative and can't get any additional hormone therapy after chemo etc.  

NannaBaby - Could the meeting be just a standard procedure.  They are done that way at certain hospitals, it is a normal course of action.  Ask you Oncologist about it, so much can scare us and I know for myself I read too much into things.     

I just had neoadjuvant for a 11 cm mass, 6 months of Chemo, weekly Taxol and Herceptin for 12 weeks and 12 weeks of every three weeks of (5 FU, epirubicin, Cytoxin) FEC. Almost a complete response, a few cancer cells left and 2 positive nodes.  Clean margins -when I had my MRM.  Originally I was told I would have more Chemo after surgery but had such a great response that I was told I didn't need to do more.  

To add to this discussion: I had neo chemo in '05, 3 months of A/C, then 3 mos of Taxotere/herceptin.  I did not have a good response (I still had stage 3a disease at surgery.) So,  I consulted a couple of oncs about whether to do more chemo after surgery.  The consensus was (at that time) that there was no research to support the benefit of additional chemo.  I continued with rads and 9 months more of herceptin, but no more chemo.  

I've done really well, by the way.  No recurrence.  Highly her pos, hormone neg, very aggressive path.

Annaanne 

NannaBaby,    I know it is hard to hear that you need more chemo.  I can remember being told that, too.  As crumby as it is to face more treatment, you know your doctors are doing everything they can to see that you are healthy.  You are right, we want to do it right the first time.

Thanks, NannaBaby.  His name is Smokey and he's my companion.  I rescued him while I was in treatment.  Good to hear you have the energy to get in shape.  Hugs!

What a beautiful cat your Rascal is.  I can almost hear him purr.

I did Taxol/Herceptin for 12 weeks then had my mastectomy and 4 AC (herceptin for a year) after the surgery.  For me it was recommended to get some Herceptin prior to my surgery bc my tumor was large. 

So I had Neo and adjuvant but no more in total than if I did it all before or after

Karyn

Nanna I know what you mean by freaking out! My family and close friends are freaking out also and that is not helping. God I hate BC!  I have spent the day telling myself this is what I need to do and trying to get into the right frame of mind. Will be glad to go to work tomarrow and not think about it till I have my first cycle on fri.

I'm keeping an eye on this thread just in case...

I asked my doctor Monday about the chances of having to do adjuvant, and she said it was very unlikely due to my good response to chemo.  When I asked what would we do if I still had residual disease in my nodes, she said she would take it to tumor board...

I hope you guys do well!  I can only imagine trying to get back into the mindset...I think I'd just focus on my kids as much as I could.

Lynn - that's good to hear your doctor feels the same way. For some reason, residual in the nodes bothers me more than in the breast, even though with TN it doesn't seem to care.

Nannababy,

Thank you for that article!!! I am so pleased to read that.  After neoadjuvant and then mastectomy, all my lymph nodes were now clear and about 8-9 were involved to begin with but there was a tiny bit of residual left in the breast tissue.  I was concerned of course, but all my doctors were ecstatic.  Now, I know why.  Thank you.

Take care all.