So how can I get a Pathologic Complete Response??????

yes- that is pcr.

and rcb - or residual cancer burden - can be directly linked with event free survival etc...

basically, the better the chemo works, the better your long term prognosis.

i had neoadjuvant chemo as part of a clinical trial - ispy-2.  

after 12 weeks of taxol, with carbo every fourth cycle and a twice daily parp inhibitor, i had four rounds of ac.  mri was probably showing NED after 12 weeks of taxol... the images appeared consistent with scar tissue.  after 4 rounds of ac, it looked slightly different - still consistent with scar tissue.  surgery showed only scar tissue remaining, and my sentinel node(s) was clear.  so, that was terrific news!  in this clinical trial, pcr is achieved at a pretty high rate, according to the onc leading the study in my neck of the woods, but i don't know the actual fraction of patients getting to that magical pcr point.

so, how to get it?  good question - this is a major and active area of research.

i think that if the chemo does not get you to pcr... then additional treatment could be warrented. after the 12 weeks of taxol, i could still feel my lump.  it did not really change during the ac portion of my chemo, which prompted me to ask my onc dr whether additional treatment after surgery could be warrented if my result was not pcr.  he said - yes.  he went on to describe a few options for tnbc....  i was delighted when my pre-surgery PET showed no evidence of disease (no lit up lump).  so, i went into surgery nervous but cautiously optimistic.

does this help?

can you feel your tumor changing?  mine shrunk quite a lot, but mostly it changed in texture.

best wishes - i hope for pcr for you!

Biker Lee--could you elaborate on the options your MO gave you and are they only for triple negatives? I did not get a full pathological response from neoadjuvant, but I am ER and PR positive, so maybe there is nothing for me, but I'd like to discuss with my MO. It makes me nervous to know that I had it in so many nodes and having extra capsular extension despite the neoadjuvant chemo. Thanks.

hi mary - looks like we had our surgeries just one week apart!  how are you healing up? i feel like my scars are thick, but otherwise i feel nearly "normal"... are you flat?  i'm totally flat, and i love it.

anyway - on to your question - i seem to recall "metformin" as something the onc mentioned... but to be totally honest, the drug options completely left my mind after hearing the pathology results after my mastectomy.  and yes, the options he mentioned were specifically for triple negative bc, which is notoriously MORE responsive than er+/pr+ tumors to chemotherapy.

i think one of your options is tamoxifen and other drugs specifically for hormone positive cancers. oh - i see femara in your post-treatment plan...  that would be one of those drugs....

and keena - i want you to be in that 50% too!!!!! so, a few thoughts.  are you using glutamine as a supplement?  my onc was very supportive of this...  helps with side effects but does not interfere with the chemo action on the cancer.  also, i have read some interesting things about selenium, which is supposed to protect healthy cells but make cancer cells more susceptible to the chemo.  so, perhaps ask your onc about supplements that might be good for protecting the good stuff and good for hopefully killing off the bad stuff (aka - the cancer).

lee

Hello ladies,



My cancer was ER/PR- and HER2+++ and yes,I had a pcr. My tumor was huge -13 cm - and I had a lot of positive nodes,therefore very poor prognosis,but here I am still NED after 6 years and and 2 months.I felt so good when,after 4 rounds of A/C,the oncologist told me he can no longer feel the tumor.And the pathologic report showed no cancer in breast and nodes.So ladies I wish pcr for all of you.You will be ok,I am pretty sure.



Regards to all,Marina

Keena,

I did not have a pcr but my remaining tumor possibly changed from ER- to slightly ER positive after chemo.  I chose to get additional chemo in a clinical trial due to the fact that my type of cancer (only 5-10% ER positive, grade 3, two positive nodes after chemo) was aggressive.  I started my first chemo Feb 2011 and my last Feb 2012.  I am doing well now, and feeling good. I had a unilateral MX following the first chemo, then rads, then more chemo.  I have not yet had reconstruction and am still undecided about it.

I had TAC X 6 first - last chemo was six cycles of eribulin (Halaven.) I just realized this is Stage 3 - sorry but I am going to leave post in this case because I hope it is helpful to Keena - I was stage 2B downstaged after chemo to Stage 2A. My tumor shrunk from 2.5 cm to 2 cm but I often wonder if it shrunk at all because the breast MRI showed only 2 cm prechemo - it was the mammogram that showed 2.5 cm.

Hi, I got a complete response and I have my Lumpectomy on 19th June.

Thanks Marina, I think I get it now.  I want the chemo to get rid of everything so nothing shows up?  This is all very confusing and I don't really ask my MO any questions, just do what he tells me to.

  My MO said the rate of response was also a great indicator. The pathologist called it a partial response, but my IDC went from 3-4 cm to two little less than .1cm foci. My DCIS was also turned to scar tissue, and my two positive nodes had no live cells.  I could barely feel the tumor after the first round and by the second it couldn't be felt. I also had been nursing when I was dx and after the third round it changed. My blocked duct started working again. It's been 8 months since my bi-lateral. I did six rounds of taxotere-carboplaten before surgery and 17 herceptin total. 28 rads.  Hope this helps. Oh and I did the l-glutamine. My Mo also had me take Vitamin E, D and stay on my pre-natals. I made it through all six rounds on time never got sick, with three kids and a camping trip.