Neoadjuvant chemotherapy - Pros and Cons - Help please

melb44 -- I had neoadjuvant chemo for the same reasons your doctor suggested. Also, I was diagnosed with locally-advanced cancer (5 cm) that was aggressive (Grade 3) and seemed to have already invaded one lymph node. Also, I am HER2+ and one of the targeted therapies for HER2+ (Perjeta) has been approved for neoadjuvant chemo for locally-advanced cancer. By the end of chemo, my lump was gone and the MRI and PET scans could detect no active cancer. I did end up having a lumpectomy and ALND, and now I'm doing radiation.

The pros of neoadjuvant? You can see whether or not your protocol works for your cancer. In some cases, you get Pathological Complete Response, which is generally a good sign for your future survival.

The cons? No one likes to do chemo if they don't have to. Also, many women don't have a definitive stage until after surgery -- sometimes, surgery confirms the size and extent of someone's cancer (as determined by scans) and sometimes, it shows that the lump was bigger and that there is nodal involvement. If surgery reveals the latter, chemo may be indicated.

Hello Mel, sorry you are going thru this but you have certainly come to the right place for answers! I had neoadjuvant chemo, then surgery, then rads. This is the protocol for my type of cancer, Inflammatory BC. I am also triple negative. I did not mind being in the group that had chemo first. I was able to do my chemo, knowing that my cancer was being killed off, eliminated. Then when I did have surgery, my pathology showed the results....I had a clean pathology report after surgery, thank God. My tissue had the dead cancer cells, but no active cancer present. Then after a few weeks of recovery, I had radiation. As I said this is standard care for IBC, but IBC makes up only 1 to 4 % of all breast cancers. Maybe that is why you are only seeing where the sisterhood posts having surgery first then chemo, there just are not as many. But this was the norm for me and it felt right, was right. I would suggest try letting your team present the treatment for you, If you have confidence in them, then just relax and go with it,. They are after all the experts. There must be reasons why they want this for your treatment plan. Ask on Tuesday why they want this for you, and please keep us posted.

I had it for the same reasons you listed. I liked having to do chemo first instead of having to worry about painful surgery scars or lymphedema while doing it. Also, my MO had me to Taxol first before A/C and those on here who have had surgery first do the opposite.

I'm doing neoadjuvent TCHP now. I'm HER2+, and my tumor size was 3cm, so I fell into the group that fit with Neoadjuvent + Perjeta.

This is a relatively new protocol... only approved in 2013 by the FDA. I was diagnosed in Nov. 2014 and even then, some doctors were still referring to surgery first as the gold standard. This is because people have been doing that for years and there are many more long-term studies, etc.

However, new treatments are being tested and implemented all the time, so it may depend on how conservative you or your doctor is... go with the tried and true or go with the newer treatments that show promise. Sometimes there is a very clear choice. Sometimes not. There are so many factors to consider.

Your oncologists and surgeons will help narrow these down to the ones that fit your case, hopefully.

I even got a 2nd Opinion and some of their recommendations over-lapped: that of neoadjuvent chemo... so that got settled, at least! And I ended up changing MOs to my 2nd Op doc since he seemed more up on the latest treatments (like Perjeta), which sounded good to me.

Sorting out this stuff is not easy!!! But once you get a team of doctors in place, whom you like and trust, and a course of treatment determined, things will settle down a bit. Getting diagnosed and having to ramp up on all this stuff and sort through it all, that's very stressful. Good luck with sorting it out.

You have probably already decided since this thread is from a little while ago. I just wanted to say that I did chemo first and was so glad that I did! I could feel my tumor shrinking and that gave me such a psychological boost when chemo got rough. It also gave me time to consider surgical options and calm down from the "I have cancer and am going to die" first reaction. I had 5 months of chemo to get used to the idea of cancer treatment and could casually read articles/step away when I got overwhelmed. In my case, I ended up being able to have a lumpectomy instead of mastectomy. My tumor got smaller by almost half (was about 6-7 cm to start). If I had had to decide immediately, I would have chosen bilateral mastectomy even though I now know that for my case it wouldn't have provided any risk reduction.