neoadjuvant hormone therapy sisters

Hey - nice to find another sister taking this approach! I did 7 months neo-adj. Femara. I'll see if I can figure out some of my threads from last year and send you links over the weekend.

I did neoadjuvant anastrozole for a year and was able to have a lumpectomy as a result.

Hi Angela

I've seen 2 BS who both recommended neoadjuvant chemo, one before I was even biopsied, so I gather that's now common in Singapore. Most of my friends expected me to do surgery first. After my PET-CT we found out that I have an inoperable supraclavicular node that can only be cleared with neoadjuvant treatment, so I didn't have a choice really.

My MO thought neo HT would be a good option for much the same reason as yours (I am ER+ 100%), but also felt that it alone would take too long (estimated 1 year). I'm relatively young (39) which made him think that it's likely my tumour would also respond to chemo. Doing both simultaneously would halve the time. He could already feel my lymph nodes softening by the second week, so this seems to be right too.

I do feel pain in my breast, and it's reassuring to know the chemo is working! I've only had one Lupron shot so far so I doubt it's that. I had 3.75 and breakthrough bleeding this week, but he doesn't seem too bothered by that. I should be due for another Lupron on Mon but not sure when I will start on Femara. No serious side effects from Lupron so far so I hope that holds. Chemo already wears me out.

No scans since I started, but MO does a clinical exam every week before chemo. So far quite encouraging!

I'm curious as to why your MO has chosen Tamoxifen? I've been reading that AIs are more effective, though with more SEs.

ayr1016 -- My tumor was about 7cm when I was diagnosed and 2.2cm when it was removed. The MRI right before surgery showed no cancer at all so the 2.2cm residual tumor was unexpected. So much for the accuracy of MRIs. My Oncotype DX score was 16.

I don't hang around these boards much any more but Julie alerted me to this thread and since there aren't a lot of us we need to speak up. It will be 4 years this summer since I was diagnosed with a very large lobular tumor and I was truly panicked. Lobular is hard to pick up on mammography so late diagnosis is common. My greatest fear other than death was having to do chemo and I was fortunate enough to have a MO who had taken part of his training at MD Anderson and this was just around the time that MD Anderson came out with the research that showed that neoadjuvant hormal therapy was more effective on certain ER positive tumors. He told me that I was an ideal candidate and that frankly with my low KI-67 score chemo probably wouldn't do me much good because it is more effective against rapidly multiplying cells.

I jumped at the chance to do it. I am a nurse and my husband is a physician so reading the research gave us a good bit of reassurance that it was right for me. I also opted for a bilateral mastectomy both because lobular is slightly more likely to recur in the other breast and because emotionally I just couldn't deal with something that might come back and not show on mammography until very late. Also I was 73 and not doing a lot of swimsuit photo shoots. I have never had a moment of regret about either decision. I had a repeat MRI about 3 months after I started the aromasin and it showed the tumor out of the muscle and quite a bit smaller. You could feel the difference and yes it did give me twinges at times while shrinking. They approved me for surgery at that point but I waited a couple of months longer so as to not be having surgery over the Christmas holidays so I wound up with five months of hormonal therapy prior to surgery.

I am fanatical about taking the medication every day. So far I have NED and am doing well except for side effects of insomnia which I manage with minimal medication and joint pain which I basically just live with because I can't take NSAIDs. Exercise and massage and heat all help. I no longer take anything about life forgranted and don't put off travel and other things that I want to do. Each day is a gift for which I am deeply grateful. Do I still worry-of course I do. Having a serious cancer changes your life forever and you never fully accept the sword of Damocles that hangs over your head for the rest of your life. I find that participating in a weekly cancer support group has saved my life emotionally. I also try to be careful about my diet and exercise but you have to find balance . Life without a couple of squares of dark chocolate a day is not worth living. Good luck to you and what you are doing is cutting edge evidence based medicine. People who don't accept that are not up to date in their research so don't worry about them. Just be glad that you found a doctor who is current. In the support group that I am a part of the women who did chemo have a lot more permanent side effects than those of us who did not

Hello, sisters! Really, there are not so many on this type of treatment. In my case it is my mom, who was diagnosed with BC in November 2015, ER 70%, PR 40%, KI67 - 60%. It was a 3 cm tumour and one suspicious lymphnode in the armpit (was not biopsied, just considered malignant by appearance). Mom is postmenopausal. By the way, we are in Russia, and many things are not available or not so common here. We do not have Oncotype available (well, it can be done by taking tumour samples to another country, but that's too expensive).

Interesting, but a lot of research on neoadjuvant hormonal therapy was performed by the Russian oncologist Mr. Semiglazov. I read tons of information on this treatment before I asked our surgeon about it. He said we could try, but a repeated biopsy is required in 2 weeks to see how Ki67 responded (in many clinical trials repeated biopsy may be done in 4 or more weeks, but he insisted on 2 weeks). In only two weeks on Femara the tumour shrank twice, and Ki67 was down to 5%. Basically, it is like an "in vivo" test of treatment efficiency. Only neoadjuvant treatment provides such opportunity. Mom will continue on it for another month or so (about 5 months in total) and then will have surgery. Oh, and they inserted a metal clip in the tumour, too, to be able to find it during surgery. At this time, after 3 months it has turned into something like fibrosis with calcinations (judging by mammo that mom recently had).

As for side effects, mom is doing relatively OK, maybe more emotional than usual and more tired. Our surgeon says that depending on the tumour pathology after surgery no chemo will be required. I will let you know how that goes. From the information I gathered on this approach, good response to this therapy is a very very good prognostic feature. It is especially good for Luminal A cancers (those with lower Ki67 at the start), but Luminal B (as in our case) seems to respond well, too.

I also want to mention that in Russia there was a trial to compare efffiency of neoadjuvant chemo and neoadjuvant hormonal therapy on luminal cancers, and the efficiency of neoadjuvant hormonal therapy was not inferior to chemo, at least equal or even higher. http://meeting.ascopubs.org/cgi/content/short/22/1...

Best wishes to all in this treatment!