What's the point of neoadjuvant chemotherapy?

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WC3
WC3 Member Posts: 1,540
edited August 2018 in Chemotherapy - Before, During, and After

I'm halfway through neoadjuvant chemotherapy getting and getting kind of tired of having this cancer in my body and I would like it out. The center I go to does neoadjuvant chemo standard for my type of cancer...I wasn't thrilled about it for a few reasons and ultimately they said I could do adjuvant if I wanted to but it's a respectable facility and I decided to follow the protocol because I knew my knowledge might be lacking and I did not want to be at odds with my treatment team given that fact.

But the more I learn I learn the more the rationale for neoadjuvant chemo seems to not apply to me...

1. A greater chance of breast conserving surgery: I'm not keeping the breast. I don't want it for a variety of reasons.

2. They can tell if it's responsive to the chemotherapy: I understand this. It has been, but I've read genetic testing can now determine this. Why do an experiment when you don't have to?

3. It allows them to test new drugs: I'm not a part of a clinical trial and no one is giving me experimental drugs even if I requested them. So moot point.

4. It allows them to predict survival rates: Some studies refute this and telling me my tumor shrunk x% so my chance of recurrence is Y is irrelevent to me because whether I have a 40% chance of recurrence or 10% of recurrance I will still have the same screenings with the same frequency.

Am I missing something here? Is there a good reason for this or am I needlessly spending my summer existing with a lump of cancer in my body?

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  • oxygen18
    oxygen18 Member Posts: 164
    edited July 2018

    W3C,

    My reasons were:

    I wanted more time to decide between mx and lx.

    I am a doubting thomas and wanted pathological evidence of complete response.

    I wanted to immediately annihilate any cancer cells that had obtained passports and were already vacationing in the usual tourist spots.

    I wanted the post surgery healing period to not be soon followed by chemical warfare.

    (BTW, is that W3C as in WWW standards?)

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  • WC3
    WC3 Member Posts: 1,540
    edited July 2018

    oxygen18:

    Thanks for the reply. Was neoadjuvant the standard where you went?

    WC3 = Wing Commander III. It's a great game I used to play when I was a teenager. But it can double as the WWW standard in honor of that as well.

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  • hapa
    hapa Member Posts: 920
    edited July 2018

    I've heard of oncs trying a different chemo if the tumor isn't responsive to the first one. And sometimes there are other drugs that they may or may not have you take depending on your response to chemo. Plus I get a shot at saving my lymph nodes. If I got a good response they would do an SNB, test it while I'm on the table, and if its clean then I don't need ALND. Also, I had multiple tumors so there's no guarantee even with mastectomy that I won't have radiation, but if I have a really good response to chemo I probably won't. Basically, if you do chemo first and have a really good response they'll probably scale back the rest of your treatment a bit.

    I don't think genetic testing for response to chemo is considered reliable yet.

    And there is some belief that chemo before surgery is better for mopping up any micrometastases since surgery causes inflammation, and inflammation allows cancer cells to get a foot hold in other parts of the body.

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  • oxygen18
    oxygen18 Member Posts: 164
    edited July 2018

    Neoadjuvant was still a bit of a novelty . I was offered the choice, at first I balked (what, keep the breast crap in for months???) then after thinking just how aggressive my case was, I got the feeling that the real killer threat was from what might already be outside the breast.

    Of course it's not as if chemo instantly kills all cancer cells, but I wanted those tourist cells, if any, to have their vacation begin to be ruined asap.

    I hope you feel better about neoadjuvant tx, me I was ecstatic with my choice. I am glad neoadjuvant is now widely available tho I wish it were not forced on anyone.

    Ah, I had a dyslexia moment with your nom de plume. WC3, Wing Commander 3, I trust your chemo molecular minions are hard at work cleaning up!

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  • oxygen18
    oxygen18 Member Posts: 164
    edited July 2018

    Hapa, I always wondered whether the surgery itself could cause migration of cancer cells, the answer I heard was no, but I still wondered. The inflammation idea makes sense to me.

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  • NotVeryBrave
    NotVeryBrave Member Posts: 1,287
    edited July 2018

    The funny thing with the "breast conserving" point is that the BS was still planning to take a sizable chunk out even with great imaging results post chemo. I mean - I know that it's not like the cancer cells are green or something and I'm sure they want clear margins if possible, but it sort of negates that purpose to me.

    I was very happy to be aware that the lump could not be felt after the first round of chemo. I figured that if it was having that significant of an effect at the site of the tumor then probably any other cells were getting hit, too.

    I chose BMX for multiple reasons. I was lucky to not need radiation after surgery and could concentrate on healing.


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  • yellowb
    yellowb Member Posts: 131
    edited July 2018

    WC3 - I was also told that it can get you much cleaner margins when you do the surgery -- though if yours is not close enough to the chest wall for the margins to affect non-breast tissue, that might not be applicable.

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited July 2018

    Some years ago neoadjuvent chemo was given for those with larger tumors of any type and hormonal receptor status, or with proximity to skin or chest wall in order to achieve better margins or enable lumpectomy over mastectomy. Triple negative patients are often given neoadjuvent chemo to determine whether the chosen chemo regimen is working on the tumor since adjuvant anti-hormonal therapy is not available for this subtype. In late 2013 Perjeta was approved by the FDA for use by early stage HER2+ patients, but only for neoadjuvent use and when added to Herceptin and a taxane. Only patients with tumors 2cm or larger, or node positive, we’re eligible. This is what has driven neoadjuvent treatment going forward for HER2+ patients. At the beginning of 2018 adjuvent treatment with Perjeta was approved, so it is possible that in addition to continuing Perjeta with Herceptin for some higher risk patients after surgery, there may be a swing back to surgery first for some.

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  • WC3
    WC3 Member Posts: 1,540
    edited August 2018

    Thanks everyone for your input.

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