Xeloda + Chemo After Sx for TNBC Improves Outcomes

I have questions about Xeloda.

My primary, local oncologist and second opinion oncologist from Dana Farber have both recommended Xeloda based on “currently accepted data and research”.

I have just completed the “big three” for triple negative breast cancer (TNBC): AC and Taxol chemo, full right mastectomy and 6.5 weeks of radiation. (I did not receive a complete pathologic response to the chemo, so after surgery I went on to radiation. The post-surgical pathology report revealed a micromestasis with one positive lymph node). I am now scheduled to start Xeloda next week and I am having second thoughts about it.

The Dana Farber oncologist confirmed that there is current controversy about whether Xeloda is even effective with patients who have the “basal sub-type” of TNBC. My local oncologist says I have basal-type TNBC, though I have not had the genetic EGFR and CK5/6 testing that identifies this. When I requested these tests, she declined to order them as they are “not FDA approved“ and thus the health insurance company wouldn’t pay for them. Regardless, I am willing to pay for these tests and the necessary tumor specimen from my mastectomy can easily be sent from the local pathologist to a genetics lab.

My local oncologist additionally says that I have completed the “required” three therapies as noted above and thus Xeloda is an optional “extra”. This statement, as well as the lay person research I have conducted, leads me to believe that while “standard of care”, Xeloda is not yet clinically considered an “automatic” treatment like AC and Taxol for TNBC.

I am not opposed to further chemo. (In fact, I am looking at a Mayo Clinic clinical trial for a TNBC vaccine which includes the use of Cytoxan for both arms of the study.) However, I’m wondering if Xeloda is even worth enduring the 6 months of treatment if its efficacy is “iffy” for thebasal sub-type of TNBC.

Any information or guidance you could provide would be greatly appreciated.