Is chemo really needed in this case? HELP!!

hemi4 · July 2007

Hello

My mother recently got diagnosed with Breast Cancer:

Stage IIA
Sentinel Lymph node: Not involved
Size: 2.8 cm
Histopathlogic Grade III
Estrogen Receptors : Negative (no estrogen therapy)
Her 2 : Results not available yet
Margins: Clear
Metastasis: No evidence of any metastasis (CT scan/MRI/ultrasound)

She recently had a modified masectomy.

She is a 65 year old, otherwise, healthy woman. We are debating whether chemotherapy would do her more harm than good. Given than she is 65, we are concerned that chemotherapy would irreversibly harm her health.

Can someone point me to any good research sources/papers on this subect.

Thanks

Tom

2curvy · July 2007

I am cetainly no doctor, but my oncologist (well respected in Los Angeles), had me do chemo, 4 rounds of Taxotere and Cytoxin. I was Stage 1, grade 3, triple neg., no lymph nodes, clear margins. Although I am 48, not 65, I found the chemo to be very doable, with no lasting side effects. I believe that triple negatives are supposed to respond very well to chemo. Good luck to your mother.
Colleen

dklaus · July 2007

I also can not point you in the right direction, however, I am 44 and dx 6/07 Stage 1,grade 3, 1.3 cm, triple neg., 2 lumpectomies, clear margins. sentinel node biopsy--none involved(13 removed). I did 6 rounds of CAF and 35 radiations. A lot depends on the oncologists beliefs of chance of recurrence. I would err on the side of caution. Unless your mom is not really healthy, I would do it if that is what your onc. believes. Get a second opinion. It will not reflect badly on your mom to consult with another onc. Your mom has to be comfortable in the treatment options. Remember that she is in charge of her medical treatments. Ask lots of questions. Shop around till all of you are comfortable. Good Luck and come back here to ask more questions. It really does help alot.
Debbie

Indigoblue · July 2007

Always get a 2nd or 3rd opinion. Overall health and quality of life are important factors to consider. Personally, I think 65 is young. My mother was 65 when dx and had inflammatory cancer; she did chemo, radiation, and radical surgery all at the same time! This was in the early 1980's, and the treatments were extremely harsh in those days. She lived over 3 more years, but her immune system failed because of the massive doses of treatment.

Oncologists are very careful with dose amounts, and so much has changed according to choices, dx, anti-nausea, and survival.

My MIL is 88, and just had a mastectomy and 32 radiation treatments; she has diabetes, and is not a candidate for chemotherapy due to the type of cancer and I suspect her age is a consideration. She is doing great for now, however; and doesn't regret her decisions to fight this disease and survive. She'll be 89 soon, and I still think of her as youthful and spirited as ever!

Good luck to your mom, and whatever she decides, it's wonderful she has you at her side.

((hugs))

Indi

AlaskaDeb · July 2007

Get two or thre opinions and then go with what feels right. I can tell you that I would get the chemo based on those stats simply becasue chemo works well for trip neg cancer and you have less weapons later (like tamoxafin sp?) than the Est positive gals.

Just my opinion. Chemo sucks, but it works....

Hugs too your mom

ravdeb · July 2007

I suggest going for more opinions as well. But, seeing that she is an otherwise healthy 65 year old woman, I would suggest she go for the chemo.

Chemo works the best for triple negative women. She is not too old for chemo. It is not easy and it does have side effects that could be life long, but they are nothing compared to not being able to live a long life.

I was 51 when I did chemo.

luckymel · July 2007

Chemo is not easy, as ravdeb said....but it is also not what you are probably imagining. Most people don't spend their days vomiting, gray and skeletal and weak, as in days of old. The drugs to treat nausea are excellent, now, so that is not a problem for most people. There are other potential side effects, but most people do well. I worked for 5 1/2 of my six months of chemo. At the relatively young age of 65, I would think your mom would do fine, unless she has some major health problems going in. And it does sound as though chemo is indicated, from what you said.

hemi4 · August 2007

Hello everyone,

We met with my mom's Medical oncologist finally.

In her case, the 10 year out statistics are as follows:
w/o Chemo: 50% had no recurrence, 42% had recurrence, 8% died of "Other causes"

w/AC: 57% had no recurrence, 35% had recurence, 8% died of other causes

So, his recommendation is to go for 4 cycles of AC (no dense dose). He thinks sequential T would be overkill in my mom's case.

She is very nervous about the chemo because I lost my dad in 1991 to cancer. We took him to Sloan and MD Anderson back then.

Looks like she will have to take the plunge and go through it. She is, hopefully, going to agree to staying with me through this treatment. I dont know if I can convince her.

Indigoblue · August 2007

Luckymel,
I spent weeks, days, vomiting, and think I damaged myself internally; the antinausea drugs were worthless.

a

jansdaughter · August 2007

My mom was 65 when diagnosed with bc. Had lumpectomy, chemo and rads. I will say it was no picnic for her but she fought through it. We were so naive about breast cancer but we're scholars now. I'm glad your mom is going for the chemo. Take care of your mom and take care of you. Dianne

watergirl · August 2007

I'm going to be politically incorrect and say that your oncologist sounds "old school". They are leaning way from AC these days because of the heart problems and they aren't sure it works any better (or as good with respect to Taxol). A good option for women who don't/need alot of chemo is TC. The taxol really isn't very hard on most women, so skipping weekly taxol doesn't buy you much but doing it gets you alot (or about a 10% decrease in reoccurance). Also, whether you do AC or TC, the once every 3 week dosage doesn't work nearly as well as the once every 2 weeks. Recent research where they give the chemo before removing the tumor is showing more frequent chemo can make a huge difference in the %PCR (pathological complete response meaning no cancer at time tumor was removed). Dose dense (and weekly for that matter) is close to 40% PCR and once ever three weeks is in upper teens (~18%) If your going to bite the bullet and do chemo I say do it right. Another benefit of dose dense is that she will get done in 4 (or 2 if you only do AC, T, or TC) rather than 6 (or 3 months). Your mom may even qualify for some of the newer drugs in a clinical trial (some ladies in my area got Avastin and they were stage II).

All that said, given I'm not in the medical profession I recommend getting a second opinion at a large research hospital. If they say once every 3 weeks AC is the best choice then you can feel very comfortable with your choice.

LisaSDCA · August 2007

I concur that if your mom is healthy, her path report definitely suggests chemo. And I agree wholeheartedly with watergirl in encouraging you to seek an opinion from an oncologist who is a bit more familiar with current protocols.

Good luck!
Lisa

hemi4 · August 2007

The oncologist said in recent studies, for cases such as my mom's, the dose dense chemo is not showing very promising results. Adjuvantonline.com (pretty much all medical oncologists refer to this website for statistics) shows some statistical numbers for First-gen chemo (AC*4) and Second-gen chemo (AC*4 followed by T*4) and third-gen chemo (AC*4 followed by T*4 all dose dense) - each gen drugs show an improvement of 15-20% over previous generation in terms of relapse.

Our oncologist thought using second or third generation in my mom's case would be overkill.

My question is: has anyone taken AC*4 followed by T*4? What are the side-effects of T*4 - is that a "cake-walk" after "AC*4"?

Thanks for all you responses.

Tom

twink · August 2007

Hmmm...I wouldn't call T a cake walk... In my case the T was Taxotere and in many ways I found it more difficult to cope with than the AC. I hade 4 DD AC followed by 4 DD T. Taxotere made my eyes water constantly, my eyebrows and eyelashes fell out but my hair started to grow back. I was spaced out most of the time but I was like that on AC too. My stomach felt better on T than AC but I still wasn't normal...little appetite. I did not suffer from nausea on either chemo. I had thrush following my last 3 T txs which I didn't have on AC. Now, 2.5 months following my last treatment, my nails are discolored, ridged and several toe nails have simply fallen off. My joints are very sore when I first get moving whether first thing in the morning or after sitting for 15 minutes or more. I felt that T was less toxic to my system than AC but I also felt that I had a harder time coping with the SEs.

slanderson · August 2007

Most onc's say triple neg needs chemo. One because it's agressive and one because it responds well to chemo. That together with a 2.8cm tumor says "chemo" to me, loud and clear.

Shannon

snicklefritz · August 2007

Chemo is definately a plus here, but I read a study that said that TC works just as well in 4 doses as does the AC. I would advocate for that for two major reasons: First, minimal hair loss, and Second, minimal nausea. Because your mom is triple negative, chemo definately works!!!! Try to get rid of the Adriamycin part and go for Taxol and Cytoxan. That is what I would do! Best Wishes.

Mary Jane

Is chemo really needed in this case? HELP!!

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