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Nora

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Dear Gina, dear Constantine
and everybody going through a similar situation,

I'm new to this forum which I discovered only recently and I am grateful about all the helpful information I am finding here! It is still a bit overwhelming and right now I feel completely lost and desperate: Whatever therapy I am on, my cancer is gradually growing.

Here is my medical history so far:

Diagnosis October 2013: TNBC, stage 1b, no lymph nodes involved, G3, V0, L1 (lymphangitis carcinomatosa),
First Chemotherapy regimen, December 2013: 4x Epirubicin + Cyclophosphamide, 12xPaclitacel,
BRCA1 positive, rare subtype: c.5572>C, Exon 24 (Diagnosis April 2014)

July 2014: Radical mastectomy, silicone implants + mesh,

Diagnosis March 2015: bone mets, pleural and lung mets, lymph mets,
Second Chemotherapy regimen since April 2015: BROCADE-study: Carboplatin, Taxol +- Veliparib (or Placebo).

Dioagnosis June 2015: bone mets and lymph mets have grown, pleural and lung mets seem stable, new brain mets.

My oncologists now want to do radiation therapy to reduce the brain mets and treat the bone lesions. Furthermore it will be crucial to find out, whether I was on Veliparib or the placebo medication during the BROCADE-study-regimen. If it was the placebo medication, I'll probably be getting a higher dosage of Veliparib (likely without Chemo), if not, there is no clear treatment strategy yet.

Do you have any thoughts?

Thank you so much for your help!

Nora

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P.S. - I forgot to mention: So far I have been on Zometa for my bones, now my onc has recommended me to have Denozumab as an injection every 4 weeks.
edge

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Nora:

I only just read your posting, and I can well understand your confusion and distress, and would be glad to help clarify and untangle these matters and issues, and also to provide some appreciation of your many options - and there are many (I specialize in breast cancer CNS/brain disease, especially that affecting the TNBC tumor biology - and what some of the tradeofs are in certain key decisions, as well as how to secure more information.

I am just discharging some critical prior obligations, but I am confidant that I will be able to get you some guidance and feedback within the next 24 - 36 hours at the outside, but more likely sometime tomorrow if my obligations go acccording to plan.

In the meantime, rest assured that I and Gina and the wonderful folks of the No Suurender Breast Cancer community will do all we can to help guide you to the best possible treatment options, and be partners on your journey to assure intelligent and proactive care and management.

So we'll communicate again within the next day or so, and understand that however confusing and complex you find all this, we have advanced considerably in the care and treatment of brain metastases, as well as in TNBC disease in general, including with viseral (lung/pleural) and  bone involvment, and can serve as allies in the battle.

Constantine Kaniklidis
Research Director,
No Surrender Breast Cancer Foundation (NSBCF) 
Nora

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Dear Constantine,

thank you so much! I'll be patiently waiting for your reply!

In the meantime I have recieved the recent tumor board information as a copy. The re-staging reads as follows:

General disease progress:
- hilar and axillary lymph node metastases progredient
,
- pulmonary metastases partly progredient, partly regredient,
  decline of pulmonary infiltrates,
- 2 new suspect hepatic lesions,
- 2 new pin-sized brain metastases,
- new spinal and cranial bone lesions.

By Tuesday I will know if I have been taking Veliparib or the placebo "medication" during the BROCADE-protocol.

Over here in Germany, some alternative treatment options are quite popular and I have been suggested to try the following preparations as subcutaneous injection:
- Helleborus Niger planta tota (christmas rose),
- Helixor M SE I (misteltoe),
- Plumbum Metallicum Praeparatum (a homeopathic lead preparation),
- Cerussit (homeopathic medication containing lead(II)-carbonate).
According to your experience, what do you think about these medications?

In addition I am taking Vitamin D3: I increased my daily dose to 4000 IE/day, since my recent blood serum levels are only at about 30ng/ml. I am taking calcium as well, as calcium acetate 500mg/day, but I read that you preferably suggest calcium phosphate. I am drinking at least 5 cups of japanese green tea every day (mainly gyokuro and sencha), brewing it for 8-10 minutes. However, I'm not sure if this is enough to absorb sufficient amounts of EGCG. The same applies to curcumin and turmeric, which I use as a spice daily, in combination with black pepper. I am supplementing with freeze dried broccoli sprouts (I cannot stand kale and other cruciferous vegetables) and I am eating a mediterranean diet with lots of vegetables, low glycemic fruit, whole grains, fish, meat occasionally (especially white meat), avoiding any added sugar. I'm very confused about dairy (no dairy versus low-fat dairy or produce from grass-fed animals, sheep and goat's milk versus cow's milk), but I also know that I have to gain weight (I'm currently a little underweight) and probably need extra protein and fat. I also started to do strength training. Before diagnosis I loved to run, but my actual lung capacity doesn't let me!

I am sorry to bombard you with all that information, but on the other hand it only seems correct to give you as much information as I can about my current state.

Thank you so much for being such a lovely ally in my battle!

Nora
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Nora:

First as to conventional therapies:

1. Local/Locoregional Control

For brain metastases, whole brain radiotherapy (WBRT), as your oncologist appears to be suggesting, is certainly one choice.

Guidance: But you should  discuss with your oncologist or with a referred to interventional radiologist the possible use of an alternative, that of stereotactic radiosurgery (SRS) - in the form of Gamma Knife, Cyberknife or LINAC forms, although Gamma Knife is the most common - which is especially attractive when brain disease is limited or the number of brain lesions is small, and to avoid the potential for neurocognitive decline that is sometimes associated with WBRT. In particular current consensus suggest that Gamma Knife (radio)surgery (GKS) appears to as effective as surgical tumor resection (level I evidence, the highest), avoiding the impairments in cognition and quality of life that can be a consequence of WBRT (level I evidence), with high local efficacy, preservation of cerebral functions, short hospitalization and the option to continue systemic chemotherapy at the same time, all being factors in favor of this minimally invasive stereotactic radiosurgery (SRS) approach, and SRS can be later, if necessary, combined with WBRT.  Of course every case and patient is unique, but this option should be explored further to discuss its viability for you.

 

2.  Systemic Therapy: Targeting both Extracranial and Cranial Disease

Systemic therapy remains the mainstay of treatment whenever there is extracranial involvement (to other viscera or organs, like lung or liver, or to the bone). To date you have had EC/T (epirubicin + cyclophosphamide / paclitaxel (Taxol)), but it remains to be determined whether you've been exposed to the PARP inhibitor veliparib under the BROCADE clinical trial (carboplatin + paclitaxel (Taxol) + veliparib), veliparib being a good choice for your case of BRCA1-positivity. 

However once there is CNS (brain and/or leptomeningeal) involvement, the most promising therapeutic agents are those that can cross the blood-brain barrier (BBB) in order to be effective both in extracranial (lung, liver, bone) as well as CNS disease, and these are reviewed extensively in my paper CNS Metastasis from Breast Cancer – New Promise: A Review (at: https://www.researchgate.net/publication/232754712_CNS_Metastasis_from_Breast_Cancer__New_Promise_A_Review).

Of all of the cross-BBB agents, capecitabine (Xeloda) has been the most extensively studied, and of confirmed benefit in breast cancer brain metastases. To add further cross-BBB anti-metastatic activity, capecitabine (Xeloda) is often combined with temozolomide (TMZ), in dosage and schedule as detailed in my review.

Bone metastasis have their own special protocols, which always involve either a bisphosphonate, namely zoledronic acid (Zometa) or the RANKL inhibitor denosumab (Prolia/Xgeva), and both are good choices, and switchable when or if needed.

Guidance: There are more cross-BBB chemotherapies such as vinorelbine (Navelbine) and cisplatin, among several others (including liposomal doxorubicin (Doxil/Caelyx) and possibly also bevacizumab (Avastin)), so many options exist as fallback should they be needed after a trial of X-TMZ (capecitabine (Xeloda) + temozolomide (TMZ)). But given the known efficacy of capecitabine (Xeloda) w/wo temozolomide (TMZ), I would strongly advise exploring this option first with your oncologist.

 

3.  Complementary and Alternative Medicine (CAM) Modalities

First, as to the CAM agents you enumerated commonly used in Germany, only standardized mistletoe extract in the form of the commercial product Helixor, has any robust human clinical evidence of potential benefit, with one prospective randomized controlled clinical trial (Piao and colleagues at Universitåt zu Köln, Anticancer Res 2004) plus a strong systematic review of controlled clinical studies (Kienle and Kiene, Freiburg, Integr Cancer Ther June 2010) which also conclude that it beneficially reduces the side-effects of conventional therapies (both chemotherapy and radiation therapy) in cancer patients and thus improves quality of life (QoL). The others lack sufficient robust evidence of benefit to make any recommendations.

Guidance: As to the other CAM interventions you mention you are on, here's my commentary, inline (in brackets) with your original text), but please consult my latest guidelines in my Edge-CAM regimen (version 4, here on No Surrender, at: http://www.nosurrenderbreastcancersupportforum.com/post/edgecam-v-4-0-62413-6399492?goto=lastpost):

In addition I am taking Vitamin D3: I increased my daily dose to 4000 IE/day, since my recent blood serum levels are only at about 30ng/ml.

[EDGE Commentary: the goal is to take sufficient supplemental Vitamin D3 to achieve a threshold of at least ~66 ng/ml, so no one amount is right, but rather your Vitamin D levels have to be retested to assure that that level is obtained, as I document in the Edge-CAM regimen]

I am taking calcium as well, as calcium acetate 500mg/day, but I read that you preferably suggest calcium phosphate. I am drinking at least 5 cups of japanese green tea every day (mainly gyokuro and sencha), brewing it for 8-10 minutes. However, I'm not sure if this is enough to absorb sufficient amounts of EGCG.

[EDGE Commentary: it's generally infeasible to be able to achieve the optimal level of EGCG polyphenols through consumption of dietary green tea, and in any case the dose delivered would not be standardized on active content, which is required for optimal activity, so supplementation with a standardized green tea extract is needed.]

The same applies to curcumin and turmeric, which I use as a spice daily, in combination with black pepper.

[EDGE Commentary: ditto here; it's just impossible to achieve to highly precisely, certified, standardization of active curcuminoid components by other than supplemental, not dietary, consumption.]

I am supplementing with freeze dried broccoli sprouts (I cannot stand kale and other cruciferous vegetables) and I am eating a mediterranean diet with lots of vegetables, low glycemic fruit, whole grains, fish, meat occasionally (especially white meat), avoiding any added sugar.

[EDGE Commentary: this is a good regimen (I am not a fan of broccoli sprouts and do not believe there is sufficient evidence of benefit to warrant any recommendation, but modest consumption may be without significant harm). Remember to assure optimal olive oil consumption (about 4 tablespoons daily).]

I'm very confused about dairy (no dairy versus low-fat dairy or produce from grass-fed animals, sheep and goat's milk versus cow's milk), but I also know that I have to gain weight (I'm currently a little underweight) and probably need extra protein and fat.

[EDGE Commentary: the latest systematic reviews suggest that it is intake of high-fat dairy, but not low-fat dairy, that is associated with a higher risk of mortality after breast cancer diagnosis (Kroenke et al., JNCI 2013). Therefore moderate consumption of skim or low-fat  milk or yogurt should be unproblematic.

Guidance: But better still is to shift to soy consumption, which the evidence now clearly establishes as beneficial to breast cancer, but some amount of low-fat dairy can be support.]

I also started to do strength training. Before diagnosis I loved to run, but my actual lung capacity doesn't let me!

[EDGE Commentary:

Guidance: The best physical exercise for anticancer benefit is a mixture of strength (resistance) plus aerobic exercise, and the aerobic exercise can be as simple as walking in place at home holding 5 - 10 pound weights in each hand, swinging arms as you walk in place. Although running may be good, most often it isn't, as many people run in urban areas where the increase in respiration almost always assure unfavorable high  consumption of air-borne pollutants and carcinogens.] 

Guidance: Consult the Edge-CAM regimen recommendations, as well as the lifestyle recommendations that accompany it.

Final Advice: the above is a lot of material to digest, but worth the effort, as is also having some candid discussions with your oncology concerning the options I raised above in terms of conventional therapies, and I would add also that a second opinion is almost always advisable and of benefit. Finally, in the unlikely event that the optimal therapeutics still allow for disease progression, at that time we can consider evaluating potential clinical trials, but for now, you  have many promising options to choose from.

And as always, I am here for any further questions you may have.

 

Kind regards, and best fortune to you.

Constantine


Constantine Kaniklidis

Director, Medical Research,

No Surrender Breast cancer Foundation (NSBCF) 

Nora

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Dear Constantine,

thank you so much! Your knowledgeable and thorough reply means very much to me!

Indeed, my oncologists want to treat my very small brain lesions with stereotactic radiosurgery (SRS), and I'm glad that the plan agrees with your suggestion. In addition, I will show them your review about cross-BBB systemic therapy agents and will let you know, which type of therapy will be proposed.

Studying your latest CAM-regimen, I've come up with a few more questions:

1)
Are there single substances that might interfere with systemic therapy or radiosurgery?
As I read, boswellia should be fine to combine with these therapies, but I'm not sure about:
- fish oil /DHA (the suggestion to avoid it is supported by the Dutch National Working Group for
  Oncologic Dieticians and the Dutch Cancer Society),
- a very high dose of curcumin (being a possible iron chelator and blood thinning agent),
- EGCG (an oncologist advised me against the consumption of green tea [and soy] during my first
  chemotherapy regimen),
- high dose red yeast rice (being a statin equivalent).

2)
Your advice is to take curcurmin and boswellia after a large meal. Curcurmin works in synergy with EGCG. Can I take all three supplements at the same time? How about the bioavailability-enhanced curcumin formulation with Bioperine? Can the black pepper extract be overdosed, taking 6000 mg of the enhanced curcumin formula daily?

3)
What does AI-therapy mean (paragraph about melatonin)?

4)
Lately there has been some kind of hype about the ketogenic diet for cancer patients. What do you think about it? Reading your lifestyle suggestions it might be counterproductive...

You see: The more I know, the more questions seem to arise! So it's good to have your help and powerful knowledge!

I send you my very best wishes,
Nora



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Nora:

Glad to help, and good questions! 

Below I take up your queries, with my  response inline (bracketed, in red) with your original query:

1)

Are there single substances that might interfere with systemic therapy or radiosurgery?

[EDGE Commentary: The inclusion criteria for EDGE-CAM are highly restrictive, one prerequisite being that any included component have no demonstrated potential for adverse clinically relevant pharmacokinetics (interference: drug-drug, drug-CAM, and drug-food), as documented in my widely consults (and downloaded) Drug Interactions in Oncology Review, at: https://www.researchgate.net/publication/248702917_Drug_Interactions_in_Oncology_-_Review?ev=prf_pub]

As I read, boswellia should be fine to combine with these therapies, but I'm not sure about:

- fish oil /DHA (the suggestion to avoid it is supported by the Dutch National Working Group for

  Oncologic Dieticians and the Dutch Cancer Society),

[EDGE-Commentary:

This is wholly in error: although the Amsterdam NCI study (Daenen et al., JAMA June 2015) was a  human clinical study, the human clinical part of the study did NOT demonstrate any relevant interference of omega-3 fish oils with chemotherapy, but rather - illicitly - the authors deduced a potential adverse interaction of "chemotherapy-negating effects in preclinical models" (meaning in this case in vitro / in vivo, not in humans), but that extrapolation goes beyond the data, and indeed stands in contradiction to true human clinical data where a higher response rate and a trend toward a higher 1-year survival was found when fish oil was added as an adjuvant to chemotherapy (Murphy et al, Cancer 2011).

There is a sleight of hand here, in having a human clinical component to the study, along with a mouse component, but note that interference/interaction was NOT even evaluated or monitored in the human component of the study, where the authors solely measured concentration (pharmacodynamics), NOT interaction (pharmacokinetics). Pharmacokinetics was evaluated only in the mice, not in the humans, so no deduction whatsoever can be made about potential interactions in humans. Yet one naive medical source after another has ignorantly reported the study, with blaring headlines that "Fish Oil Supplements May Suppress Effects Of Chemotherapy", utter nonsense and no such conclusion is supportable from the study (which stands in contradiction with more robust data).

This shows the price that is paid when researchers and medical reporters do not have the evidence-based skills to critically appraise the methodological quality of a study and its power to support the very conclusions it claims to draw.]

- a very high dose of curcumin (being a possible iron chelator and blood thinning agent),

[EDGE Commentary: Again in error, as per my  Drug Interactions in Oncology Review (and note that anyone on anticoagulant therapy would be monitoring their INR (coagulation levels) and adjust accordingly)]

- EGCG (an oncologist advised me against the consumption of green tea  during my first

  chemotherapy regimen),

[EDGE Commentary:  Again in error, as per my  Drug Interactions in Oncology Review , and in contradiction to the dozens of studies in which EGCG was consumed with chemotherapy with no clinical relavnt adverse interaction (only benefit).]

- high dose red yeast rice (being a statin equivalent).

[EDGE Commentary: that is the whole point of using RYR, given the anticancer potential of statins that behave as mTOR inhibitors, of benefit in breast cancer.]

2)

Your advice is to take curcurmin and boswellia after a large meal. Curcurmin works in synergy with EGCG. Can I take all three supplements at the same time?

[EDGE Commentary: yes, to leverage the potential synergies; just remember that if you are not taking a caffeine-free EGCG supplement, then avoid dosing with EGCG after 4 - 5PM in the afternoon, to avoid potential interference with slleep, or use a caffeine-free product.]

How about the bioavailability-enhanced curcumin formulation with Bioperine? Can the black pepper extract be overdosed, taking 6000 mg of the enhanced curcumin formula daily?

[EDGE Commentary: assuming a formulation that delivers ~1000 mg (one gram) curcumin per pill, that would deliver a total of 30 mg of piperine since each pill would be bioavailability-enhanced with 5 mg of piperine, and that is well within human-safety limits, so no problem.]

3)

What does AI-therapy mean (paragraph about melatonin)?

[EDGE Commentary: that's aromatase inhibitor (AI) therapy, a  form of endocrine (hormonal) treatament used for ER-positive patients, but not relevant to TNBC which is ER/PR/HER2-negative.]

4)

Lately there has been some kind of hype about the ketogenic diet for cancer patients. What do you think about it? Reading your lifestyle suggestions it might be counterproductive...

[EDGE Commentary: there is insufficient robust human clinical evidence to warrant at this time any recommendation for these diets.]

Kind regards and best fortune

Constantine Kaniklidis
Research Director
No Surrender Breast Cancer Foundation (NSBCF)

Nora

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Dear Constantine,

you helped me through a whole jungle! It's not always easy to get the right information just by asking Dr. Google. So thanks a lot!

Did you ever hear of D,L-methadone as a chemosensitizer? I just read an article about it: http://www.campus-technologies.de/wp-content/uploads/TO_UEE20120404Methadon-Short-1_.pdf
Do you think it might be worth a try in my case?

Today I ordered most of the supplements you suggest and will start the CAM-regimen as soon as possible, but I still have to find a good fish-oil brand. Is it right that SAM-e and Traumeel might be a good combination to try for bone pain?

I send you all my best wishes!
Nora
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Nora:

Dear Constantine,

you helped me through a whole jungle! It's not always easy to get the right information just by asking Dr. Google. So thanks a lot!

Did you ever hear of D,L-methadone as a chemosensitizer? I just read an article about it: http://www.campus-technologies.de/wp-content/uploads/TO_UEE20120404Methadon-Short-1_.pdf

Do you think it might be worth a try in my case?

[EDGE Commentary:  Wholly premature - despite the expected hype that accompanies any patent application such as this, this is an unproven intervention based solely and speculatively on preclinical (and largely in vitro cell) studies. ]

Today I ordered most of the supplements you suggest and will start the CAM-regimen as soon as possible, but I still have to find a good fish-oil brand.

[EDGE Commentary:
Mega EFA from Vitacost is still one of the best, but there are also more concentrated preparations that thereby become more affordable: CARLSON Super DHA contain 500 mg per softgel and retail for as low as approximately $15 USD for 60
(http://www.naturalhealthyconcepts.com/super-dha-60-p-carlson.html?kpid=super-dha-60&gclid=CM6t0eSI7MQCFQIQ7AodvmwAFw
; about £10; or three times that quantity (180) for about $ 38 to 40: http://www.naturalhealthyconcepts.com/super-dha-gems-C180.html; or http://www.allstarhealth.com/de_p/13046/CARLSON_Super_DHA_Gems.htm),

but at that concentration only 3 daily would be needed , not 9, daily, to achieve optial dosing, and widely aggregated consumer/user feedback suggest no reports of GI distress, burping or odor after-taste.

Another option – and more affordable still - is a molecularly distilled formulation: these are intrinsically odor free due to the exactitude of highly enhanced advanced purification. One good commercial preparation meeting that high standard is Nature’s Way EfaGold Mega DHA, about $11 – 12 USD for 60 (http://www.swansonvitamins.com/natures-way-efagold-mega-dha-1000-mg-60-sgels), with each softgel being again 500 mg DHA, so again just 3 daily. 

And Piping Rock’s Triple Strength Omega-3 Fish Oil 1360 mg (http://www.pipingrock.com/fish-oils/triple-strength-omega-3-fish-oil-1360-mg-963) retails for ~$28 for 250 softgels, each  delivering ~400 DHA, so requiring 4 daily. This preparation is not certified odor-free but one trick to remember is  that the odor tends to be solely from natural decomposition, so I typically store in very cold refrigerator storage (in the ice box area, but inside a paper bag to avoid freezing), and feedback from consults suggests this effectively eradicates odor and consequent distress. And I always advise consuming with a meal (toward end of meal, not earlier) and followed by consumption of a strong peppermint tea, or I myself use peppermint gels (excellent for any digestive distress; http://www.swansonvitamins.com/now-foods-peppermint-gels-90-sgels).

However, if you don’t care to deal with cold-storing, then the EfaGold Mega DHA represents a good compromise, not quite as affordable but still reasonable (and if all else fails, EfaGold Mega DHA from Amazon UK still retails for just £8.53 with modest shipping (http://www.amazon.co.uk/Natures-Way-NWY56827-WayMega-Dha-Softgels/dp/B000MXG1G2/ref=sr_1_fkmr1_2?ie=UTF8&qid=1428690930&sr=8-2-fkmr1&keywords=EfaGold+Mega+DHA).

Is it right that SAM-e and Traumeel might be a good combination to try for bone pain?

[EDGE Commentary: The evidence is weak, but there  is no harm in a trial to determine efficacy for  you. Recent data suggests that high-dose  glucosamine (that is, above the conventional 1500 mg daily) acts as a powerful anti-inflammatory and analgesic agent (effectively, a NSAID], so given that these higher doses are  unproblematic, you may want to try a trial of 10 days to 3 weeks of a glucosamine / chondroitin combination, at high-dosing. I would suggest the highly affordable formulation from Puritan (http://www.puritan.com/puritans-pride-brand-0102/triple-strength-glucosamine-chondroitin-750-mg-600-mg-041633?scid=6831) but start dosing at three, not two caplets, daily which you  deliver 2250 mg of glucosamine, and if you find that that dose provides some appreciable pain relief, then you can push up to four  caplets daily (at 3000 mg glucosamine). 

I send you all my best wishes!

Nora

 

Thanks Nora, glad  to help!

Kind regards, and best fortune to you.

Constantine


Constantine Kaniklidis

Director, Medical Research,
No Surrender Breast cancer Foundation (NSBCF) 

 

Nora

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Reply with quote  #10 
Dear Constantine,

thank you so much! I will let you know how it goes.

My best wishes,
Nora
Nora

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Reply with quote  #11 
Dear Constantine,

first of all: my oncologist has been very fond of your advice concerning stereotactic surgery and systemic therapy! However, if I didn't "exert a little pressure", simply by sending him your advice via email, I probably still wouldn't know, if I was taking Veliparib or the placebo medication during the BROCADE-trial: in my case, it was Veliparib! This not only makes me very sad but scares me: such a promising new targeted therapy regimen for treating BRCA1-mutatated cancer cells, which did not work for me at all!

For now, this is how the new battle plan looks like:
The cyberknife treatment is scheduled on Tuesday and I started taking Xeloda today. Since the two brain metastases are very tiny, the oncologist decieded not to add TMZ to the protocol to avoid - as he said - "unnecessary" side effects, since temozolomide is most often used for brain tumors, but wouldn't help with lung, liver or bone metastases from breast cancer. Anyway, after the "success" of the BROCADE-protocol, I still have to regain confidence. I'm afraid that Xeloda might not works either.

In addition, a sample of a metastasis will be taken and researched to find out if there are any antibody-receptors on the cells. Do you know of any viable therapy in this case?
Furthermore, I'm interested to know if there are any minimally invasive chirurgical options (similar to the brain treatment) for removing some of my lung and/or liver metastases and if these should be removed prior to or after systemic treatment?

Right now I am experiencing a lot of changes in my body temperature: today I measured 38.6°C, earlier 37.7°C and 37.4°C, having an almost normal temperature this morning (36.5°C). Yesterday it was similar. I know that the mistletoe-treatment might be the cause, but I'm not sure. I stopped the injections for now, just to be able to understand. Have you any idea what else I could do?

For the "hand-feet-syndrome", accompanying the treatment with Xeloda, my doctors gave me a cream containing uridine. Do you have any additional advice?

Concerning your CAM-suggestions, you probably know what most oncologists think about them...

Very many thanks in advance for your time and help!
I send you my best wishes,
Nora


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