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ninel

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Reply with quote  #1 

The bad news: The 1.7cm tumor is sitting right up against my pectoral muscle and doesn't want to go in and do surgery right away because he doesn't want to take part of the muscle to get clear margins.
 
The good news: The surgeon wants to start chemo first to shrink it away from the muscle and in 3 months go in to do the surgery and spare the muscle. I think this is good becase we will be absolutely sure the chemo is working as opposed to doing the surgery first.
 
The MRI shows stage 1 with no lymph node involvement.
 
So the plan is on 7/18 get a sentinal node biopsy to be 100% sure the nodes are clear and get a port inserted.
 
The week following get started on chemo. In 3 months get the bilateral mastectomy. The good thing my surgeon told me is he does skin and nipple sparing reconstructive surgery. And then continue with the chemo.
 
My husband and I came out of the doctor's office like a ton of bricks have been removed from our shoulders. I just hope we're not minimizing how serious the situation still is.
 
Has anyone else gone through something like this where the tumor is up against their muscle?
 
Ninel


nosurrender

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Reply with quote  #2 
Hi Ninel,
My triple neg cancer was close to the chest wall, but had not touched it yet. My breast surgeon said that it was a matter of weeks before it made contact because it was growing so fast.

I know of many women who have had neo-adjuvant chemo to shrink their tumors and it has been very successful. One friend had her tumor shrink so much that they had to put a marker in her breast so they knew where it was!

There are lots of studies on the great results that neo-adjuvant chemo delivers. So you and your husband are right to feel a weight off your shoulders.

Also, it sure feels good when you have a plan in place doesn't it? I always say that the worst time of this whole thing is when we are being given all this info about what is wrong with us and no one is telling us what they are going to do to fix it!

Great news on the stage 1 too!

By the way, I had my triple negative breast cancer in 2001. It is beatable.

Do you know what chemo you will be doing? Let us know and we will get you totally prepared.

Hugs,
g



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ninel

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Reply with quote  #3 
I had my SNB. The surgeon removed only one node because it looked clear. Turns out they found microscopic traces. So this bumps me up to Stage IIb.

They still want me to do chemo first. This is the plan:
4AC then 4 Taxol (every 2 weeks) then surgery then radiation.

Does this sound right for my staging and grade and being triple negative? Does this sound aggressive.

Ninel
nosurrender

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Reply with quote  #4 
Hi Ninel,
That is the standard chemo for node positive cancer.
A lot of oncologists are switching to the platinum drugs for tripleneg cancers. And there are some who are even giving Avastin as first line treatment as well.

I got a second opinion when I was diagnosed the second time. I am glad I did because I got a different protocol. The first onc recommended the second onc to get the second opinion from. She was very open to it and all good oncs are.

Breastcancer.org just had an Ask The Expert Conference on Triple Negative disease. The following is what they said about the best chemo choices:

Answer —George Sledge, M.D.: Let me answer in general terms. When we have looked at chemotherapy regimens over the past 2 decades in the adjuvant setting or early disease setting, what we have learned is the addition of taxanes such as Taxol (chemical name: paclitaxel) or Taxotere (chemical name: docetaxel) to previous regimens has added benefit. We also have evidence to suggest that using these regimens in what is called a dose-dense fashion, i.e., more frequent administration of the agents, seems to improve benefit. This appears to be true in triple-negative breast cancers as it is in other subtypes, but perhaps more so in triple-negative breast cancers. We are still wrestling with whether specific drugs should be included or excluded for triple-negative breast cancers. For instance, oncologists are currently arguing over the role of Adriamycin (chemical name: doxorubicin) in early stage breast cancer. Over the next few years we are likely to see a number of new agents enter the adjuvant setting. Currently, for instance, Avastin (chemical name: bevacizumab; an agent that targets blood vessels) is being studied in large adjuvant trials for early stage breast cancer including triple-negative breast cancer. There are also robust studies going on to see whether platinum-based chemotherapies, which damage DNA, may work better in triple-negative breast cancers than they do in other cancer types, but we do not yet have an answer to this question for early stage breast cancer patients.
The entire transcript can be found HERE
Our own expert, Constantine, has offered a lot of advice here in the Triple Neg forum and the Cutting Edge forum. Here is one example of his take on the best tx for tripleneg:

List of Triple-Negative Sensitive Genotoxic Agents

Cyclophosphamide (Cytoxan)

Carboplatin (Paraplatin)

Cisplatin (Platinol)

Doxorubicin (Adriamycin)

Epirubicin (Ellence)

Mitomycin C (MTC / Mitomycin / Mutamycin)

Radiation (Radiotherapy

PARP Inhibitors

 

What About Taxanes?

Note that all anthracyclines are genotoxic and hence DNA-damaging, but the antimicrotubular taxanes, classed as mitotic spindle poisons, such as docetaxel (Taxotere) and paclitaxel (Taxol) are non-genotoxic. However, this does not mean they are not active in triple negative disease.  Quite the contrary: Roman Rouzier[4] found that these basal-like tumor are more sensitive (with a 45% pathologic complete response (pCR)) to taxane/anthracycline regimens in the form of paclitaxel- and doxorubicin-containing preoperative chemotherapy than the luminal and normal-like cancers which only sustained a 6% responsive.  I should note here that another neoadjuvant study - the infamous "The Triple Negative Paradox" study of Lisa Carey[5] at UNC � is often cited as suggesting that the clinical response (pCR) to doxorubicin and cyclophosphamide was considerably higher in patients with triple negative tumors than in those without. However, this study strikes me as somewhat methodologically compromised, as over a third of the triple negative group failed to receive any chemotherapy, and of those patients who did less than half received adjuvant anthracycline and taxane chemotherapy, casting doubt on the methodological robustness of the conclusions.  Nonetheless, the weight of the evidence strongly supports both taxane and anthracycline regimens as beneficial in the treatment of triple negative disease.


New Insights about Platinum Sensitivity

An important set of data is typified in the results of the Harvard team of Chee-Onn Leong and Leif Ellisen[6] who found that triple negative cancers independently share the cisplatin sensitivity of BRCA1-associated tumors (even in those without BRCA mutations), a sensitivity that is mediated by activation of a proapoptotic (inducing programmed cell suicide) molecular pathway p53 family member, and from this and other studies it appears that p53 is what fundamentally mediates the apoptosis induced by DNA-damaging agents.

 

Extending these findings John Chia's team[7] conducted a retrospective analysis to determine the response rates of such patients treated with paclitaxel and carboplatin (TC) chemotherapy, finding that TC induces a high response rate in patients with metastatic / recurrent triple negative disease, even for patients with prior exposure to taxanes and moreover, and impressively, even for those with large volume disease.


Collectively, therefore data from preclinical and clinical studies indicate that both BRCA1 and triple negative tumors have unique sensitivities to platinum agents such as cisplatin and carboplatin, as well as to the genotoxic biological agents, the poly(ADP-ribose)polymerase (PARP) inhibitors, and these observations are helping to guide a new series of clinical trials, and at least as importantly, helping to hone and optimize the treatment of triple negative disease, and suggest for instance that adding platinum agents to taxane chemotherapy may induce high levels of efficacy for triple negative disease

This can be found HERE

I hope this helps!!!!
Hugs,
g


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Indigoblue

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Reply with quote  #5 
Interesting...my mother was dx in the early 80's with Inflammatory Breast Cancer; her treatment was Platinum, extensive rads, and mastectomy.  She was only supposed to survive a few months; she survived for almost four years, and had she not had a compromised immune system, gone "out" to have fun, she might not have been infected with an incurable pneumonia. 
 
Years later, I was informed her Breast Cancer had all the indications of triple negative disease.  She likely had it for years, and until she was bumped in a car accident, it was not evident. 
 
TNBC has so many complications and factors, unknown to physicians and researchers.  If you suspect you may be genetically predisposed, don't take "no" for an answer.  Protect your quality of life, become your own advocate, and kick the system where the sun never shines.  They will ignore you unless you get up on the table and dance like a woman with a will, a skill, and a chill for NO SURRENDER! 
 
My only sad regret is not having the resources and beautiful intellects who are capable and responsible enough to tell us the reality of what is, and what isn't.  You are and you will be as long as you are knowledgeable, thinking, and take your diagnosis as a serious and treatable disease. 
 
I was in total denial...and so were the doctors.  Or, were the doctors in total denial, and therefore, inspired a false sense of well-being?  I don't know...found the tumor through SBE, and did my best to access the most reliable and available physicians at the time; Dec., 05.  I should have done flip-flops months or years earlier; nobody would listen, and few knew anything about Triple Negative Disease and all of it's variables.  Thank goodness, and thanks to G, Constantine, Triple Negative Support Lines, BC.org, and to the brilliant contributors in their efforts to improve research, effective treatment plans, and someday, (hopefully), a cure for this ubiquitous, unknown charlatan form of Breast Cancer (if that is, in fact, what it really is, who knows?).  We will prevail, and whatever it's cause, one day our world will no longer suffer the insanity of this disease. 
 
Thank you for your uplifting and positive energy.  It is the best cure:  Hope, Love, and Invincible Ideology, believing in oneself, and jumping over the moon.

 
Love,
Indi

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