The debate to have chemo or Not? We are now taking the guess work out of it.

[Jean]

Hi All,
There is always that nagging question for some - "Should I have chemo?"
Becky posted yesterday on the trials when she was at ASCO....
this morning I found this great article.

I for one am so glad I did not accept the traditional answers from my
onc. here on the East Coast and flew out to see Dr. Slamon who in
my opinion is way ahead and on the cutting edge. He told me back then
taxol a must with herceptin for my sub type.

To All Women I say: "Ask and then ask again, seek new and CURRENT
information, and most of all seek out those who are involved in
current research."

http://www.medicalnewstoday.com/articles/85232.php

Hugs,
Jean

[Joanne S]

Should I have Taxol or not?

Taxol beneficial for ER- or HER2+ breast cancers

http://www.medicalnewstoday.com/articles/85301.php
Chemotherapy Treatment Taxol Ineffective In Treating HER-2 Negative Breast Cancer, NEJM Study Says

http://www.time.com/time/health/article/0%2C8599%2C1670604%2C00.html
Targeted Chemo for Breast Cancer
Thursday, Oct. 11, 2007 By LAURA BLUE

It might not seem like good news. A paper in this week's New England Journal of Medicine (NEJM) shows that one of the most common breast cancer chemotherapy drugs doesn't work for probably half the women taking it. A separate study, published Thursday in the online journal Breast Cancer Research (BCR), suggests that about 60% of young breast cancer patients, aged 40 and under, are getting far less benefit from their chemo courses than other patients.

But good news it is, say the researchers behind both papers. Knowing which drugs work — or don't work — for which patients will open the door to far more effective treatment programs than those prescribed today. "Traditionally the only criterion we've used to determine whether to give someone chemotherapy has been the odds of metastasis" — that is, whether the cancer will spread through the body — "and not the odds of whether it will work," says Daniel Hayes, a lace>University of Michiganlace> oncologist and the lead author of the NEJM paper. "That's pretty crude." At the lace>Leiden University Medical Centerlace> in lace>Hollandlace>, Sven Mieog, an author of the BCR study, says these studies are the first step toward a more sophisticated approach to cancer care: "This is taking us toward personalized treatments, tailor-made treatments," he says.

The two new studies this week, along several others from the last five years, demonstrate that certain markers on breast cancer cells can help doctors predict the effectiveness of chemotherapy in particular patients. There's a reason breast cancer patients take the drugs they do. Adjuvant chemotherapy, as it's called when a patient gets cancer-fighting drugs as well as surgery, has helped bring about a tremendous decline in breast-cancer mortality rates since the 1970s. But, as any cancer patient will tell you, chemo is not only expensive but often has horrendous side effects. Depending on the chemicals, patients can expect nausea, hair loss and increased risk of infection.

The paper in BCR involved 480 patients, aged 40 and under, in lace>Europelace>. Among them, the women whose cancers were estrogen-receptor-positive (ER+) — meaning that the patients had a high proportion of cancer cells needing estrogen to grow — responded to chemotherapy programs less favorably than those with estrogen-receptor-negative (ER-) cancers.

The NEJM took a larger sample: 1,322 North American women whose cancer had spread to the lymph nodes. All patients got four cycles of AC chemotherapy (two drugs: Adriamycin and Cytoxan); half of the women got an additional four courses of the drug paclitaxel, better known as Taxol. That study found that adding Taxol benefited women only when their cancers were ER- or HER2+ — that is, overexpressing the HER2 protein, a sign of a more aggressive cancer. For these women, Taxol boosted the chance of surviving disease-free for 10 years by 30% to 50%.

But for roughly half the patients in the study whose cancer cells were both ER+ and HER2- (the most common type of breast cancer) the drug did no discernible good. That's significant because, right now, most women in the Western world are prescribed Taxol, or another in the taxane family of drugs, when they get adjuvant chemotherapy for breast cancer.

The authors of neither study advocates big changes to clinical practice just yet — as Hayes cautions, the stakes are high, and women can't stop treatment based on early findings — but the future of patient-specific breast-cancer therapy does look bright. In addition to drugs like Tamoxifen, which interferes with estrogen and slows or stops the growth of ER+ cancers, and Herceptin, which targets HER2+ cancer cells, individually tailored chemo treatments could further boost each woman's odds of recovery, and, of course, prevent the costs and side effects of unnecessary, unhelpful treatments. The era of personalized care could come soon, Hayes says: "I think the good news is that, for patients five years from now, this is a harbinger of things to come."


http://www.msnbc.msn.com/id/21225760/
Widely used Taxol helps far fewer women than believed, new research finds

[G. Ann]

Hi Jeanne,
The story appeared in our local paper also. Got me thinking back in 2004 my onc said the benefit of taxane drugs (taxol or taxotere) did not outweigh the risks so he suggested and I agreed to only receive four AC. Over a year later, I did beg and pester him & received Herceptin for a year. (Sometimes I think my onc ignores the Her-2 neu status.) My MUGA score started at 61 and dropped down ton 55 after Herceptin treatment was over in 1/07 so that wasn't the reason he stated to skip Taxol.

It's too late now to go back in time, but should I be checked more than every 6 mos since the article states women getting Taxol were 40% less likely to have a recurrence?

In 8/07 ferritin level (iron storage) was low at 12, but hmg & hct normal; onc suggested 1 iron pill to bring iron storage level up. Also, my Vit D was on low end at 36 (suggested to take 2000 mg Vit D). I don't know if these blood results mean anything as far as the cancer returning. I was advised to repeat blood work in 11/07 to see if ferritin level had improved.

Since Herceptin tx ended, I've lessened my anxiety but don't want to go the other way and be too passive. Thanks for any info.

[Joanne S]

G Ann,

I found the articles very interesting as did Jean. In my opinion, if you are NED, you probably don't need to be concerned with Taxol now, but that's for you to discuss with your dr. As far as the statistics go, I personally don't put much stake into them. Just about every aspect of BC seems complex to me so I attempt to simplify it as much as possible. For example, if there is a 70% chance of something happening and a 30% chance of it not happening, I see it as a 50-50 chance for me; in other words, I have a 50% chance of being in the 70% and a 50% chance of being in the 30%. As you know there are just too many (known and unknown) differences from patient to patient in every facet and combination of BC along with non-BC factors to determine the precise/absolute treatments and the exact duration between follow-up. Only you and your doctor can determine how often to be checked for continued NED/recurrence.

Prior to 2005, Herceptin was only prescribed for BC Stage IV, so I'm not sure how you talked you doctor into it? Congrats---on your persistence in pursuing it and convincing your dr to administer it to you for a year!

Sorry I couldn't be more specific in my response to your questions.
Continued well wishes,

[Jean]

Ann,
You continue to remain NED - Amen.
I see my onc. every 3 months since I just finished herceptin in
May. He will continue to check me every three months for this
first year. He does markers and a physical check up. I have
a digital mamo every 6month and I alternate with MRI the other
6th month (so 2 times per year) between mamo and MRI
I am now for the first time switching to the new Dillon machine
see hopeful's post on this "Breast Specific Gama Imaging".

Once a year I have a CT chest scan and a bone density test.
I will have a Brain MRI for the first time just to have a base line.

I believe in a maintenance program and as we know early
detection is key.

Your doing great remember the first two years are very important
and you are past that point.

God Bless,
Jean

[Jean]

G Ann,
I am sorry you mentioned about the blood test re: Your Iron count being low. Since your dr. advised an Iron Pill I think it is correct that you should have a follow up visit for testing in 3 months as he suggested in Nov.
By then with the pill - more than likely your Iron count will be up -
make sure along with that pill to take Vit. C as it helps to absorb Iron.
A very good source of Iron is found in raisins (try to eat a handful )
each day. Fish, poulty, eggs, peas, beans, and whole grain breads
are all great foods to build Iron. Don't take your Iron pill with Milk
and it will interfere with the Iron being absorbed.

Hope this helps.
Hugs,
Jean

[Joanne S]

Thanks Jean! I appreciate your prompt and informative responses!

[gdpawel]

The most widely used chemo drug for breast cancer and it does not work for the most common form of breast cancer, and helps far fewer patients than has been believed? This would be roughly half of all breast cancer patients who get chemotherapy now.

MD Anderson's Donald Berry says that "we should have done this [study] a long time ago." He says that "tools" were lacking to do this, so they gave virtually every breast cancer patient Taxol, just in case? I'm sorry, the "tools" were there. They've kept them under a breadbox for the last fifteen years.

Taxol is an extremely potent drug, often producing a number of side effects in patients. Side effects can include severe allergic reactions, cardiovascular problems, infections developing from white blood cell deficiencies, apolecia, joint and muscle pain, irritation at the drugs injection site, low red blood cell count, mouth or lip sore, and numbness or burning in the hands and feet.

They say that for now, many doctors will be reluctant to skip Taxol for fear of lawsuits if the cancer recurs and Taxol wasn't given. It's just so much easier (and more money to be made) to give the Taxol and know you've been "super-aggressive."

Oncologists have the responsibility to their patients to be aware of this report and patients should be given the choice not to receive Taxol.

According to the National Cancer Institute's official cancer information website on "state of the art" chemotherapy, no data support the superiority of any particular regimen. It would appear that published reports of clinical trials provide precious little in the way of guidance.

I agree with University of Michigan's Dr. Hayes, we should use the biology of the cancer to decide whether the chemotherapy will work before subjecting women to it. The problem is that few drugs work the way oncologists think and few of them take the time to think through what it is they are using them for. More emphasis should be put on matching treatment to the patient (personalized medicine), through the use of individualized pre-testing.

The New England Journal of Medicine editorial comment made by Ann Moore of the Weill Cornell Medical College, could not have been stated with any more precision that the "one-size-fits-all" approach to breast cancer treatment is coming to an end, and should come to an end. Also, oncologists do have a responsibility to their patients to be aware of the University of Michigan report.

As we enter the era of "personalized" medicine, it is time to take a fresh look at how we evaluate treatments for cancer patients. More emphasis should be put on matching treatment to the patient. Patients would certainly have a better chance of success had their cancer been chemo-sensitive rather than chemo-resistant, where it is more apparent that chemotherapy improves the survival of patient, and where identifying the most effective chemotherapy would be more likely to improve survival.

The academic center-based oncologists are misguided in not recognizing that they continue to try and mate a notoriously heterogeneous disease into "one-size-fits-all" treatments. They predominately devote their clinical trial resources into trying to identify the best treatment for the "average" patient, in the face of evidence that this approach is non-productive. However, such unsuccessful experiments will never be viewed as such by the people whose careers are supported by these kinds of experiments.

The methods of cancer medicine during the last thirty some years are coming to haunt the "one-size-fits-all" establishment. Technologies, developed over the last twenty years by private researchers, hold the key to solving some of the problems confronting a healthcare system that is seeking ways to best allocate available resources while accomplishing the critical task of matching individual patients with the treatments most likely to benefit them.

Survival in metastatic breast cancer hasn't improved substantially in thirty years. Improvements in overall survival for all patients are owing largely to a marked trend for earlier diagnosis and surgical technique. Even this doesn't mean that many more patients are being cured. If you diagnose someone earlier in the course of disease, of course they'll live longer from the time of diagnosis. This is what's known as lead bias.

There have been truly minuscule improvements as a result of adjuvant chemotherapy and the net benefit to the community of breast cancer patients in the real world isn't all that clear. And the criticism remains: All of the clinical trials resources have gone toward driving a square peg (one size fits all chemotherapy) into a round hole (notoriously heterogeneous disease).

http://content.nejm.org/cgi/content/short/357/15/1496

[G. Ann]

Hi Jean & Joanne,
Thanks for responding. I'm sure the food suggestions & Vit C for the low iron count will help boost the count.

As far as digital mammograms, I am only able to get 1 per year. (Originally though back in 2004 the mammogram did not show a lump even though I felt one as well as the GYN. Mine was dx'd by FNA.) Breast MRIs are not offered at Kaiser (my HMO) without symptoms--I've never had one even when first diagnosed. I've asked my onc, surgeon, primary care, & GYN and the answer is "no" for the remaining breast. The surgeon will, however, do a prophylactic mastectomy and I could get reconstruction--I'm thinking about it. I've never had a brain scan or chest CT either.

I like the 50/50 idea. BC won't come back or it will. Worrying won't help outcome. As far as I know, I'm NED...amen, and thank you Lord.

Thanks again for good advice. This is such a great website with wise and compassionate women & men responding.