perhaps you can get into a dermatologist faster than the oncologist
below you will find two pertinent articles--the dermatologist might feel comfortable giving you topical imiquimod after a biopsy (second abstract below), but , if the ARE bc skin metastases, effectiveness is substantially improved by adding abraxane (first article below)--perhaps the dermatologist could contact the oncologist explaining why you need to be seen sooner.
PLEASE BE ASSERTIVE IN YOUR efforts TO moveup YOUR APPOINTMENT--These open sores could get infected and then they dare not give you the abraxane as it could substantially decrease your ability to fight infection by making you neutropenic (HAVING TOO FEW WHITE BLOOD CELLS TO FIGHT INFECTION), a well-known side effect of many traditional chemo drugs.
well-known signs of infection include red streaking going up you arms or trunk, having a temperature, high pulse, low blood pressure.
NO reason TDM1 should not help with the skin mets,too as far as I can tell(info from attending asco, aacr, asco breast etc, reading the literature)--that does not mean it is guaranteed that it will, just that there is no reason skin mets particularly should be exempt from its beneficial effects
Hope this helps!
Imiquimod/Abraxane Combo Effective for Skin Mets
By: BRUCE JANCIN, Oncology Practice Digital Network |
DECEMBER 28, 2011
San Antonio Breast Cancer Symposium, 2011
Imiquimod/Abraxane Combo Effective for Skin Mets
By: BRUCE JANCIN, Oncology Practice Digital Network DEC 28, 2011
FROM THE SAN ANTONIO BREAST CANCER SYMPOSIUM
VITALS
Major Finding: Among the 11 patients who were able to complete the regimen of topical 5% imiquimod plus systemic albumin-bound paclitaxel, 5 had a complete response, meaning 100% clearance of treated skin lesions at week 24.
Data Source: Fifteen heavily pretreated breast cancer patients enrolled in a single-arm, nonrandomized study.
Disclosures: The study was funded by a grant from the National Cancer Institute. Dr. Salazar declared having no relevant financial interests.
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SAN ANTONIO – The combination of topical 5% imiquimod plus systemic nanoparticle albumin-bound paclitaxel showed excellent clinical efficacy and was well tolerated for the treatment of cutaneous metastases of breast cancer in a phase II study.
Among the 11 patients who were able to complete the novel combined chemoimmunotherapy regimen, 5 had a complete response, meaning 100% clearance of treated skin lesions at week 24.
In addition, one patient had a partial response, defined as a greater than 50% reduction in the size of the largest treated lesion. Four patients had stable disease, with less than 50% reductions in lesion size. One patient experienced progressive disease, with a 25% increase in target lesion size, Dr. Lupe G. Salazar reported at the San Antonio Breast Cancer Symposium.
Fifteen heavily pretreated breast cancer patients were enrolled in the single-arm, nonrandomized study. All had skin metastases no longer amenable to standard therapies.
The chemoimmunotherapy regimen consisted of three treatment cycles. Each 4-week cycle consisted of application of topical 5% imiquimod to target cutaneous lesions on 4 days per week plus systemic albumin-bound paclitaxel (Abraxane) at 100 mg/m2 on days 1, 8, 15, and 28, explained Dr. Salazar of the University of Washington, Seattle.
Treatment-related toxicities included neutropenia, lymphopenia, anemia, nausea, and fatigue; 34% of toxicities were grade 1, 56% were grade 2, and the remaining 10% were grade 3.
Four of 15 subjects were unable to complete the treatment regimen, having withdrawn due to progression of visceral disease.
The rationale for the imiquimod plus nanoparticle albumin-bound (nab) paclitaxel (Abraxane) therapy derives from previous evidence that imiquimod, a toll-like receptor-7 agonist, has shown clinical efficacy against cutaneous metastases. Imiquimod stimulates secretion of Th1 cytokines and upregulates immune costimulatory molecules at the tumor site. Tumor-specific T cell immunity and tumor growth inhibition are enhanced. Moreover, paclitaxel has been shown to increase serum interferon-gamma levels and boost natural killer cell activity. Thus, the working hypothesis was that nab-paclitaxel would augment imiquimod’s antitumor effects, according to Dr. Salazar.
She and her coinvestigators examined the combination therapy’s impact upon endogenous tumor-specific immunity. They obtained pre- and posttreatment 2-mm skin biopsies from target lesions and were able to demonstrate that the treatment marginally enhanced endogenous immunity to the well-known breast cancer antigens HER2, p53, melanoma-associated antigen 3 (MAGE-3), insulin growth factor binding protein-2 (IGFBP-2), and topoisomerase IIa (TOPO-IIa).
60% OF PATIENTS IN THIS IMIQUIMOD ONLY TRIAL BELOW WERE HER2+:
lin Cancer Res. 2012 Jul 5. [Epub ahead of print]
Topical TLR7 agonist imiquimod can induce immune-mediated rejection of skin metastases in patients with breast cancer.
Adams S, Kozhaya L, Martiniuk F, Meng TC, Chiriboga L, Liebes L, Hochman T, Shuman N, Axelrod D, Speyer JL, Novik Y, Tiersten A, Goldberg JD, Formenti SC, Bhardwaj N, Unutmaz D, Demaria S.
Source
Medicine, NYU School of Medicine.
Abstract
PURPOSE:
Skin metastases of breast cancer remain a therapeutic challenge. Toll-like receptor 7 agonist imiquimod is an immune response modifier and can induce immune-mediated rejection of primary skin malignancies when topically applied. Here we tested the hypothesis that topical imiquimod stimulates local anti-tumor immunity and induces the regression of breast cancer skin metastases.
EXPERIMENTAL DESIGN:
A prospective clinical trial was designed to evaluate the local tumor response rate of breast cancer skin metastases treated with topical imiquimod, applied 5 days/week for 8 weeks. Safety and immunological correlates were secondary objectives.
RESULTS:
Ten patients were enrolled and completed the study. Imiquimod treatment was well tolerated, with only grade 1-2 transient local and systemic side effects consistent with imiquimod's immunomodulatory effects. Two patients achieved a partial response (20%; 95% CI 3% - 56%). Responders showed histological tumor regression with evidence of an immune-mediated response, demonstrated by changes in the tumor lymphocytic infiltrate and locally produced cytokines.
CONCLUSIONS:
Topical imiquimod is a beneficial treatment modality for breast cancer metastatic to skin/chest wall and is well tolerated. Importantly, imiquimod can promote a pro-immunogenic tumor microenvironment in breast cancer. Preclinical data generated by our group suggest even superior results with a combination of imiquimod and ionizing radiation and we are currently testing in patients whether the combination can further improve anti-tumor immune and clinical responses.
PMID: 22767669
also:canadian study with email address:
http://jco.ascopubs.org/content/32/8/e22.full