question on chemo before surgery

harrie · 07-16-2009, 11:24 PM

For a 2 cm tumor, is it standard practice to try to shrink it before removing it surgically? And also, is the tumor usually checked after the first few treatments to know that the chemo is effective so the patient does not complete the entire course and then find out the tumor did not change?

Mary Jo · 07-17-2009, 06:13 AM

Yes, Harrie, I think that is standard treatment. Also, yes, they do check the tumor to make sure the tumor is responding to treatment.

I had a 4 cm. tumor and I was told (4 years ago) that the "new" standard of treatment was to do just what you mentioned. However, in my mind, I knew I wanted the cancer removed FIRST with treatment to follow later. I kept picturing the tumor growing through treatment and knew that option wasn't meant for me. However, it is the course of treatment for most today.

Hope this helps.

Mary Jo

harrie · 07-17-2009, 11:28 AM

Thanks MaryJo, that does help. Thanks!

pattyz · 07-18-2009, 10:47 AM

Harrie,
It DID matter to us. But it was for my Lyle... He took TAC for 3 months (well, a decreased taxtore alone after I stopped the A/C). His nipple was totally involved and oozing a bloody discharge. The tumor was close to his chest wall.
In his case, it was the right thing to do as this worked to shrink the tumor for nice clean margins and did nearly visually clean up the nipple. He was dx'd Stage IIIb for the local invasion... Other wise highly ER+ PR+ with no nodes positive, No Her+ either.
He's taking Tamoxifen and doing well (far as we can tell.)

Very best of luck with hope for you,
xoxoxoxpattyz

suzan w · 07-18-2009, 11:08 AM

I felt the same way that Harrie did...I wanted that tumor GONE ASAP!!!

Rich66 · 07-18-2009, 12:06 PM

Here are a couple abstracts on the topic. If...big IF...i have any handle on the cancer stem cell issue, there may be some concern that neo adjuvant chemo can stimulate them..might not be helpful in long run. I think it might depend on whether the chemo used addresses CSCs or simply reduces bulk tumor cells, triggering CSC repopulation down the road with potential steps toward resistance. I think neoadjuvant chemo can make node status a bit tricky to determine. I think back in '04 MD Anderson was doing trials with neo-adjuvant Adriamycin and Herceptin with tremendous shrinkage of tumors. Maybe by now they have better long-term info.

1: Expert Opin Pharmacother. 2009 Jun;10(9):1423-34.

Links
Neoadjuvant chemotherapy for early breast cancer.

Mieog JS, van de Velde CJ.
Leiden University Medical Centre Department of Surgery, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
BACKGROUND: Neoadjuvant chemotherapy defines the preoperative administration of systemic therapy in order to downstage the primary tumor and affected lymph nodes to improve the surgical approach. Neoadjuvant chemotherapy is increasingly being used in the treatment of early operable breast cancer. OBJECTIVE: We reviewed the available data of neoadjuvant chemotherapy with emphasis on tumor response assessment and prediction, and locoregional management. METHODS: We searched the databases of MEDLINE and EMBASE using the search terms breast cancer, neoadjuvant or preoperative or primary or induction, and chemotherapy from 1950 to 1 March 2009. RESULTS/CONCLUSION: Compared with adjuvant chemotherapy, neoadjuvant chemotherapy increases breast conservation with equal survival and locoregional control. Tumor response assessment during neoadjuvant chemotherapy allows identification of in vivo tumor sensitivity to different agents which will help determine predictive factors for improved selection criteria. Randomized trials assessing the timing of sentinel lymph node biopsy in initially lymph node positive patients are warranted. In the near future, intraoperative fluorescent imaging and targeting of cancer stem cells will become important avenues of research.

1: Br J Cancer. 2006 Feb 27;94(4):524-31.

Links
Circulating endothelial cells and angiogenic serum factors during neoadjuvant chemotherapy of primary breast cancer.

Fürstenberger G, von Moos R, Lucas R, Thürlimann B, Senn HJ, Hamacher J, Boneberg EM.
Center for Tumor Detection and Prevention, Rorschacherstrasse 150, 9006 St Gallen, Switzerland. gfuerstenberger@sg.zetup.ch
Circulating endothelial cells (CECs) as well as bone-marrow-derived endothelial precursor cells (EPC) play an important role in neovascularisation and tumour growth. To study the impact of neoadjuvant chemotherapy on the amounts of CEC and their precursor cells, mature CEC and their progenitors were quantified by flow cytometry in peripheral blood of breast cancer patients during anthracycline and/or taxane based neoadjuvant chemotherapy and subsequent surgery in comparison to age-matched healthy controls. Cell numbers were tested for correlation with serum levels of angiopoietin-2, erythropoietin, endostatin, endoglin, VEGF and sVCAM-1 as well as clinical and pathological features of breast cancer disease. Circulating endothelial cells were significantly elevated in breast cancer patients and decreased during chemotherapy, whereas EPC (CD34+/VEGFR-2+) as well as their progenitor cell population CD133+/CD34+ and the population of CD34+ stem cells increased. Concomitantly with the increase of progenitor cells an increase of VEGF, erythropoietin and angiopoietin-2 was observed. These data suggest that chemotherapy can only reduce the amounts of mature CEC, probably reflecting detached cells from tumour vessels, whereas the EPC and their progenitors are mobilised by chemotherapy. Since this mobilisation of EPC may contribute to tumour neovascularisation an early antiangiogenic therapy in combination with chemotherapy could be beneficial for the success of cancer therapy.

Mary Jo · 07-18-2009, 12:32 PM

That is great info. Rich and I was confident someone was going to come through with some scientific date.

Back in 2005 when I was dx that was pretty much what was said to me...but being a newly dx breast cancer patient, I had one thing in my mind ------GET IT OUT! For me going the adjuvent route was the right way for me to go...if for no other reason than for my mental well being.

MJ

DianneS · 07-20-2009, 05:28 PM

Harrie - Maryanne - I did not know you are dealing with a tumor! I'm so sorry.

I had surgery in 2008 to remove the tumor, then chemo. Have they changed the rules so soon?

Hope this is ok to ask....have they done tests to see what the tumor is? I don't understand how they can do chemo before they know what to treat. This makes nada sense to me.

Best of luck to you, dear.....
Diannes

harrie · 07-20-2009, 11:49 PM

Dianne and whoever else might have been misled. I am not asking this question for me personally. I am fine.
I am asking because of another's situation that has recently come up.

Also, a close friend of mine had chemo to reduce the tumor in her breast, this was over a yr ago. She had all 6 txs and found out later that the tumor didn't even change size after all that chemo! So she ended up with a mastectomy.

pmm10414 · 07-26-2009, 07:15 PM

I did chemo first and had a complete response when I had surgury -- no cancer in either breast or 9 lymph nodes that were removed. My tumor was 5cm when I started and one node affected prior to chemo starting.

harrie · 07-26-2009, 10:36 PM

Patty, those are awesome results!! Aren't those just the most beautiful words, "COMPLETE RESPONSE"!! am so happy for you.

Savta · 07-27-2009, 08:32 AM

Hi, Harrie,

I too, had neo-adjuvent chemo. I was hysterical when both surgeon and oncologist told me that was the way to go. I, like most of you, just wanted it out of me. But, since the biopsy taken also of lymph nodes showed up malignant, they explained it would be best to start the chemo and prevent spread. I had 4 AC and 12 TH. Each month I was checked by the oncologist. After the second AC we already saw the tumor shrinking. It was a wonderful day when they gave me that news--and it gave me the energy to come back each time for the next treatment.
I also did a mammography in the middle, and twice ultrasounds.
The second ultrasound was amazing--I was told that they can only imagine where the original tumor was! (the results were so good and swift, they missed putting in clips to mark the tumor!)
When I finally had surgery, there was no evidence of tumor wither in the breast tissue or lymph nodes.
I am so glad I went this route--even though I was upset about it at the start.
Best of health to you and your friend.

pmm10414 · 07-27-2009, 09:53 AM

They put a clip in me and then could not find it when they were doing path analysis. The best plans I guess don't always work out. The news is good so I guess you take it and move on.

margo · 07-27-2009, 10:15 AM

I was given neo-adjuvant chemo in 2004 for 3.5 months, prior to my first surgery. No one I knew had ever heard of "neo". At that time, the internet was not much help for neoadjuvant therapy or my metaplastic cancer.

I understand your feelings about wanting the cancer out right away. I could not understand why it was not being removed. I had to shift my paradigm.

I was tested monthly with scans to track my progress. I lucked out when the first cocktail worked. My 5 year anniversary is coming up.

Here is to changing paradigms!

Best wishes.