why excellent response to some neoadjuvant chemotherapies may not increase survival!

Lani · 11-18-2006, 08:35 PM

FROM A LETTER TO THE JOURNAL EDITOR COMMENTING ON AN ARTICLE--
Article under discussion:

Presence of apoptotic and nonapoptotic disseminated tumor cells reflects the response to neoadjuvant systemic therapy in breast cancer
Tanja Fehm , Sven Becker, Graziella Becker-Pergola, Karl Sotlar, Gerhard Gebauer, Silke Dürr-Störzer, Hans Neubauer, Diethelm Wallwiener and Erich-Franz Solomayer
Breast Cancer Research 2006, 8:R60 doi:10.1186/bcr1611

Comments on this article (1)

Release of tumor cells during neoadjuvant therapy

Release of tumor cells during neoadjuvant therapy

Katharina Pachmann (01 November 2006) Friedrich Schiller University of Jena, Germany

The present report by Dr. Fehm confirms our previous results about dissemination of tumor cells during the course of neoadjuvant therapy presented already at the 2004 San Antonio Breast cancer symposium (Pachmann K., Camara O., Pachmann UA. Influence of primary tumor chemotherapy in breast cancer on circulating tumor cells. Indications for massive cell release into circulations concurrent with tumor size reduction. (2004) Breast Cancer Research and Treatment 88: S224), which was commented in several publications: "An article in the May 2005 issue of Oncology News International (Vol. 14, No. 5) reports that neoadjuvant chemotherapy* may cause the release of cancer cells into the blood. Katharina Pachmann, MD, of Friedrich-Schiller University in Germany said that "ironically, paclitaxel produces the greatest degree of tumor shrinkage but also the greatest release of circulating tumor cells." The cells remained in the circulation for at least 5 months after subsequent surgery. Dr. Pachmann said that this observation corresponds with results found in patients, that is, tumor response does not mean increased survival". In accordance with our results Dr. Fehm shows that after neoadjuvant therapy disseminated cells are found at a higher frequency than before. We would like to emphasize in addition, that most of these cells are not apoptotic but even of these non-apoptotic cells not all are necessarily metastatic cells. Rather, a minimal fraction of them (perhaps less than 0.01% as shown by the group of Dr. Chambers) is expected to form metastases, but release of such cells is the first step and should be avoided or the released cells be destroyed by additional chemotherapy after surgery, as suggested by us.

With best regards

Katharina Pachmann

Christine MH-UK · 11-19-2006, 07:34 AM

I had neoadjuvant FEC, then surgery, which showed that the FEC hadn't done much (I guess I'm not topo IIa positive). I made a fuss and my doctor said he could give me taxotere in addition (which he had been reluctant about because I had a really horrible time on FEC). I have always been a bit concerned about the rather odd way in which I got my taxotere, but perhaps it was all for the best after all. I am three years out from diagnosis and I know that my doctor never expected me to do that well. I have another high risk triple negative acquaintance (23/24 nodes after AC) who got the same sort of surgery sandwich that I did, at about the same time and for the same reasons, but with taxol and she is also doing much better than anyone had predicted.

kat in the delta · 01-23-2007, 09:09 PM

Christine,
.... can't remember --what does FEC stand for.....kat in the delta

tousled1 · 01-24-2007, 07:56 AM

I had neoadjunct chemo but had Taxatere instead of Taxol and my tumor did shrink considerably. I started Herceptin a week after my surgery and had 35 radiation treatments. Since both are taxanes and plant alkaloids, does this mean that after I had my surgery that I should have received additional chemo? And, if so, what type of chemo?

tousled1 · 01-24-2007, 07:57 AM

I had neoadjunct chemo but had Taxatere instead of Taxol and my tumor did shrink considerably. I started Herceptin a week after my surgery and had 35 radiation treatments. Since both are taxanes and plant alkaloids, does this mean that after I had my surgery that I should have received additional chemo? And, if so, what type of chemo?

kat in the delta · 01-24-2007, 10:54 AM

Ask you Onc. how often you will have tumor marker tests and which ones you will have......As far as more chemo...I personally do not think so, maybe rad.,,but you have had it once...ask your MD's and surgeon-sugeons know more than I thought... kat in the delta

Emelie · 01-29-2007, 11:55 AM

Kate,
I am currently recieving a 12 week schedule of Taxotere with Herceptin (AC did not shrink tumor)prior to surgery. After that is radiaton. I have wondred if I should have surgery half way through, then finish Taxotere and Herceptin, or just complete schedule as planned? Onc. not that informative about this.
Any help would be appreciated.
Emelie

kat in the delta · 01-29-2007, 12:19 PM

How large was your tumor when it was discovered? I am no ONC/ M.D. ,but I thought that the taxotere/toxol (both are Taxanes) shrink or stop the growth. My cousin took the same one as you and could feel and even see hers shrinking!- hers was initially 5 cm and in a bad location..(she was not her2+,and had it also in her spine, hips, and chestbone-and HAD to STOP the TAX. for surgery on her 6th vertebrae- which was a bit scarey-but she had to weigh the odds. She will get rad. and when her surgery heals, she will begin again on the Tax.asap,which was really helping shrink her tumor.). I would want my Onc to send me for a scan in the middle of treatments to see if the TAX.and hercep. was even helping because some chemos.may not even Get To your tumor!!
Can YOU tell yet by seeing or feeling it??
If so, I would wait 'til I had finished all the TAX. , then get scanned. If the Tax. shrinks it enough for the surgeon to get clear margins, I would have surgery- at the end of my Taxt. treatments. ( I think you can still be taking the Herceptin ..). This is my own opinion, and what I'd do. Also remember to ask your Onc. Surgeon. They know alot, so ask ( his or her opinion). Let me know how you are.
kat in the delta

tousled1 · 01-29-2007, 01:35 PM

Emelie,

When I was on the A/C I had no tumor shrinkage. When I was on the Taxatere my tumor shrank considerably. It's not the A/C that shrinks tumors, it's the taxanes. It's a hard call to make but I have no regret having the neoadjunct chemo then surgery. My onc and surgeon both wanted to me have a lumpectomy but I opted for a bilateral mastectomy. I have a very strong history of breast cancer on both my mother and father's side, also ovarian cancer on my father's side. I had previously had a lump (benign) removed -- one from each breast. My MRI showed extensive microcalcifications in the left breast and a 7mm questionable area. I thought long and hard and decided on bilateral mastectomy and I'm glad I did. As for radiation -- that is usually done after surgery not before. If I were you I'd wait and see if the tumor is shrinking with the Taxatere. You didn't mention how large your tumor is or if you have had any scans/MRIs done.

Emelie · 01-30-2007, 07:47 AM

Kate and Kat in the Delta,
Sorry for the deletions. I have Stage III with lymph node involment, HER2 ++. Don't know how many, but can see it on the PET scan. My tumor was 4 cm and had broken through to the skin on the lower part of my nipple. Had my mammogram and my GP thought it was a cyst. I have had a bilateral MRI, PET scan, brain MRI (clear!), and the biopsy.
My tumor has shrunk to the point I can no longer feel it. I have had 3 Herceptin and 2 Taxotere treatments.
If you ladies waited to complete your treatments and are doing as well as you appear to be, then this probably the best course of action. I think I am anxious to be done with it.
Thank you ever so much for your replies and for letting me know I am not alone on this bump road.
Emelie

Catherine · 01-30-2007, 11:23 PM

Interesting about the shrinking tumors. I do not know alot about the subject, however my tumors DID shrink after 4 rounds of A/C. I had an MRI after 4 rounds of A/C and the multifocal tumors in my breast (largest one was just over 2cm) had shrunk so that they only appeared as scar tissue. My 3 involved nodes also shrunk to this same intrepretation. My onc was delighted and so was I. Then I went on to Taxol and then a Bilateral Mast. Margins were clean. I only needed to have a Mast. But I am happy with my decision. Tomorrow Jan 31 is my 3rd Herceptin. I go every 3 weeks. I just keep hoping and praying that my onc is on top of everything. I feel good, but sometimes I get scared when I do too much research. I do not like that idea that 10% of Her2+++ metast. to brain. Is that one out of 10? Is that like one out of seven women get breast cancer?

I am more positive during the day time. So guess I better go to bed.
And yes, I have gained a little weight on Herceptin already.

Catherine