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Old 04-23-2009, 07:19 AM   #1
Ellie F
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Question Neulasta/neupogen

Hi everyone
I wonder if you can tell me if neulasta or neupogen are given routinely in the States as a preventative measure
during chemotherapy?
I am due to start docetaxol which my oncologist has told me killed two of her patients who developed neutropenia!!I also had neutropenia when I had AC and was quite poorly so am hoping and praying to avoid it this time round.
I have heard it is expensive and wondered if this might be a reason why it's not routinely given in the UK.
Grateful for any info
Ellie
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Old 04-23-2009, 07:42 AM   #2
Diane H
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It is not routinely given, only if your blood cell counts fall beneath a certain level. And yes, unfortunately it is expensive. Sending you hugs and hope Ellie, may you get great results this time.
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Old 04-23-2009, 08:17 AM   #3
Yorkiegirl
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I always got a neulasta shot the day following chemo.
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Vicki
Texas
Biopsy Dx'd 3-23-05 Age 48
MRM 4-5-05 w/ 2 tumor's 5cm, and 6 cm (right side)
IDC (poorly differentiated infiltrating ductual carcinoma)
5+/16 nodes
Stage III A
Grade 3
ER/PR-, Her2/neu ++
Ki67 78%
Begin Chemo 5-2-05 4XAC Dose Dense , 4X Abraxane Dose Dense (ended August 05)
28 Rad's ended October 13 2005
Started Herceptin Weekly August 2005 for one year
Had a Simple mastectomy left side after Mamo showed incresed micro-calcifications. Jan. 17 2006.
Brain MRI Feb.2006--All Clear
August 28, 2006 Last Weekly Herceptin.
October 2006--Colonoscopy, 6 Polyp's removed--all B9
PET Scan July 2007
Abdominal MRI Oct. 2007---2 Right Kidney Cysts
Core Biopsy-- Lump on Scar Line 1-10-08---B9
Brain MRI 6-2008--All Clear
PET/CT Scan 6-2008
Sept. 8 2008, 4CM area removed from mastectomy scar line. Proved to be B9.
PET/CT Scan-- July 2009 --All clear
August 17,2009 ---Had Port Removed
6 Years NED -- April 5,2011
DX'd with Melanoma left arm 10-10-2011
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Old 04-23-2009, 08:34 AM   #4
lkc Gumby
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Me too. it is routinely given to counteract the neutropenia that is expected with chemo. Why is your onc so negative and down right scary?
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Dxed Stage IIIC May 05, 12 pos nodes
er/pr -neg,Her -pos
LVI
Right partial mast & partial axillary dissection-June14,2005
Right modified mast-no clear margins- June 30, 2005
DD AC x4
Taxotere X4 with Herceptin
Rads x 35( 5 fields )
Left prophylactive mast( atypia & hyperplasia found ),
put on Tamoxifen x 1 yr; D/ced due to endometrial thickening
bilateral recon (saline implants)May 06
Nipple recon July 06
metformin 2010
removal of implants due to severe encapsulation, insertion of gummies 2013
Reclast Q yr
NED!!!
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Old 04-23-2009, 12:20 PM   #5
Ellie F
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Thanks all for the information . I will speak to the onc about it especially in view of her comments.I am sure they don't give it routinely due to the rationing of resources going on in the NHS.Last time I had been hospitalised for 3 days before the physician agreed to give it to me as he told me it was very expensive! Ellie
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Old 04-23-2009, 05:38 PM   #6
alicem
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According to my claims, the charges from my oncologist to the insurance company is about $7500 (US$) per shot. Yes it is an expensive little shot that takes them less than a minute to inject into my arm. I hope you will be able to get it.
__________________
9/15/08 (age 52) - Mammo: calcifications
9/22/08 - Biopsy: DCIS, grade 3. ER,PR status: Pos. in 75-90% of tumor cells.
10/01/08 - Ob/Gyn appt.: found complex, mostly cystic mass on right ovary - 11cmx12cmx 8cm
10/15/08 - Hysterectomy & Oophorectomy, Lumpectomy: Cyst on uterus, not ovary - all was benign. Breast - 5 of 6 bad margins. 2 Sentinel Lymph nodes removed, both negative. Stage 0, Tis, N0
12/11/08 - Mastectomy & DIEP reconstruction: Surprise! 2 cm Invasive DC, grade 2 found. One benign internal mammary lymph node. Stage 1, T1c, N0, all clean margins. ER+ (Proportion Score = 2/5, Intensity Score = 2/3) and PR+(Proportion Score = 3/5, Intensity Score = 2/3)
HER2 score = 3+
1/09/09 - Oncotype DX: Recurrence S/core of 60 !?!?! ER status is NEG!! PR staus is NEG! HER2 score = 12.2 (still positive, greater than 11.5 is positive).
1/20/09 - Started chemo: TCH
5/26/09 - FINISHED CHEMO!
1/05/10 - FINISHED HERCEPTIN!
1/22/10 - Port-a-catheter removed!
3/07/18 - Still NED
9/10/23 - Still NED
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Old 04-23-2009, 05:49 PM   #7
Laurel
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Ellie,

Here in the States Neulasta is given the day following some chemo infusions. It is generally given with therapies that drop the white cell count appreciably and where there is not enough time between infusions for the counts to climb back up. With dose dense ACTH, which is administered every other week, Neulasta is given as there is not enough time for the WBC's to return to an acceptable level. With TCH it is on as needed basis depending on the white count, but is often not employed as there are 3 weeks between infusions and therefore time for the white count to rise.

I was delivered 2 syringes of Neulasta per month at a cost of $6000. The day following my infusion I self-administered one of the Neulasta syringes.

Hang in there, Ellie! This cancer stuff just absolutely blows!!!!!
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Smile On!
Laurel


Dx'd w/multifocal DCIS/IDS 3/08
7mm invasive component
Partial mast. 5/08
Stage 1b, ER 80%, PR 90%, HER-2 6.9 on FISH
0/5 nodes
4 AC, 4 TH finished 9/08
Herceptin every 3 weeks. Finished 7/09
Tamoxifen 10/08. Switched to Femara 8/09
Bilat SPM w/reconstruction 10/08
Clinical Trial w/Clondronate 12/08
Stopped Clondronate--too hard on my gizzard!
Switched back to Tamoxifen due to tendon pain from Femara

15 Years NED
I think I just might hang around awhile....

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Old 04-23-2009, 06:04 PM   #8
alicem
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Actually Laurel, I am on a TCH regimen, getting the TC every 3 weeks and I still get the neulasta the day after. My insurance company never questioned it.
__________________
9/15/08 (age 52) - Mammo: calcifications
9/22/08 - Biopsy: DCIS, grade 3. ER,PR status: Pos. in 75-90% of tumor cells.
10/01/08 - Ob/Gyn appt.: found complex, mostly cystic mass on right ovary - 11cmx12cmx 8cm
10/15/08 - Hysterectomy & Oophorectomy, Lumpectomy: Cyst on uterus, not ovary - all was benign. Breast - 5 of 6 bad margins. 2 Sentinel Lymph nodes removed, both negative. Stage 0, Tis, N0
12/11/08 - Mastectomy & DIEP reconstruction: Surprise! 2 cm Invasive DC, grade 2 found. One benign internal mammary lymph node. Stage 1, T1c, N0, all clean margins. ER+ (Proportion Score = 2/5, Intensity Score = 2/3) and PR+(Proportion Score = 3/5, Intensity Score = 2/3)
HER2 score = 3+
1/09/09 - Oncotype DX: Recurrence S/core of 60 !?!?! ER status is NEG!! PR staus is NEG! HER2 score = 12.2 (still positive, greater than 11.5 is positive).
1/20/09 - Started chemo: TCH
5/26/09 - FINISHED CHEMO!
1/05/10 - FINISHED HERCEPTIN!
1/22/10 - Port-a-catheter removed!
3/07/18 - Still NED
9/10/23 - Still NED
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Old 04-23-2009, 06:34 PM   #9
Laurel
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Really? Good to know. I didn't think it was routine with TCH. I never had any problems with my insurance covering it either. How is neutropenia managed in the U.K., I wonder?
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Smile On!
Laurel


Dx'd w/multifocal DCIS/IDS 3/08
7mm invasive component
Partial mast. 5/08
Stage 1b, ER 80%, PR 90%, HER-2 6.9 on FISH
0/5 nodes
4 AC, 4 TH finished 9/08
Herceptin every 3 weeks. Finished 7/09
Tamoxifen 10/08. Switched to Femara 8/09
Bilat SPM w/reconstruction 10/08
Clinical Trial w/Clondronate 12/08
Stopped Clondronate--too hard on my gizzard!
Switched back to Tamoxifen due to tendon pain from Femara

15 Years NED
I think I just might hang around awhile....

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Old 04-23-2009, 06:50 PM   #10
AbbyDawg
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All are given Neulasta routinely as part of my oncol. protocol. She felt given preventatively was smart and kind. I liked her perspective toward the value of the drug ... not the cost.

AbbyDawg
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Old 04-24-2009, 02:29 AM   #11
Ellie F
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In the UK to my knowledge it is given once neutropenia has developed and you are admitted to hospital. They tend to delay your chemo by a week if your blood level is low. This has happened to quite a number of other breast cancer patients I have spoken to.I have not found anyone who has had it as a preventative measure. This is such a shame as it just adds to the anxiety of having chemo.One lady I met at the breast clinic had not ventured out of her house and wouldn't have visitors as she was so frightened of getting an infection and becoming ill! Hugs Ellie
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Old 04-24-2009, 06:33 AM   #12
alicem
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Yes, this really is a shame. Just one more reason for all of us to monitor what happens to the health care system in the U.S.
__________________
9/15/08 (age 52) - Mammo: calcifications
9/22/08 - Biopsy: DCIS, grade 3. ER,PR status: Pos. in 75-90% of tumor cells.
10/01/08 - Ob/Gyn appt.: found complex, mostly cystic mass on right ovary - 11cmx12cmx 8cm
10/15/08 - Hysterectomy & Oophorectomy, Lumpectomy: Cyst on uterus, not ovary - all was benign. Breast - 5 of 6 bad margins. 2 Sentinel Lymph nodes removed, both negative. Stage 0, Tis, N0
12/11/08 - Mastectomy & DIEP reconstruction: Surprise! 2 cm Invasive DC, grade 2 found. One benign internal mammary lymph node. Stage 1, T1c, N0, all clean margins. ER+ (Proportion Score = 2/5, Intensity Score = 2/3) and PR+(Proportion Score = 3/5, Intensity Score = 2/3)
HER2 score = 3+
1/09/09 - Oncotype DX: Recurrence S/core of 60 !?!?! ER status is NEG!! PR staus is NEG! HER2 score = 12.2 (still positive, greater than 11.5 is positive).
1/20/09 - Started chemo: TCH
5/26/09 - FINISHED CHEMO!
1/05/10 - FINISHED HERCEPTIN!
1/22/10 - Port-a-catheter removed!
3/07/18 - Still NED
9/10/23 - Still NED
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Old 04-24-2009, 08:26 PM   #13
Joan M
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Elle,

You will get a white cell booster if your white cell count falls too low.

I needed a boost not only when I had dose dense AC, but also with Taxol. I gave myself preloaded shots in the thigh.

Joan
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Diagnosed stage 2b in July 2003 (2.3 cm, HER2+, ER-/PR-, 7+ nodes). Treated with mastectomy (with immediate DIEP flap reconstruction), AC + T/Herceptin (off label). Cancer advanced to lung in Jan. 2007 (1 cm nodule). Started Herceptin every 3 weeks. Lung wedge resection April 2007. Cancer recurred in lung April 2008. RFA of lung in August 2008. 2nd annual brain MRI in Oct. 2008 discovered 2.6 cm cystic tumor in left frontal lobe. Craniotomy Oct. 2008 (ER-/PR-/HER2-) followed by targeted radiation (IMRT). Coughing up blood Feb. 2009. Thoractomy July 2009 to cut out fungal ball of common soil fungus (aspergillus) that grew in the RFA cavity (most likely inhaled while gardening). No cancer, only fungus. Removal of tiny melanoma from upper left arm, plus sentinel lymph node biopsy in Feb. 2016. Guardant Health liquid biopsy in Feb. 2016 showed mutations in 4 subtypes of TP53. Repeat of Guardant Health biopsy in Jana. 2021 showed 3 TP53 mutations, BRCA1 mutation and CHEK2 mutation. Invitae genetic testing showed negative for all of these. Living with MBC since 2007. Stopped Herceptin Hylecta (injection) treatment in March 2020. Recent 2021 annual CT of chest, abdomen and pelvis and annual brain MRI showed NED. Praying for NED forever!!
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Old 04-24-2009, 11:11 PM   #14
harrie
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I don't think it is given routinely prophylactically unless warrented. After my first chemo my labs showed a big drop in the WBC so from then on neupogen was given routinely a few days after my chemo tx.
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*** MARYANNE *** aka HARRIECANARIE

1993: right side DCIS, lumpectomy, rads
1999: left side DCIS, lumpectomy, rads, tamoxifen

2006:
BRCA 2 positive
Stage I, invasive DCIS (6mm x 5mm)
Grade: intermediate
sentinal node biopsy: neg
HER2/neu amplified 4.7
ER+/PR+
TOPO II neg
Oncotype dx 20
Bilat mastectomy with DIEP flap reconstruction
oophorectomy

2007:
6 cycles TCH (taxotere, carboplatin, herceptin)
finished 1 yr herceptin 05/07
Arimidex, stopped after almost 1 yr
Femara
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Old 04-25-2009, 08:40 PM   #15
ElaineM
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Wink Neulasta/neupogen

I agree with Harrie.
I don't think it is given automatically. I think it depends on whether or not the results of the pre chemo blood test shows a below normal number of white blood cells.
Luckily I never needed Neulasta, Neupogen or Procrit.
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12 years and counting
http://her2support.org/vbulletin/showthread.php?t=48247
Lucky 13 !! I hope so !!!!!!
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14 Year Survivor
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Old 04-25-2009, 09:21 PM   #16
vickie h
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Hi Ellie,

When I had Navelbine the first time, I was given Neupogen to take home and self adminster the shots in my abdomen for 4 days after every weekly treatment. that was 2 1/2 years ago. I am on Navelbine again, and even though I had to skip chemo a few weeks ago due to no neutrophils I was not given the shots to self administer. Instead, I had to go in every day for 4 days to receive a shot. It seems some Oncs give it as a preventative and others wait and see how your counts hold up. Since I have a history of low white counts I would assume that this Onc (up here where I live, or my local Onc) would give me the shots as a preventative, but he has decided to wait and see.
I just went in for a blood draw today and will know on Monday whether I will need some Neupogen. Since we are leaving for Las Vegas for a week on Monday, that could be a problem as I don't intend to stick around for a series of shots and cancel my vacation.
I know it is expensive but my insurance has never questioned it and has always paid.
I hope you will receive the Neupogen before your counts go too low.
Hang in there, sweet sister, you'll get through this.
Love, Vickie
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Life's not about waiting for the storm to pass,
It's about learning to dance in the rain.


Feb 04 IBC IIIC/IV er-/pr- her2+++
3/04 TCH X4
7/ 04 MRM 9/04 Taxol/herceptin wkly 1 yr 33X rads
11/04 skin mets 33x rads,10/05 Avast/Herc. 11 mos.
8/ 06 PET mets lymphs, neck
9/ 06 Navelbine/herceptin
11/ 06 PET NED
2/ 07 skin mets, 4/07 Xeloda, 5/07 add Tykerb
2/ 08 Tykerb failed. Doxil /Herceptin 6 months
8/08 PET skin mets, 8/08 Abraxane/Avastin
11/ 08 PET prog., skin mets
1/09 PET/CT progress, 1/09 Ixempra, 2/09 add Xeloda and low dose Naltrexone
2/09 off Ixempra/Xeloda
3/09 navelbine/herc/cytoxin 4/09 PET shows regress.7/09 start Topotecan. Failed.
8/09 extensive mets rgt brst, back and torso. starting Pazopanib clinical trial.
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Old 04-26-2009, 06:39 AM   #17
Becky
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Both WBC and RBC booster drugs are powerful, powerful drugs that act on your bone marrow.

They had never been routinely given until the dense dose 4 AC followed by 4 Taxol was accepted as standard of care in late 2003 (this is prior to Herceptin being added to the taxol part in mid 2005). The dense dose regime absolutely required a WBC booster - there was no way the white cells could recover in time as they could when the chemo was given every 3 weeks vs the dense dose's timing of every 2 wks.

Because oncs got used to using these drugs, they just use them even if you are not on a chemo that requires it.

If you are on a dense dose schedule, it is required. If you are not, perhaps a frank discussion with your onc and a second opinion is needed if you are just getting the shot without knowing if you actually need it.

If you need it, regardless, it is a drug that could be life saving (preventing horrendous infection) and that it keeps you on track in receiving your chemo treatments on time.

It is like anything, one doesn't take high blood pressure pills if you don't have high blood pressure so why take a WBC booster shot if your counts are adequate? These medications are not child's play.
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Kind regards

Becky

Found lump via BSE
Diagnosed 8/04 at age 45
1.9cm tumor, ER+PR-, Her2 3+(rt side)
2 micromets to sentinel node
Stage 2A
left 3mm DCIS - low grade ER+PR+Her2 neg
lumpectomies 9/7/04
4DD AC followed by 4 DD taxol
Used Leukine instead of Neulasta
35 rads on right side only
4/05 started Tamoxifen
Started Herceptin 4 months after last Taxol due to
trial results and 2005 ASCO meeting & recommendations
Oophorectomy 8/05
Started Arimidex 9/05
Finished Herceptin (16 months) 9/06
Arimidex Only
Prolia every 6 months for osteopenia

NED 18 years!

Said Christopher Robin to Pooh: "You must remember this: You're braver than you believe and stronger than you seem and smarter than you think"
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Old 04-26-2009, 04:49 PM   #18
Debbie L.
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so - did you get need neulasta/neupogen and did you recur?

I did chemo way back in 2001. A/C x 4, then Taxol x 4, every three weeks. My white counts (but not red) tanked immediately - my onc called me the neupogen queen (there was not neulasta then). He told me that some thought that this WBC wimpiness could mean that the cancer cells in my body were equally susceptible (as the bone marrow cells) to the chemo. At the time, I thought that he was just saying, that to encourage me. He is a nice man. But here I am, 8 years later, still NED. I did not expect to be here, frankly.

So my question -- for those who did not get dose-dense chemo: did you need neupogen/neulasta? How much? How long ago were you treated, and did you recur?

Totally unscientific, anecdotal survey.

Debbie Laxague
__________________
3/01 ~ Age 49. Occult primary announced by large (6cm) axillary node, found by my husband.
4/01 ~ Bilateral mastectomies (LMRM, R elective simple) - 1.2cm IDC was found at pathology. 5 of 11 axillary nodes positive, largest = 6cm. Stage IIIA
ERPR 5%/1% (re-done later at Baylor, both negative at zero).
HER2neu positive by IHC and FISH (8.89).
Lymphovascular invasion, grade 3, 8/9 modified SBR.
TX: Control of arm of NSABP's B-31 adjuvant Herceptin trial (no Herceptin, inducing a severe case of Herceptin-envy): A/C x 4 and Taxol x 4 q3weeks, then rads. Raging infection of entire chest after small revision of mastectomy scar after completing tx (significance unknown). Arimidex for two years, stopped after second pathology opinion.
2017: Mild and manageable lymphedema and some cognitive issues.
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Old 04-26-2009, 05:43 PM   #19
YMilillo
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Neulasta

Yes, I live in Upstate New York. It is standard to get a shot of neulasta the day after chemo to force quick production of your white blood cells , so you ca fight infection. It has the side affect of bone pain which lasted maybe 4 days. Hydrocodone was helpful on the most painful day. Other wise it was just lower back discomfort, almost like sciatica pain.
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Old 04-26-2009, 10:55 PM   #20
harrie
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Neupogen can also have the side effect of bone ache. I had the bone pain only once and Advil took care of the discomfort nicely.
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*** MARYANNE *** aka HARRIECANARIE

1993: right side DCIS, lumpectomy, rads
1999: left side DCIS, lumpectomy, rads, tamoxifen

2006:
BRCA 2 positive
Stage I, invasive DCIS (6mm x 5mm)
Grade: intermediate
sentinal node biopsy: neg
HER2/neu amplified 4.7
ER+/PR+
TOPO II neg
Oncotype dx 20
Bilat mastectomy with DIEP flap reconstruction
oophorectomy

2007:
6 cycles TCH (taxotere, carboplatin, herceptin)
finished 1 yr herceptin 05/07
Arimidex, stopped after almost 1 yr
Femara
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