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

[Lani]

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]

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]

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

[tousled1]

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]

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]

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]

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