M.D. Anderson neo-adjuvant herceptin/chemo

Does this improve outcome or just reduce need for mastectomy? What does "complete response" mean?

http://www.mdanderson.org/departments/news...ec300508bdcce3a

Rich,

My wife had neoadjuvant herceptin/carboplatin/taxol. This is done for larger tumors because they are hard to remove cleanly or to shrink the tumor so a lumpectomy can be performed and save the breast. The data says there is no survival difference between the two.
A complete response is either clinical where no tumor can be felt or detected by imaging equipment, or pathological where the pathologist can't find any cancer cells under the microscope in the tissue. The data says you have a 90% chance of being cured with a pathological complete response. A clinical complete response is a great sign, but means you still contain some residual cancer as some cells were found by the pathologist.

Scott

I am going through this same treatment right now -- Herceptin/Carboplatin/Taxol. My tumor is a fraction of its original size after 8 weekly treatments. Surgery is still usually necessary. I am now debating my surgery options; surgery will be after about 3 months of chemo. I could easily have a lumpectomy, but I have small breasts, so the cosmetic outcome will not be great. Another patient who is post-surgery in the clinic I attend had a lumpectomy with great results, but her breasts were larger and her tumor was near the underside of her breast. Mine is near the top, closer to the chest wall. The type of surgery will depend on the individual case. I will get three months of the same chemo after surgery.

Radiation usually follow the second half of chemo if there is a lumpectomy and sometimes folows a masectomy.

Bottom line is that neoadjuvant chemo works great in these cases -- much easier to get a good surgical result.

Val

My 37 y/o Mom had a standard simple mastectomy on a 2.1cm primary and other area of bc calcifications...no neo adjuvant therapy.
Looks like some "high risk" patients can opt for the same approach in an adjuvant setting(at M.D. Anderson). This is a new approach with limited data but do you think it would beat a standard AC regimen due to its addition of herceptin? They used epirubicin in place of adriamyacin. I suppose it makes a difference whether the patient responds to herceptin but, at least in Anderson labs, they have found a protein called Pten which in higher amounts correlates with herceptin sensitivity: http://www.wkmc.com/cancerftr/CancerNews/082404.asp
Any thoughts?

I mean 67 y/o mom

[michele u]

Val,
I had a lumpectomy for my 3 small tumors. I was afraid too because i have fairly small breast. Size 36b. After my lumpectomy, the swelling that came after was an instant reconstruction! They are both about the same size now! You can't even tell by looking. My surgeon said anyone doing mastectomy's without letting women know that the stats are the same is doing a very bad thing. If you want to email me more questions feel free. Michele

Rich,
Linda's case is similar to Michele's, except there was one very large tumor. It was substantially down-sized to about 5 mm. She was on 4 weeks AC and then 4 weeks Taxol. They would have done a masecomy except we forced the issue with the surgeon and challenged him to do the research. As it turns out, there is NO survival advantage to one over the other.
All the best,
Al