Newly diagnosed

[Shaeff]

My wife just got diagnosed with cancer in late July. We immediately went the mastectomy route thinking that after the operation we would be in the clear. The size of the tumor was thought to be 2 cm. The operation was on July 29th. Tumor was 5.5 cm invasive ductal carcinoma, positive in two nodes out of twelve, ER and PR positive and Her2 positive +3. Tumor grade was 3 and the nottingham score was 8. Due to a mixup at the hospital we haven't had any of the tests to see if it has spread to other organs. We are getting them next week. Since the operation I have been spending a lot of time trying to get up to speed on the treatments.

We visited the oncologist this week and she recommended two potential options provided it hasn't already spread.

Option 1 - ACT - Adriamycin, Cytoxan, and Taxotere in 8 3 week cycles

Option 2 - ACT - Adriamycin, Cytoxan, Taxotere PLUS Xeloda in 8 3 week cycles

Option 2 would be part of a clinical trail.

Both treatments would include Herceptin at the end (or near the end of the treatment)

Researching it appears the Xeloda changes into 5-fluorouracil inside the body. It appears the MD Anderson cancer center uses 5-fluorouracil, adriamycin, cytoxan and taxol - very similar to taxotere.

My questions are:

1. Anyone have any experience with either treatment option listed above.

2. Has anyone been through the 5-fluorouracil, adriamycin, cytoxan and taxol treatment.

3. Does anyone know about the drug Ellence (epirubicin HCI) which appears to be the only chemo agent approved by the FDA for early stage node positive cancers.

4. Since all of the tumors (one primary and one in a node) were removed, how will we know if the treatment is working?

I will be asking the doctors these questions but it would be helpful to know everyones experiences in these areas.

Thank you and good luck to all.

[*_Christine MH_*]

Ellence (Epirubicin) is an anthracycline, much like adriamycin. To my knowledge, they have never been trialed against each other to see which is better. Like adriamycin, epirubicin has usually been used in combination with cytoxan/cyclophosphamide or cyclophosphamide and 5-FU. Ellence does have a better cardiotoxicity profile than adriamycin, and for that reason is the anthracycline of choice in Europe. I found it o.k., although constipating and hard on the veins. However, because it is easier on the heart, if it turns out to be as effective, in may have advantages for herceptin-based chemo.

I guess my main concern about the trial options that have been suggested for your wife is that it was herceptin-based chemo rather than herceptin following chemo that had the big payoff in the most recently announced clinical trials. Whereas AC followed by taxol followed by one year herceptin reduced recurrence by 13%, AC followed by (taxol+herceptin) followed by one year herceptin reduced recurrence by over 50%. That's a really big difference in outcomes. And the nice thing about the trial was that it seemed to have really dramatic reductions even when there were lots of nodes involved.

I'm a bit surprised that your oncologist hasn't recommended the trial combination or some other herceptin-based chemo, since this was hailed as one of the greatest breakthroughs in early breast cancer treatment ever at last May's ASCO.

[Laurie S]

I was diagnosed 3/21/05 and had a diagnosis similar to your wife. My tumor was 4.7, grade 3, Her2+ and 2 nodes pos. but I was er/pr-.I don't know if that affects type of chemo chosen. I had dose dense 4x AC then 12 X taxol/herceptin. I will continue to take Herceptin for a year alone. I thought that Herceptin should not be given with Adriamycin. You stated that Herceptin might be given toward the end of treatment, but that would be giving it with Adriamiycin, which I think was found to increase the risk of Heart Problems. My onc said I had to wait a few weeks after finishing AC before I could start the Herceptin. How old is your wife? I think that also comes into play when they decide what chemo. I am 37, and I told the dr. I wanted the most agressive chemo that they could give me, I am hoping that is what I got.
In regard to question 4, they unfortunately won't know. I asked my onc the same thing and his answer was "we won't" It was very disheartening, at first, to be doing something that was making me so sick and not knowing if it was helping or not, But I realized I had to have faith that there has been so much testing of these drugs, and these were the ones that my onc thought would be the most helpful. I have one taxol/herceptin left and I had scans done two weeks ago and everything came back fine. I can only hope and pray that I continue to get good results. Good Luck
Laurie

[*_BonnieT_*]

Hello
?4--- After her treatments she should be monitered by her Oncologist , I see mine every 3 months, I have labs done ( routine, plus liver panel, and tumor markers) also chest xrays. You can also ask to have an MRI or PET scan done,
a PET scan scans your whole body. This way if the cancer does come back you will catch it as early as you can.
Keep us posted
Bonnie T

[Lisa]

How to tell if you "got it all." Tough question. There's never anything definitive since cancer can be very small when it starts. But she will have regular blood tests, CT and PET scans, and of course will be aware of any aches and pains.

I'm concerned that she's had no other tests for metastasis. Such tests as bone scans and brain MRIs, etc. are usually done prior to a mastectomy. It wouldn't change the breast diagnosis, but it might have affected the order of the chemo vs. surgery.

Adriamycin, Cytoxin and Taxotere is a very commonly used combo. As someone mentioned, she'll have to wait to start Herceptin until after the Adriamycin.

Do keep us posted.

Love and light,

Lisa