Is tumor responding?
 

Kiri was offered the option of neoadjuvant chemo for several reasons: she could participate in a clinical trial (where she is scheduled to take lapatinib (tykerb) and Taxol for 16 weeks before surgery), the possibility of the tumor shrinking made a lumpectomy a (remote) option, the tumor, if it did shrink, would be easier to excise and hopefully get clean margins with, we could determined what drugs the tumor responded to, and there was virtually no chance that the tumor would get larger with chemo. All good scenarios, and I was glad when she chose this option.


She's now had 5 treatments, including the one today, and been on the regimen 4 weeks. Last week her tumor was measured and had shrunk from 8 X 9 cm (these are measurements taken OUTSIDE the breast; the original internal u/s measurement was around 3 cm) to 8 X 8 cm. This week the tumor was still 8 X 8 cm, but the nurse said it felt "softer" and was therefore responding.
It's still early in the regimen, but I would some honest feedback from those who've been there, done that. Are we being given false hope? Is "softer" really a good indication the chemo is working? Kiri is ER+, PR- and Her2+++, and I've read that the PR- tumors can be iffy in terms of responding to chemo.



Would be grateful to hear of others' experiences. I know that neoadjuvant therapy isn't that common, and neither is the combo of ER+ and PR-, so I kind of feel we're in a vacuum here.


Thanks--

Re: Is tumor responding?
 

My tumor was also ER+ (50%) and PR negative. I had always been under the impression that tumors that are less hormone positive respond better to chemo than the highly positive ones but these studies do not take Her2 into account. Is Kiri also receiving Herceptin?

I saw a paper at the San Antonio Breast Cancer Symposium once on PR negative tumors (but this also did not take Her2 into account. How ER+ is Kiri's tumor? Many tumors that are ER+ but PR neg genetically look either like they are ER+PR+ or ER-PR-. It was a great paper and most on ER+PR- are in that there is not alot of research in this pathology. Supposedly, Herceptin and Tykerb together work well on these tumors. Is Herceptin in the future?

You can see my treatment from my signature. My tumor was smaller so I had surgery first. I also did not have Herceptin with chemo as it had not been available to me at that time but was after my treatment concluded so I returned to the chemo room for my Herceptin because there was no way I wasn't having it even though I had Herceptin alone.

The big thing is that the tumor is shrinking and I think softening of the tumor is good because the chemo is "making holes" in the tumor therefore, if compressed, it is probably much smaller than its measurements. Think about a big snowball - hard and compact. You only see it shrink with heat if the heat is applied only to the outside but if the heat is also coming from the inside, the inside will melt and make holes but it won't appear that the size of the snowball is any smaller at first. However, as time goes on, that snowball will collapse and it will be very measureably smaller. Have faith!

Re: Is tumor responding?
 

Kiri was randomized in the clinical trial at Dana-Farber into the arm that receives lapatinib (tykerb) and Taxol in the neoadjuvant setting. There are three arms: one with herceptin, lapatinib and taxol, one with herceptin and taxol, and one with lapatinib and taxol. She will get herceptin later, after her surgery, for a year.

Thanks for that analogy about the snowball - that's really helpful! :-)

Edited to add:

I just reread this portion of your analogy: if the heat is also coming from the inside, the inside will melt and make holes but it won't appear that the size of the snowball is any smaller at first. This is really interesting because apparently, as a small molecule, lapatinib enters the HER2+ cells and attacks them from the inside, rather than externally, as Herceptin does. So that might account for the softening rather than size reduction. Just my hypothesis. ;-)

Re: Is tumor responding?
 

Hi Kirismum:

I am ER+/ PR- /Her2+ and I am currently undergoing neoadjuvant therapy with TCH. In August when I was first diagnosed my tumor was 2.2cm. As of 3 weeks ago, my tumor can no longer be felt. I have two more chemo cycles, then surgery. I am also in a clinical trial.

Neoadjuvant therapy has offered me the possibility of a lumpectomy vs a masectomy due to the position of my tumor. I also liked the idea of 'flushing out' any cancer cells prior to surgery.

You are not alone! Best to you!

Re: Is tumor responding?
 

Hi Kirismum,

I wouldn't worry about it so much. If changes are being felt, then it's likely that her tumor is indeed melting. I had the same ER+/PR-/HER-2+ pathology, and could feel the tumor getting softer as you describe. Is she getting a scan mid-treatment? You can ask about that - the trial may have it as part of its protocol.

Have a wonderful holiday with my best wishes for a cancer-free future!

Marcia