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11-18-2006, 08:35 PM
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#1
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Senior Member
Join Date: Mar 2006
Posts: 4,778
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why excellent response to some neoadjuvant chemotherapies may not increase survival!
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
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11-19-2006, 07:34 AM
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#2
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Senior Member
Join Date: Sep 2005
Posts: 414
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Really interesting
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.
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01-23-2007, 09:09 PM
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#3
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Senior Member
Join Date: Apr 2006
Location: MS Delta in Clarksdale="Home of the Blues" (near Memphis,TN)by Misssissippi River/levee's highest pt.
Posts: 224
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kat in the delta
Christine,
.... can't remember --what does FEC stand for.....kat in the delta
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01-24-2007, 07:56 AM
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#4
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Senior Member
Join Date: Feb 2006
Location: Acworth, GA
Posts: 2,104
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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?
__________________
Kate
Stage IIIC Diagnosed Oct 25, 2005 (age 58)
ER/PR-, HER2+++, grade 3, Ploidy/DNA index: Aneuploid/1.61, S-phase: 24.2%
Neoadjunct chemo: 4 A/C; 4 Taxatore
Bilateral mastectomy June 8, 2006
14 of 26 nodes positive
Herceptin June 22, 2006 - April 20, 2007
Radiation (X35) July 24-September 11, 2006
BRCA1/BRCA2 negative
Stage IV lung mets July 13, 2007 - TCH
Single brain met - August 6, 2007 -CyberKnife
Oct 2007 - clear brain MRI and lung mets shrinking.
March 2008 lung met progression, brain still clear - begin Tykerb/Xeloda/Ixempra
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01-24-2007, 07:57 AM
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#5
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Senior Member
Join Date: Feb 2006
Location: Acworth, GA
Posts: 2,104
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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?
__________________
Kate
Stage IIIC Diagnosed Oct 25, 2005 (age 58)
ER/PR-, HER2+++, grade 3, Ploidy/DNA index: Aneuploid/1.61, S-phase: 24.2%
Neoadjunct chemo: 4 A/C; 4 Taxatore
Bilateral mastectomy June 8, 2006
14 of 26 nodes positive
Herceptin June 22, 2006 - April 20, 2007
Radiation (X35) July 24-September 11, 2006
BRCA1/BRCA2 negative
Stage IV lung mets July 13, 2007 - TCH
Single brain met - August 6, 2007 -CyberKnife
Oct 2007 - clear brain MRI and lung mets shrinking.
March 2008 lung met progression, brain still clear - begin Tykerb/Xeloda/Ixempra
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01-24-2007, 10:54 AM
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#6
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Senior Member
Join Date: Apr 2006
Location: MS Delta in Clarksdale="Home of the Blues" (near Memphis,TN)by Misssissippi River/levee's highest pt.
Posts: 224
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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
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01-29-2007, 11:55 AM
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#7
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Senior Member
Join Date: Jan 2007
Posts: 144
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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
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