I need advice on chemo treatment

[diannel]

Hi Chrisy:

Thanks for the response. Yes, they are saying the kidney tumor is a new primary, and that it has been there at least since 2004, but I guess I will know for sure when the pathology comes back on it, after surgery.
My oncologist said he might switch me to Tamoxifen, since the Arimidex didn't seem to work. This new breast tumor was 70% ER positve, PR neg. and Her 2 positive. Whereas the one from three years ago on the other breast was 60% ER positive and 30% PR positive and Her 2 negative.
Thanks,
Dianne L

[diannel]

Hi Lala:

Thanks so much for the two articles. It still sounds like reduction for risk of recurrence is better by 12% for the Adriamycin group. I guess I have to find out if I am Topo II positive. Does anyone know anything about the test or where to get it?
Thanks,
DianneL

[Lala]

Dianne
I am confused as to where the 12% recurrence rate is stated in which article?

I just looked at the article
Breast Cancer: Non-Anthracycline Regimens Superior for Early Her2 Positive Disease once again.

It states that
Both of the trastuzumab-containing regimens significantly improved disease-free survival compared with the non-trastuzumab-containing regimens; at four years, 92% of patients on ACTH and 91% of patients on TCH were still alive compared with 86% in the AC→T arm.

TCH outperformed AC→T and AC→TH in the treatment of breast cancer, Dr. Slamon said.

TCH had the optimal therapeutic index, thus avoiding the cardiac damage related to sequential use of anthracyclines and trastuzumab.

The best outcome for early-stage HER2-positive breast cancer is obtained with a non-anthracycline regimen [TCH], and results of this trial should impact the way early-stage breast cancer is treated. TCH should be the preferred option in HER2-positive early breast cancer. He questioned whether there is still a role for anthracyclines in the treatment of early breast cancer.

Because Anthracyclines are cardio toxic there is a higher risk for those who take herceptin.

I still think TCH is the better combination overall.
Also in regards to tamoxifen I tried it but found it did not work for me. I was told that Fasoldex would be better as there are studies showing it works in mets. I too am pre meno so I would have to use this with a Lupron shot. Maybe you should ask your oncologist for the studies showing tamoxifen vs fasoldex. It takes 3 months for hormone drugs to show response vs chemotherapy that takes 2 months. There are so many treatment options available.

I wish you the best.

[Jean]

Dear Dianne,

Welcome to our site and I am sorry that you are in need to join us.
But here you are - and you have the best place to gain support
and knowledge.

First of all let me explain about the TOPO 11 test...I had the test done.
If you are going to have TCH...(which by the way is what I had)
you will not need to bother with the TOPO 11...this test is important if you
are going to have A/C...it has shown that patients that are TOPO 11 positive
the A/C treatment will work well...if negative not so good....If you are not
going to have the A/C it does not matter about the TOPO 11. This test is
done by a sample of your tumor sent out to a lab. The lab I used was out
in Calif. with Dr. Slamon. It was covered by my insurance and was not
expensive about $250.00.

Next: You will be wasting your time and money on the Oncotype DX test
since that would be for a patient who is boarder line on chemo treatment,
for instance a small tumor under 1cm and less...
and your tumor is 2cm which means a ticket to chemo. So save your money on this test which is $3,000.00 and your insurance may not cover it.

A little confused about your kidney tumor. You mention that it has been there as a slow growing tumor since 04...does the dr. think this is not
cancer? I am wondering if the tumor on the kidney is not a threat would
the dr. consider treatment for the bc a priority? Since you had a lumpectomy
I am also assuming you will be having radiation treatment? Have to figure in
time line for that treatment also.

It is impossible to advise on the schedule of events...but if the tumor on the kidney is not a health threat - I would want the bc treatment started.
TCH is the preferred treatment these days. It eliminates most of the risk
of heart damage and is very doable. I did loose my hair on the TCH
and most of the gals on the site that did TCH lost their hair. But I don't think
that is important either way...we all look beautiful with or without our hair.

Everyone on the site is extremely helpful and you will gain much knowledge
as you begin to make decsions. I think the hardest part is getting the answers to all the questions, so many decisions. Just make careful decisions
but I think you will discover here that the TCH is the better choice.

If I can be of any help - just reach out....
Wishing you all the best and please let us know more about the kidney tumor.
Regards,
Jean

[Jean]

http://www.breastcancer.org/research...in_012606.html

Diane,
Please read this link...I think you may have mis-read the part about %...
it was not 12%...but 1.2% (1 point .2)%

Jean

[diannel]

Hi Lala and Jean:

Lala: I was looking at the interium 23 month study which gave the ACTH arm 51 % reduction in risk and the TCH 39% reduction in risk of recurrence. That is a 12% difference. But now the 36 month results are out and you are right, it is 91 and 92% still alive. (Does still alive mean no recurrence, I wonder?)
Jean: I was thinking the same thing about the kidney tumor, since it is slow growing and not much of a threat, let's get all the breast treatment out of the way, then go after the kidney. But my husband and I sat down with the oncologist, and also talked with the urologist, and neither of those guys think it would be prudent to wait six months to get the kidney tumor out. Then I got bronchitis and couldn't keep my surgery date with the urologist for today.
I also failed to mention that we have a big family vacation plannned and paid for (No refunds) the last week of June, with all four daughters and husbands and two grandbabies who will attend. So the urologist is willing to wait to remove the tumor. My breast surgeon was against my having a chemo treatment and then my going out of town, and I didn't especially want to go on the vacation under the effects of the first chemo treatment. So everyone is holding off until the first week of July when I return to Houston. The way it stands now, I will get the kidney tumor removed, wait two or three weeks, and then "hit me with the chemo." Then radiation after the TCH, if I choose that regimen. I want the chemo that is going allow me into old age.
As for the TOPO II test, from what I read in the 1/27/06 article in AACI news, which is a year old, about Herceptin, etc...."TOPO II is more likely to respond to Adriamycin" so I conclude, if you've got TOPO II you'd be better off taking Adriamycin.
Also, something else I would like to know: There are about four different types of Her2 amplifications that they know about so far. Wouldn't it be better to find out which one you have, and how it responds to the different chemo regimens? But I guess there's no test like that for sale yet.
Signing off for now, I haven't quite got my quote thought up yet,
DianneL

[Bev]

Hi.

1. Did AC, but I'm not sure what is best. Maybe get a few more opinions.

2. I don't know about kidneys, but as you have 2, I would be thinking about getting that one out.

3. I think the fish test is telling you that you have roughly a 50% chance of responding to Herceptin.

4. I have read that most oncotypes for HER 2 + will come back as high risk. It seems to be most helpful for stage 1.

5. Somewhere there is a definitive study as to optimal times for treatments. If you search, you may find it. The Docs like 3 to 5 weeks, but I think people fared well up to 8 weeks. This would be worth looking for.

If you're like a lot of us, you could probably do treatment a week before vacation and be OK. But it looks like if you deferred treatment. you wouldn't be further out than 6 weeks which I think might be OK.

So keep asking questions. Good luck and enjoy your vacation. Bev