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Re: No Pain, No Gain: A Fallacy So Far
Just a note on the section about tamoxifen. There was a recent report posted here that perhaps CYP2D6 testing had been discarded prematurely based on outright stupidity in the method of testing.
http://www.medicalnewstoday.com/releases/286786.php
Quote:
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...two large clinical trials found no link between the CYP2D6 genotype and tamoxifen effectiveness, prompting recommendations against testing. In the new Mayo Clinic study, researchers found that previous studies, which used tumor tissue instead of healthy tissue [emphasis supplied] to determine the CYP2D6 genotype, were prone to error. The study found that up to 45 percent of breast tumors exhibit genetic alterations affecting the CYP2D6 gene. Thus, the use of tumor tissue to obtain DNA leads to a distortion of the patient's true or inherited CYP2D6 genotype.
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Why on earth anyone would test *tumor tissue* to determine CYP2D6 metabolizer type is a mystery for the ages.
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2/6/09 Core needle biopsy: negative; Mammos through 2010: no change
3/30/11 Pea-sized lump in left breast at site of prior biopsy; mammo negative, sonogram not so much
4/14/11 Core needle biopsy: negative for cancer
5/18/11 Excisional biopsy 1.2 cm tumor, LVI, positive margin; ER+60%,PR+20%,HER2/CEP17 5
6/15/11 BMX: Left DCIS & LH; Right ADH; SNB: 2/3 nodes: 1.4 cm and 1 mm; ALND L1&2: 0/10; Stage IIa, Grade 3
7/14/11 CT/Bone scans NED; MUGA 66%
7/19/11 Biweekly dd AC w/Neulasta; done 8/30/11
9/13/11 Transfusion (Hemoglobin 8.6); MUGA 64%
9/20/11 Start Taxol + Herceptin; Taxol done 12/6/2011; continue Herceptin until 9/4/2012
12/27/11 Radiation - 6 weeks; 2/27/2012 - DONE! Yayyyy!
2/29/12 Start Tamoxifen 20 mg/day; continue until 2/28/17
5/16/12 Start five-years Metformin trial
6/19/12 MUGA 61%
8/21/12 Brain MRI NED (head still hurts, brain still fogged)
9/4/12 Herceptin done!
9/6/12 Port out!
7/11/13 Aricept 5mg for cognitive impairment; increased to 10mg as of 8/23/13; back to 5mg 12/2013
5/2014 Add Namenda 7mg
9/2014 Stop Aricept and Namenda; Neuropsychological evaluation
10/24/14 Start cognitive rehabilitation therapy
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