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Triple negative breast cancer and chemo

mimivac's picture
mimivac
Posts: 2147
Joined: Dec 2008

This came out in the New England Journal of Medicine on May 14th. Apparently, older women with early stage receptor status negative breast cancer (as well as those with positive receptors) did much better on standard chemotherapy than on Xeloda, which is becoming a treatment option for certain triple negatives. Even though I am not over 65, it is good hear that study subjets who received standard chemo had an overall survival rate of 91%. Here is a synopsis:

"Standard chemotherapy more effective than capecitabine for older women
Older women with early-stage triple negative breast cancer had four times the chance of relapse if they were treated with the chemotherapy drug capecitabine (Xeloda ) rather than standard chemotherapy, either cyclophosphamide/methotrexate/fluorouracil, or doxorubicin/cyclophosphamide. Their risk of death was three times higher.

Capecitabine is taken orally.

Women 65 and older were randomly assigned to standard chemotherapy or capecitabine . Among the patients in the standard chemotherapy group, 133 chose cyclophosphamide/methotrexate/fluorouracil, 184 chose doxorubicin/cyclophosphamide and nine withdrew without choosing a treatment.
CMF was administered in standard doses for six cycles repeated every six weeks.

AC was administered in standard doses for four cycles repeated every three weeks.

Capecitabine was administered in two divided doses for 14 consecutive days every three weeks for six cycles.

Patients were evaluated at an average of 2.5 years. For all women regardless of receptor status, those in the capecitabine group had double the risk for recurrence and a similar risk for death. Breast cancer was the most common cause of death in the capecitabine group compared with other cancers or cardiovascular disease for patients in the standard chemotherapy group.

But when women were further evaluated by receptor status, those in the triple negative group fared even worse, with four times the risk of recurrence and three times the risk of death.

Standard chemotherapy also resulted in increased estimated three-year relapse-free survival (85percent vs. 68percent) and overall survival (91percent vs. 86percent) compared with capecitabine for all women, regardless of hormone status.

The data were published in the May 14 issue of The New England Journal of Medicine."

Aortus's picture
Aortus
Posts: 967
Joined: Jan 2009

Thanks so much for sharing the great info, Mimi! How on earth do you find all this new stuff? We're meeting with our St. Louis oncologist this afternoon, and will certainly pass along anything new we come across.

Joe

mimivac's picture
mimivac
Posts: 2147
Joined: Dec 2008

Joe, if it's not too late, I found something else interesting you might want to ask about. It's from a study that came out of the Impakt Breast Cancer Conference in Brussels and talks about androgen receptors. This is a new concept for me. A summary:

"Androgen receptors: a new category of triple negative breast cancer?
Another receptor—the androgen receptor—is being studied to help evaluate the aggressiveness of breast cancer tumors and how they react to treatment

“I think we are seeing the birth of a new concept in breast cancer—the androgen-receptor-positive breast cancer,” says Jose Baselga, M.D., co-chair of the Impakt Breast Cancer Conference in Brussels, Belgium. “This is an important development in finding new targets that we can attack with new drugs in the future.”

The Impakt conference was sponsored by the European Society for Medical Oncology May 7-8, 2009.

Patients who were triple negative breast and who also had androgen receptors tended to react less favorably to chemotherapy than those without the receptors.

A clinical trials is now underway to target these receptors, with the hopes of using it for prognosis and the development of drug therapy."

Christmas Girl's picture
Christmas Girl
Posts: 3689
Joined: Apr 2009

Are your keen research abilities - and the amazing way you translate complicated & technical into "layman's terms" - in any way connected to your government job? Just kidding!!! :-)

Am enjoying your new pic - from your post-chemo & pre-rads vacation? You look lovely, as does the backdrop.

Kind regards, Susan

mimivac's picture
mimivac
Posts: 2147
Joined: Dec 2008

Yes, the picture was taken in Puerto Rico on our hotel room patio. The blue you see behind me is the Caribbean.

Christmas Girl's picture
Christmas Girl
Posts: 3689
Joined: Apr 2009

Been thinking about you, Moopy. You, too, Joe. Warmest best wishes for the best possible outcome from this very important appointment later today. I'm sending lots of HOPE!

Kind regards, Susan

mimivac's picture
mimivac
Posts: 2147
Joined: Dec 2008

Joe and Moops, please let us know the outcome when you can. I am thinking of you.

Mimi

cats_toy's picture
cats_toy
Posts: 1462
Joined: Feb 2009

I am seconding Susans wishes, let us know how it goes!

=^..^=

Aortus's picture
Aortus
Posts: 967
Joined: Jan 2009

Moopy's appointment this afternoon went very well. Not that there weren't surprises, but our oncologist was most gracious with her time and attention. She is an amazing physician and an amazing woman.

Some tips before I forget: 1) if you had Adriamycin and/or radiation on the left (heart) side, our oncologist recommends monitoring by a cardiologist with chemo experience. 2) close monitoring by one's PCP or internist is important. 3) During radiation and up to 3 months afterward, one is at increased risk of dry cough and shortness of breath - so report it right away. 4) Keep the port in until this period is over; it will be useful for treating the cough/breath condition if needed. 5) Skin which has turned brownish will get back to its normal color if one uses sunblock.

As for treatment post-rads, our oncologist strongly believes in not using additional treatments until they are proven necessary. She was also not keen - and that is a considerable understatement - about Moopy participating in clinical trials, Stage II and below.

Thank you all for your concern. We are both feeling uplifted and your good wishes and kind thoughts mean so much to us!

Joe (and the Moopster too)

Christmas Girl's picture
Christmas Girl
Posts: 3689
Joined: Apr 2009

It all sounds really good, just great! Most importantly, your confidence in Moopy's "2nd opinion" oncologist is comforting to all of us who care so much about Moopy, and you.

So glad you're BOTH feeling UPLIFTED! YAY! :-)

Thanks for the update. Now, on to rads!

Kind regards, Susan

djteach's picture
djteach
Posts: 275
Joined: Apr 2009

Thanks MiMi,
Thank you for all of the research you do and share with us. I have learned so much from the sisters and brothers here you just wouldn't believe.

I wanted to but into this thread because of the information that Moopy and Aortus shared from their onc. I had the andriamycin or Red Devil is what my onc called it. Before chemo, I had no heart problems, not even high cholestoral. I had 5 different drugs in my "cocktail". My first chemo was on sept.5 of '05 and I had two heart attacks by oct. 8. I didn't know what the first one was. My second one lasted about 20 min. and I still wasn't sure what it was. I called my onc. the next morning and was sent to the emergency room immediately. I was so lucky. Both my cardiologist and my onc. agreed that it was the combo of the cocktail, but especially the red devil that was the culprit combined with the radiation that I had between my 1st and 2nd chemo. So it really does happen. Luckily, I have regained 95% of my heart muscle function back, Yeah! I hope it never happens to anyone else.

I'm glad that everything is going so well for you, Moopy. You, MiMi and 12/25 are my heros. Aortus, you are a hero too for being so involved with your wife's survival and you remind me of my baby brother.(that's a compliment)

MiMi, keep that info coming because it makes sense when you say it. I used to be able to read and understand research but,,,I forgot.

Love and gentle hugs,
Donna

Murphy27's picture
Murphy27
Posts: 1
Joined: Sep 2020

Hi, I was diagnosed with TNBC last month. I've been going for testing and I have met with the breast surgeon who is saying that chemo for 4-6 months every 2-3 weeks and then surgery and radation after that. is the best treatment for this type of cancer. I am in early stage 2 and the MRI showed it wasn't in my other breast. They don't "think" it has spread to the lymph nodes. I am meeting with the medical onc tomorrow and going for a 2nd opinion the next day. I'm terrified of chemo. I am 68 years old and don't know if my body can handle it. I have high cholesterol that I have been dealing with for many years with very little success. Any suggestions? Thanks

QtKish's picture
QtKish
Posts: 2
Joined: Oct 2020

Hi Murphy, 

I love what Kristen said to you, and I would have loved to have heard those same words from someone in her position when I was newly diagnosed with tnbc, but I would have been really upset about it later. Because not all experiences are the same - some of us really do have a horrible time in cancer treatments just like the movies portray it - if not worse. 

I'm not saying this at all to scare you further during this already incredibly scary time in your life, please believe me in that, but after reading so many posts during the last almost year like Kristen's, and feeling weak and beating myself up for not having an easier time with treatment, I thought I should speak up for the ones of us who are more like me and have an aversion/allergy/sensitivity/whatever to chemo and radiation. I joined this site after not talking about my experience with bc on any other forum, or really with anyone, because of your comment/question. I didn't want you to go away thinking that bc treatment is a breeze for everyone. That's what everyone had me believing, and treatment almost killed me. And losing my husband by my side in the middle of chemo due to covid, was one of the reasons I almost died. 

If you have any questions or need to talk, I'm usually up really late contemplating life and it's struggles. I pray that your experience is way more like Kristen's than mine during your journey through this difficult time. 

You'll be in my prayers.

Kristen0630
Posts: 10
Joined: Aug 2020

QT,

I am so sorry if my comments made you beat yourself up. We are all on this journey together, and that was never the intention of what i wrote. Chemo is hard--certainly not easy for any of us. I only wanted to share that it is possible to make it though and we are all stronger than we think we are. That doesn't mean things are easy, but that we can get through them. Especially with the support of others who are on the same path.  It sounds like you've really been through a lot and that we are at very similar places in treatment. I'm here if you ever want to talk to someone going through a similar experience. And I will keep you in my thoughts and prayers. Again, please know my intention was never to make anyone fighting this disease feel less. 

Kristen0630
Posts: 10
Joined: Aug 2020

Murphy,

I had to say hello from a fellow recently diagnosed TN. I was diagnosed this spring and just finished chemo two weeks ago, so I really feel where you are right now. It sounds like you are on the same treatment path as I am: chemo, surgery, radiation. I just wanted you to know, if I can make it through chemo, you can too. I will also share one thing my oncologist said that helped me out a lot. It's not at all like what you've seen in the movies. Hollywood makes it look horrible, because it's Hollywood. It is not as bad as you fear. And doing this through COVID is scary, because you think you will be alone, but you won't. Nurses in general are amazing, but chemo nurses are off the charts special. They will understand how hard it is to be alone, and if you're lucky like me, you will end this yucky chapter with some amazing friends. 

There are a lot of people on this board so much further along and more knowledgeable than me, but please know I'm here, too. We triple negatives have to stick together, right? Youre stronger than you know. Please keep us posted and know I'm happy to be there any time for you. This is scary, so having friends on the same path is such a help.

Sending you a virtual hug,

Kristen

anniemshe's picture
anniemshe
Posts: 77
Joined: Oct 2017

Stay strong! Prayers and positive thoughts sent your way 

beek70's picture
beek70
Posts: 1
Joined: Oct 2020

Hi All! I am so happy to find this forum. from what I see TNBC is rare. I am in the process of undergoing chemo after a lumpectomy & a negative sentinel node biopsy. I am 50% through the treatment & am finding it very difficult. the strange thing is that after every infusion I seem to get different side effects and also how I feel can vary almost from hour to hour. I have never experienced anything like this & I am wondering if anyone else has experienced this as well. I find that as the infusions progressed in number the side effects got worse so I'm assuming it's cumulative. After #1 I was almost ok after 7 days, now it's 10 days out & I am really still feeling weak & debilitated. I came into this really strong but now that's not the case. I was walking 3 mi/day in the beginning. now I am lucky if I can make it up the block. Seen anything like this?

Primavera's picture
Primavera
Posts: 195
Joined: Mar 2019

I am having chemo before the surgery. AC every two weeks, 4 treatments, and then taxol weekly for 12 weeks. The first AC treatment left me with just a bit of fatigue the second or third day and then I was OK, as if I hadn't had anything. The second was easy, too. I started to think I wouldn't get much on side effects, except for losing my hair. The third one last week has given me a lot of fatigue. It's been a week and I feel weak and dizzy; I noticed my nails are starting to get black near the cuticle. Third day after getting the last AC treatment, I started sleeping. I've slept most days (and nights!) past 3 days.

My hemoglobin keeps on dropping consistently, so not sure if that's why I'm so tired. I haven't been exercising at all because I've been afraid to get out on my own. I tried to walk after the first infusion, but was a tiny bit dizzy.

All in all, it's not awful. You have to take it one treatment at a time. Who knows? Maybe the next one will be OK. And then I'll worry about Taxol. Some people think Taxol is a piece of cake after getting AC, while a few have a hard time with Taxol. I can only think ahead to the next one. All I'm trying to prevent for now is neuropathy in hands in feet; doing the icing.

I found another thread about this from earlier in the year.

https://csn.cancer.org/node/321125

 

Bob C
Posts: 2
Joined: Oct 2020

Hi,  My wife has had 8 treatments with taxol and the nausea is constant.  We have all the meds but nothing seems to help.  They did a brain MRI today just to be safe.  Anyone else have this problem and if so, did you find anything that helped the nausea.   She has always been very receptive to the side effects of all meds, even to OTC ones.  thanks in advance

Kristen0630
Posts: 10
Joined: Aug 2020

Bob,

I also struggled with nausea. Luckily, I habe a very caring MO who was willing to try many different meds until we find the right one. It was actually off label for nausea, but worked wonderfully for me. It took a lot of tries until we found the right med for me. I would say stay close to your MO and keep trying until you find the right med. I'll be thinking of you and your wife. Please let us know how she is doing. 

kristen 

Bob C
Posts: 2
Joined: Oct 2020

thanks.  Can you say what finally helped you with the nausea?

Primavera's picture
Primavera
Posts: 195
Joined: Mar 2019

I take what my doctor has given me: Ondansetron (Zofran?), 1 tab by mouth every 8 hours for 3 days after chemo; but I've really haven't done it religiously. Sometimes I take one a day and I'm OK. I do try to stay away from the kitchen or any food smells. I feel like that triggers nausea.

I have another prescription that I've never opened, to take if nausea continues three days after chemo. I think these pills give you constipation, so I try not to overdo it.

Friends from the office have sent me these candies for pregnant women called Queasy Drops. Once, when I got nauseous after port surgery, I sucked on one of those candies for a long while and it took it away. I don't like the ginger ones, but I think it's ginger that helps the most.

I've read (a lot!) that eating watermelon helps; people highly endorse watermelon. I've never tried it.

Some people have tried ginger cookies from Trader Joe's. Some people suck on a popsickle or ice chips.

The three drugs that I've read about the most at this site are: Emend, Zofran and Compazine. I don't know which one your wife has been given. I remember copying this here, when I was getting ready for chemo.

-----
The three common anti nausea meds - Emend, Zofran and Compazine work differently in the body...
Emend is a wonder drug--it works on the vomiting center in the brain.
Zofran works on receptor sites in the stomach.
Compazine is for breakthrough nausea.
------
I'm glad I took Emend for nausea, they call it the miracle drug, very expensive 3 pills cost the insurance 360.00. Made by Merck. My copayment was 6.00.
------
See if your mother's doctor will prescribe Emend which prevents nausea and vomiting.  It's normally given in pill form, but I got it approved to be put in my port before my chemo was started each time, as the pill form was going to be too expensive with my insurance.  I had the pill form with a different insurance back in 2010.  I've never had nausea and vomiting. 

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