Karen's results from Vanderbilt

All,

Here is all we found out yesterday. Any thoughts or suggestions are
much appreciated, as are prayers.

Results of Tests:

CT Scan of abdomen and chest - negative for tumors
PET Scan of entire body - negative for tumors
Blood tests for liver, etc. involvement - negative for tumors
Pathology - triple negative (not responsive to estrogen, progesterone,
and HeR-2 protein)
Ki-67 60% of cells staining (HIGH, unfavorable)
Infiltrating ductal carcinoma grade 3/3

Ultrasound used today and two needle biopsies taken from underarm
lymph nodes on Wednesday (yesterday).

Discussion:

This is a highly aggressive tumor, large size (3cm on mammagram 6/26,
external palpitation was 6 x 8 cm today 7/18), and triple negative
(not responive to estrogen, progesterine, or protein) so the risks of
recurrence are higher for spread and recurrence than typical for this
type of cancer.

Treatment Plan:

Port to be installed on 7/23 along with sentinel lymph node biopsy (if
today's biopsy proves negative for cancer)
Chemo to begin with Taxotere every 2 weeks for 4 treatments, to be
followed by a combination treatment of Cytoxan and Adrimycin every 2
weeks for 4 treatments. Rest for ~1 month then surgery to remove
primary tumor and potentially all lymph nodes depending on previous
lymph node biopsies. After surgery immediately begin radiation
treatment (local) for 6 weeks, 6 days a week (total of 36 radiation
treatments). The logic in doing chemo first is to gauge the
effectiveness of the chemo before the malignant tissue is removed,
more so than achieving a better "cosmetic" result.

Doctors refuse to give prognosis at this point due to lack of
knowledge regarding lymph node involvement.

I have a few questions:

Is it equally effective to administer Taxotere prior to Adrimycin and
Cytotax compared to reversing this order (AC then T)?

Is it safe to have chemo done in Nashville 100 miles away and have a
local family doctor direct any problems with side effects through the
Huntsville Hospital?

Has anyone else had this "dose dense" application of Taxotere,
Adrimycin and Cytotax delivered either as Taxotere every two weeks
times four doses then Adrimycin and Cytotax every two weeks for four
doses?

Thanks,
Jeff

Jeff wrote:

snip

>
> Discussion:
>
> This is a highly aggressive tumor, large size (3cm on mammagram 6/26,
> external palpitation was 6 x 8 cm today 7/18), and triple negative
> (not responive to estrogen, progesterine, or protein) so the risks of
> recurrence are higher for spread and recurrence than typical for this
> type of cancer.
>

snip

>
> I have a few questions:
>
> Is it equally effective to administer Taxotere prior to Adrimycin and
> Cytotax compared to reversing this order (AC then T)?
>
I don't think there is any real evidence of a preference across the
piece, it will depend on the specific tumour which works better. My gut
feeling is the taxane would most likely be best first here, but I'm not
exactly sure why, maybe because of the high division rate.

> Is it safe to have chemo done in Nashville 100 miles away and have a
> local family doctor direct any problems with side effects through the
> Huntsville Hospital?
>

I would think so as long as the cancer centre is only a phone call away
if anything goes awry. There are always possible situations and
solutions the local guys might not pick up on immediately, but with
expert backup it should be OK.


Tim Jackson

>
> Has anyone else had this "dose dense" application of Taxotere,
> Adrimycin and Cytotax delivered either as Taxotere every two weeks
> times four doses then Adrimycin and Cytotax every two weeks for four
> doses?
>
> Thanks,
> Jeff
>

It is done often in the Boston area. A good link is

http://www.youngsurvival.org/young-w...-bc/resources/


I agree with Tim a local hospital can deal with any chemo issues. Sounds
like you have a game plan.

Alex