How many chemo's should be taken, when and Why

[AMTIL]

My MIL is diagnosed with BC with 7cm lump on her right side. Doctor suggested us to go with chemotherapy of 4 sittings and then surgery and targeted therapy. After 3 chemo's is done doctor insisted us to proceed with the surgery as it can be operable, but he also said that 1 more chemo should be given after surgery as 4 chemo and 4 targeted therapy is mandatory.

Can someone tell me why 4th chemo has to be given if it is operable now.

As she has few side effects of chemo we asked doctor whether 4th chemo can be given before surgery or not so that she can recover from the surgery fast if she does not have to take the chemo after surgery.

He said it can be given now and so we decided to go for 4th chemo now.

Kindly through some knowledge on the how many chemo's should be taken and when and why it has to be taken before/after surgery.

Note: ER,PR Negative HER Positive Stage 2 and 3.

Thanks,

AMIT.

[roxboxfox RadiationOncologist]

What is the chemotherapy protocol your mil is undergoing.

There are quite a few protocols...like

FEC T

Epi CMF

AC T

EC T

TAC

One undergoes 6-8 Cycles of chemo and from 3-4th chemo you also start with Herceptin

It does nit make a difference whether u have 3 or 4 or 6 upfront....

Total number should be 6-8

The reason this fixed as the chemo not only shrinks the main lump but also eradicate the micrometastasis deposits in her body which are not seen by our eyes nor are they seen on scans.

[AMTIL in reply to roxboxfox]

Thanks Doctor for your quick reply!!!.

She is under AC T. The reason I have asked this is, the information that I have got is the number of chemo's before surgery actually improves the chances of breast conservation is it really true? Given a chance Lumpectomy and mastectomy which will have the more advantages.

Why can't the surgery be carried out first and then chemo in few cases(like in my MIL case).

[roxboxfox RadiationOncologist in reply to AMTIL]

The protocol is designed for pts with Locally advanced Breast cancer

where 4 cycles of AC are given followed by 4 cycles of Taxotere.

(Total 8 cycles over 24 weeks).

The Herceptin (in cases of Her 2 Positive pts) is added once Taxotere is initiated.

She would need to have 17-18 cycles of Herceptin over a 1 year period.

Some surgeons give upfront all chemotherapy.

Some sandwich chemotherapy before and after chemotherapy.

Some give chemotherapy post surgery.

The survival and long term results for all three above cases is the same.

You are right, Neoadjuvant chemotherapy or Preop chemotherapy improves the surgical resectability rates.

For someone who is borderline operable, it will help surgeon achieve clear margins.

For someone who wishes to have Breast conservation, if a surgeon feels upfront surgery will lead to significant distortion of the breast cosmesis, then once again Preop chemotherapy may help > 50% women achieve that.

For someone with a 7 cm mass, I think breast conservation is perhaps unrealistic, and a Mastectomy would be the plan for most surgeons, but its difficult to give comments without knowing the Mammo report, reviewing the patient and knowing about patients expectations....

I m sure Dr Sumeet will shortly express his views as well, if someone has large breasts, and has a large mass 7 cm, in his experience has he conserved such Breast after having given Neoadjuvant chemotherapy.

Dr Rohit Malde MD, DNB, FRCR (UK)

BNH HCG Cancer Centre

Dr Balabhai Nanavati Hospital

Vile Parle, Mumbai

Vertex (Apex) Hospital

Mulund

[AMTIL in reply to roxboxfox]

Thanks Doctor for your detailed mail.

[sumeet_shah Administrator]

Dr. Rohit has already answered what I would have answered.

The standard total chemotherapy cycles are usually six or eight and all patients need to take full course of chemotherapy. Half courses do not help. So my suggestion, you sit with your Oncologist and understand how they wish to give the chemo. They are in the right line, don't worry.

Also, when tumour is large, surgeons give chemo first and then lookout for a suitable window to operate when it has become small. Sometimes, tumour reduces fast and surgeons may operate after 3rd chemo. Sometimes, it is slow to reduce, and they wait till 4 chemo. But, on an average, it is seen that if it doesnt shrink by 4th chemo, it wont shrink any more and so we do not wait more after 4th chemo.

Apart from this, as for your last question on number of chemo and all, each and every patient is different and decisions are tailor made according to the type, stage, grade and response. So it is best that you sit with your Oncologist and discuss it out.

[ran_sav]

amit,i had almost the same size of tumor,i was given 3 cycles of chemo,than was operated.many doctors had advised to go for the mrm,but my oncosurgeon on seeing the results of chemo decided for lumpectomy.i am really grateful for him.after the surgery i took another 5 chemos.so a total of 8 chemos overall and 21 days radiation.

[greenbear]

Masectomy and lumpectomy are the same as far as prognosisis concerned. If her tumour has shrunk and they feel it is operable why not. It depends on her preference. I had 12 weekly cycles of herceptin and taxol and then surgery and then three cycles of FEC chemo. Even if the tumour disappears you have to take the full course and the reason is given by Dr. Rohit. If she is her2 + then a total of 17 cycles of herceptin.