I am writing this on behalf of my Mother, 52 years old homemaker, who was diagnosed with Breast Cancer exactly a month ago. PET Scans done 2 days later confirmed she was stage 4 with one large lesion (Abt 7 Cm) and multiple small lesions in the Liver. PET scan suggested possible Mets to Bones and suggested MRI to confirm the same but results of the MRI was still inconclusive. Attaching the MRI Report here. She is ER/PR- and HER2+ (3+).
It surely has been a life changing news for us in the family and have been running from pillar to post ever since. Living in Delhi, we are blessed to have close family ties (though we are a nuclear family) and everybody around has been there to encourage my mother and offers a helping hand with Daily chores and household management. However, at the end of the day the enemy inside her is determined to take her down and I am not going to let it win! Having met the best of doctors in this part of the world, I understand that standard of treatment for this stage is a palliative treatment combining Chemotherapy and Targeted Therapy. As she is HER2 positive, Herceptin (Trastuzumab) is to be given for targeted therapy and Perjeta (Pertuzumab) can be combined with that too.
Coming back to my mothers situation, we are determined to give her the best possible treatment. Accompanying costs is not an issue, she has a very modest insurance cover of about Rs. 3,00,000 rest of the funding would be done through our monthly incomes and savings. After complete rounds of testings etc, she finally started on her Chemo on 29th April. The regimen imlemented by our current onco is as follows - 3 Cycles of FEC (5 Fluoroacil + Epirubicin + Cyclophosphamide) + Herceptin every 21 days followed by 3 Cycles of Docetaxel + Herceptin. The doctor has suggested that we begin with giving Herceptin alone and see how she responds and could add Perjeta later on if he feels necessary. The treatment is being done at Delhi State Cancer institute, under guidance of Dr. Rajesh Grover. I have a few questions, I have tried to find answers through the doctors as well as internet research, but yet to have complete clarity -
1. I am not sure if FEC chemo is appropriate for this treatment. I am aware that in US the standard currently is Taxol + Herceptin + Perjeta. As per my doctor, FEC is as or more effective than Taxol but Taxol has been propagated more because it is expensive and benefits the Pharmas. Would love to hear some learned opinions on the same
2. Is it appropriate to begin with Herceptin Alone and add Perjeta later, or maybe when the Herceptin resistance develops?
3. Doctors are not looking at establishing mets to bones so aggressively. I do understand that the treatment will remain more or less same even if there is mets to bones, barring role of radiation if pain increases, but do feel we should have complete clarity on the extent of spread Further the MRI results are also non conclusive. How important is this information and what is the best way to confirm bone Mets?
4. Timings of PET Scans - As per my view we should get a PET scan after this first round of chemo so we can see if the treatment is effective. But I am not sure if one cycle is expected to yield noticeable results?? My concern is that if this combination of chemo and medicine is not so effective then we should take corrective action in quick time. What is the ideal timing for PET scan initially and thereafter? My doctor plans to schedule one after 3 cycles, but I wonder what if its too late? PET scans in Delhi can be done for as low as Rs. 9000, so its a fraction of the treatment cost. Will it useful to get one done every 45 days or so? We are also getting her some alternative treatments based on ayurveda and homeopathy. It would be important to track their efficacy as well
5. Vitamin C infusion - Is it effective? Has anybody on this forum used it for stage 4 and seen positive/no result??
6. Any opinions on Delhi State Cancer institute and doctor thereby?
I just realised how long this post has already been So I will cut it short here and thank you all for going through it. All opinions/suggestions are most welcome. Wish everybody battling this terrible disease the very best.
Strength and Love to you and your family.
Her Loving Son,