Triple negative Breast cancer reoccurrence and treatment

Harpreet1Harpreet1 9 hours ago 0 Replies

Hi this is Harry,my sister is 34 and she had breast cancer in one of her breast last July 2016. As soon as it was diagnosed, bcs was done. Then we came to know it was a triple negative Breast cancer and had her nodes affected too. Then chemotherapy (Taxol,4+4) was done followed by radiotherapy(30). The chemotherapy got over by 30th December 2016. Radiotherapy was over by March 20th 2017. The cancer has come back in her other breast and we only got it confirmed yesterday. We have been advised a PET CT which will be done tomorrow. We all are so shaken and want to know the further line of treatment that needs to be given. We have now get her BRACA 1/2 done. Results are awaited... Please advice.

Thank you

Harry

India

4 Replies

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  • hi harry. I am a layman, but the chemotherapy regimen the first time around seems lacking. WHY did they not use FEC (5 fluorouracil (also known as 5FU), epirubicin and cyclophosphamide OR the other option, an Anthracycline, following the Taxane (Taxol). The treatment provided to your sister is not standard regimen, and you really should consult with a top breast specialist (another doctor specializing in breast health) - and share the treatment history with them).

    Yes the Petct results and the BRCA results will help guide you towards further treatments.

    If the BRCA test comes out either BRCA 1 or BRCA 2 positive, then you should discuss adding a Platinum such as Carboplatin or Cisplatin to your other recommended chemotherapy regimen. Since she has already completed using the taxane I am not sure if they will use a stronger taxane such as nab-paclitaxel, doxirubicin, or if they will go with other combination chemo drugs.

    Just know that when she was first diagnosed, she should have gotten 4 dense dose bi-weekly (or 12 smaller doses weekly) of a Taxane (such as taxol), followed by 4 dense dose treatments using FEC or an Anthracycline. Why your doctor did only Taxol 4+4 and then 30 Rounds of Radiation is incorrect and is not as per standard treatment for tnbc.

    If the taxane was not working then the other chemo therapy regimen following the taxane may have worked. As your sister had BCS (Breast Conservation Surgery), before chemotherapy, she had what is called Adjuvant Chemotherapy. Sometimes doctors leave the tumor in the breast and do neo-adjuvant chemotherapy so they can monitor if the tumor is shrinking, but perhaps your doctor did this because the tumor was very small, or it was too large - I do not know. But some doctors do Adjuvant Chemo, and some do Neo-Adjuvant chemo, for various reasons, which can be discussed for this recurrence with a top specialist.

    Also, talk to a TNBC specialist or at least a breast specialist at a leading Indian hospital (get a second opinion). I would not trust the 1st doctor based simply on his regimen used - it is not even what is the Global Standard, and the Global Standard is also used in India by the best specialty hospitals.

    The tnbc coming back could happen even with standard treatment, but the regimen your dear sister received is not enough and it is not as per Standard International Guidelines.

    Please consult with a better breast doctor at a bigger hospital (Tata Memorial, Jaslok, AIIMS Delhi, Fortis, or another large hospital with top breast care, in your city).

    The Petct will tell you if the cancer is limited to the breasts. IF that is so, then it is good. But either way, you need a second opinion and you need to see a more specialized doctor immediately.

    All will be well. You can read a lot about treatments and other issues on this site.

    tnbcfoundation.org/

    Also you can talk to Sumeet Shah on this forum. He will let you know if the therapy she received initially was appropriate or not, and also what she should do when she gets her BRCA results and her petct back. Be aggressive and work with a specialist as TNBC requires the best and aggressive care. TNBC needs the best clinicians care and guidance. You cannot go to some doctor that is not an expert in the field as it is not just a standard cancer nor is it a standard breast cancer. It needs specialized and aggressive attention.

    God bless you, your family, and your sister.

    made2b2gether.

  • Dear Harry,

    Please go through the chemo details and try to.understand what is 4+4

    Some ppl may be surprised that Anthracyclines were used.

    If you still have doubts seek second opinion from an oncologist, but not online......

    In my opinion, she has been treated adequately and it's rather unfortunate that a second Metachronous Breast Primary has been detected in the contralateral breast.

    Your oncologist has the sufficient expertise to know and ask for BRCA testing and should this be positive

    The fault lies in the genes and not the Oncologist treating you.

    Your sister has triple negative cancer and every layman knows that this spells bad prognosis and indicates high likelihood of disease coming back soon.

    Hope that PET CT scan shows no evidence of spread elsewhere and quick recovery for your sister.

    My wishes are with you in this difficult times.

  • Harpreet Our prayers for your sister. Do as Dr Rohit has guided you

  • Dear Harry, this is NOT a re occurrence. This is a new cancer developed in other breast. A breast cancer CANNOT spread from one breast to the other breast. When someone gets a cancer in the other breast, it is a NEW cancer which has developed probably because of underlying genetic defect or any other reason, and is known to occur in Triple Negative Breast cancers. Many people have a genetic defect causing one breast cancer. Even though the treatment has happened, we cannot change the genetic defect; and it causes the cancer again in the other breast; or sometimes in ovary or elsewhere.

    So don't worry, since this is a new cancer, your sister will be treated and will soon be fine. Just follow your oncologist. Trust him.

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