Managing Recurrence: Treatment Options for Breast Cancer Patients

Q: Managing Recurrence: Treatment Options for Breast Cancer Patients

Dear Miss Len：<br>1. <br>Are you planning to pursue aggressive treatment? ---> You should be encouraged! You can rest assured that if chemotherapy becomes intolerable, your physician will pause and make adjustments!<br>2. <br>After a period of chemotherapy, is it necessary to per

Relapsing?

Dear Dr.
Wu,
I apologize for continually bothering you.
I have completed my surgery, and 19 lymph nodes were removed, with 17 of them being infected.
Currently, my doctor is no longer considering the use of Vinorelbine (he believes it is ineffective) and has suggested using Eribulin plus Gemcitabine.
According to my new pathology report, my hormone receptors have changed to negative (previously positive), and HER2 is (++), which must be sent to Taipei for further testing to confirm whether it is negative (previously positive).
Therefore, my initial plan to use Lapatinib is no longer feasible.
If the results do turn out to be negative, I am considering Avastin.
I have a few questions:
1.
I am currently planning to pursue aggressive treatment (I feel the need to put in the effort), but I am very concerned that chemotherapy may further weaken my immune system, which could be detrimental.
It feels contradictory.
Given my current situation, do you think I should proceed with aggressive chemotherapy?
2.
Since I still have lymphatic infections, after a period of chemotherapy, will I need a PET scan to determine if the treatment is effective? How long will it take to assess the effectiveness of the medication? (Will a CT scan show the results?)
3.
If I want to self-pay for Avastin, should I start it immediately after confirming that HER2 is negative, or should I first see if chemotherapy is effective?
4.
Is HER2 negative considered safer than positive?
5.
If Eribulin plus Gemcitabine is ineffective, what should I do? Are there any new drugs available?
I can only express my gratitude.
Sincerely,
Doctor Q&A Teams

len, 40~49 year old female. Ask Date: 2008/04/09

Dr. Wu Jingtang reply Breast and Thyroid

Dear Miss Len:
1.
Are you planning to pursue aggressive treatment? ---> You should be encouraged! You can rest assured that if chemotherapy becomes intolerable, your physician will pause and make adjustments!
2.
After a period of chemotherapy, is it necessary to perform a PET scan to determine if the medication is effective? ---> YES!! How long until we can assess the effectiveness of the medication? ---> After 2-3 treatment cycles, it can be considered.
Will a CT scan show the effects? ---> It would be better to track using the previous method for better comparison!
3.
Is HER2-negative safer than HER2-positive? ---> YES!!
4.
Avastin or the combination of Olaparib and Pembrolizumab should both be worth trying for you! Avastin is reported to have good effects.
What about your financial situation? You might consider using it without worrying about subsequent medications, as some drugs that have been used before can be considered for reuse! Keep it up!
Sincerely,
Dr.
Wu Ching-Tang
Attending Surgeon, Taoyuan Hospital, Department of Health

Reply Date: 2008/04/09

More Info

Managing recurrence in breast cancer patients is a complex and nuanced process that requires careful consideration of various factors, including the patient's current health status, previous treatments, and the specific characteristics of the cancer. In your case, the recent pathology report indicating a change in hormone receptor status and HER2 expression adds another layer of complexity to your treatment options.

1. Aggressive Treatment vs. Immune System Concerns: It is understandable to feel conflicted about pursuing aggressive chemotherapy, especially given concerns about the impact on your immune system. Chemotherapy can indeed weaken the immune response temporarily, but it is important to weigh this against the potential benefits of controlling the cancer. In cases where there is significant lymph node involvement (as indicated by the infection in 17 out of 19 lymph nodes), aggressive treatment may be warranted to reduce the risk of recurrence. Discussing your concerns with your oncologist can help clarify the risks and benefits specific to your situation.

2. Monitoring Treatment Efficacy: After starting chemotherapy, it is common to monitor the effectiveness of treatment through imaging studies. A PET scan can be particularly useful for assessing metabolic activity in tumors, while CT scans can provide structural information. Typically, imaging is done after a few cycles of chemotherapy—often around 2-3 months—depending on the treatment regimen. Your oncologist will guide you on the appropriate timing for imaging based on your specific treatment plan and response.

3. Avastin and HER2 Status: If your HER2 status is confirmed to be negative, the use of Avastin (bevacizumab) may be considered, but it is essential to evaluate the overall treatment strategy first. Avastin is not a standard treatment for breast cancer and is typically used in combination with chemotherapy for specific cases. Your oncologist will help determine the best timing for introducing Avastin, whether it should be initiated immediately after confirming HER2 status or after assessing the effectiveness of chemotherapy.

4. HER2 Negative vs. Positive: Generally, HER2-positive breast cancers tend to be more aggressive than HER2-negative ones. However, the safety and treatment options depend on various factors, including the overall tumor biology and individual patient characteristics. HER2-negative cancers may have a better prognosis in some cases, but this does not mean they are without risk. Each case is unique, and your oncologist will consider all aspects of your cancer when discussing prognosis and treatment options.

5. Alternative Treatments if Current Regimen Fails: If the combination of paclitaxel (Taxol) and gemcitabine (Gemzar) does not yield the desired results, there are several other treatment options available. These may include other chemotherapy agents, targeted therapies, or clinical trials that explore new drugs. The landscape of breast cancer treatment is continually evolving, and your oncologist can provide insights into the latest options available based on your specific cancer characteristics.

In conclusion, it is crucial to maintain open communication with your healthcare team as you navigate these treatment decisions. They can provide personalized recommendations based on the latest research and your individual health status. Remember that managing breast cancer is a collaborative effort, and your active participation in discussions about your treatment plan is vital for achieving the best possible outcomes.

Similar Q&A

Understanding Breast Cancer Recurrence Risk and Treatment Options

Thank you for the doctor's response. I have a low level of education and do not understand what the doctor means by medication treatment. Hello! Your cancer recurrence index is as high as 136 (with >30 indicating a high recurrence rate). It is recommended that you undergo...

Dr. Li Zhonghuai reply Surgery
Hello! Yes, it is recommended that you proceed with the necessary treatment. Although chemotherapy regimens may vary between hospitals, the principles are generally similar. From the current medical perspective, breast cancer is considered a systemic chronic disease. After treatm...

Understanding Recurrence in Breast Cancer: Treatment Options and Prognosis

Hello Doctor: In November 2000, I was diagnosed with stage I breast cancer (T1N0M0) and underwent breast-conserving surgery followed by four cycles of chemotherapy (Adriamycin) and 30 sessions of radiation therapy. At that time, the pathology report indicated: nuclear grade 2, ER...

Dr. Chen Junyi reply Oncology
1. It is likely related to issues with the pathological examination at that time, or the degeneration of cancer cells. 2. As for the subsequent treatment and prognosis, it may depend on the patient's response to the medication. Thank you.

Understanding Recurrence in Early Stage Breast Cancer: Key Insights and Concerns

Hello, Doctor! I was diagnosed with breast cancer in November 2021 and underwent a right mastectomy with reconstruction. Post-surgery, it was found that there was a 0.1 cm invasive cancer in the lymph nodes with no metastasis, and the subtype was hormone receptor-positive. The do...

Dr. Chen Sirong reply Oncology
Evans, 43 years old, female. Due to the lack of personal insurance, the medical burden is really heavy. A: It is possible to choose treatment options covered by the National Health Insurance, but the general public tends to want to follow the doctor's advice if they can affo...

Understanding Post-Surgery Treatment Options for Breast Cancer

Your mother is currently sixty years old and underwent a left mastectomy on December 21, 2015. The tumor measured 0.7 cm with no lymph node metastasis, and testing revealed HER2+++ which is considered positive. The physician has recommended chemotherapy along with hormone therapy...

Dr. Lai Yicheng reply Oncology
Ms. Han: 1. Your mother has a left breast cancer tumor measuring 0.7 cm, with no lymph node metastasis. Her2 is 3+ (positive), estrogen receptor positive (+, 10%), and progesterone receptor positive (+, 40%). She underwent a left mastectomy on December 21, 2015. 2. According to t...