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Category:

Chemotherapy

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Question:  #61 2/14/2009		Q:	Thank you for the quick answer....to add a bit, I am 41 year old...I just realized that my FISH for HER 2 was not amplified 1.6 was my score. Does this make a difference in below and is this good or bad as far as treatment of hormone therapy is concerned down the road. I believe he wants me on tamax down the road. I was also wondering if there are any studies to compare the 2 tx plans. I am nervous about the adraimycin and the heart muscle risk which is why I requested the oncotype which oncologist thinks I am in the middle. Thanks for this great site, I am making a donation now :) From earlier email.... I had L breast mastectomy, sentinol node removal (negative) ER + > than 90% PR - 0% HER 2 was 2 + equivocal by FISH, Stage II (tumor size 2.1cm) grade 2, good margins, 70% IDC and 30% DCIS, waiting result of oncotype score but oncologist thinks it is in the middle range. He suggests either AC Taxol 4 treatments each over 16 weeks (if my oncotype is on high end) OR Taxotene and Cytoxan 4 treatments every 3 weeks.....Says risk if I do nothing is 35% of recurrance, 10% if do above and hormone treatment afterwards. I am on the right path?
		A:	you are a candidate to hae oncotypeDX done because of being hormone receptor positive and HER2neu negative. your doctor will do an echo of your heart to ensure it is in good shape if that drug, adriamycin, isused. so the HER2neu test results of being negative is good news. also, it makes it more likely to consider both options including the adriamycin drug since you won't need Herceptin which is also hard on the heart for some patients. LS
Question:  #62 2/14/2009		Q:	I had L breast mastectomy, sentinol node removal (negative) ER + > than 90% PR - 0% HER 2 was 2 + equivocal by FISH, Stage II (tumor size 2.1cm) grade 2, good margins, 70% IDC and 30% DCIS, waiting result of oncotype score but oncologist thinks it is in the middle range. He suggests either AC Taxol 4 treatments each over 16 weeks (if my oncotype is on high end) OR Taxotene and Cytoxan 4 treatments every 3 weeks.....Says risk if I do nothing is 35% of recurrance, 10% if do above and hormone treatment afterwards. I am on the right path?
		A:	yes, makes sense. and keep in mind this is to prevent you from having to revisit this disease and its treatment again. great that you have good prognostic factors too so celebrate this good news while preparing to roll up your sleeves and get chemo and hormonal therapy to further maintain your good health. LS
Question:  #63 2/8/2009		Q:	Lilli - A question posted 1/25/09 is amazingly similar to my situation with some twists. I am a 17 yr survivor of IDC (Stage II, HR+) Rt. mastectomy (4.0 X 3.0 x 1.5 cm, 3/20 lymph nodes) followed by chemo (CMF eight doses with later addition of G_CSF) No radiation. No tamoxifin. Current diagnosis is: Rt. axilla, IDC, grade II/III, triple negative. Surgery removed a 4.0 x 2.6 x. 1.6 cm mass, No benign breast tissue. Mo definitive lymph node identified. Margins not clear. Multiple small foci suspicious for intralymphatic involvement are seen. Doctors are calling this a recurrence - but is it, and does that matter? Two different treatments are recommended: (1) TC x 4 or 6 or AC x 8 followed with T. Both will follow up with radiation. I''ve been reading about the toxicity of adriamycin and am hesitant to go that route unlessit is demonstrably better for my situtation. Are there better alternatives? D in SD
		A:	can't be recurrence with different prognostic factors-- hormone receptors are negative this time when they were positive before. and the length of time is considered too long too. so if in the axillae and no nodes were found sounds like to make be residual breast tissue?? that's important to know too. recurrence is more concerning that new primary being found. stats would imply survival better with new primary. so sounds like its time for a second opinion at a comprehensive breast center. LS
Question:  #64 2/9/2009		Q:	what is the best chemo for triple negative breast cancer
		A:	Triple negative disease usually has a 3 drug regimen depending on stage and behavior of the tumor. Treatment Guidelines for Patients with Breast Cancer from NCCN lists some drugs used with chemotherapy. (found on www.cancer.org website) The combination and choice of drugs can vary with the medical oncologist. The key is to be treated by medical oncologist who specializes in breast cancer. ds
Question:  #65 2/8/2009		Q:	dear lillie has abdominal cramps with vomiting been described with gemzar thank you
		A:	not usually. but remember that you can get other GI disorders like the flu. some people can get nausea when first starting. call your medical oncologist to discuss this further and ensure that all is well. LS
Question:  #66 2/8/2009		Q:	Hello! I am trying to make an informed decision about whether to do chemo or not. I''m 43, invasive lobular, Grade II (6/9), T1bN1 (micromet), ER/PR+, Her2-, Ki-67 low. Main tumor was .7cm with at least 5 smaller foci. Micromet .5mm in sentinal node, 8 other nodes clean. Clear margins. Had a bilat mastectomy (left side prophylactic) 4 weeks ago. OncoType score 6, BRCA1 & 2 neg. I am getting different opinions...some say OncoType is very low so risks of chemo outweigh benefits. Others say take into consideration my age, the fact that I had lobular, and the fact that there was a micromet, so don''t rule out chemo. Can you please share your opinion? Thank you in advance!
		A:	Not an easy decision, and there is unfortunately no right or wrong answer. You've been told all the right things and ultimately you will have to make the informed decision with all the input you have been given. We cannot tell you which way is right or wrong, but there are some points to consider. 1) No test, including Oncotype is 100% perfect, 2) in general, having any dz in the node is concerning and 3) you only get one shot at cure. If breast cancer comes back as met. dz, it is not curable, though sometimes it can be highly treatable, almost like a chronic dz. though those are exceptions to the rule. But chemo is not benign, and some studies suggest despite lobular's tendency to spread, overall outcomes are better than ductal cancer, (though there are conflicting reports). This probably didn't help much, but you need to know all the pros and cons before making your decision. That said, once you make it, move forward and never 2nd guess yourself. Warmest regards.
Question:  #67 1/31/2009		Q:	Hello, diagnosed 12/08 with stage 1, grade 2 invasive tubular carcinoma. Had lumpectomy and centinal node removed Jan. 9th. nodes are negative, margins negative. I am Estrogen+, progesterone+, herc.-. I had the oncogene typing done and was told yesterday that I had a score of 12 Which means 8% chance of getting cancer without chemo. I am trying to get input from different sources on what route to proceed at. I would appreciate your input as 12 is so close tho the low scale. Anyways of making a sound decision? My oncologist said he had no qualms if I didn''t do chemo but I can''t help but think about that 8%. tumor is 1.5 cms. Thanks so much
		A:	most patients would opt to not do chemo and most doctors would be fine about that. the key for you is hormonal therapy. so it isn't as if you are doing nothing. you are doing very effective systemic treatment with hormonal therapy. LS
Question:  #68 2/1/2009		Q:	I''ve taken ACT, Xeloda, Carboplatin, Gemzar, Abraxane, Avastin, and Navelbine. I have mets in entire left lobe of liver and throughtout a good part of right lobe. I am now on Ixempra. What can you tell me about that?
		A:	Dear Shagger 398, Not really sure what you are asking. Do you have a specific question regarding your chemotherapies? You definitely have metastatic disease and it appears that you have been on many chemotherapies. Ixempra is a relatively new chemotherapy for breast cancer, but is generally reserved for very advanced breast cancers ie after progressing through other chemotherapies. I am sorry that I cannot comment more than this.
Question:  #69 1/25/2009		Q:	Lillie, I was diagnosed w IDC, .9 c,. clean margins, no lymph invasion, Lillie, I was diagnosed with a .9, grade 1 IDC, clean margins, ER/PR+, Her2 Neu neg. (the report also stated DCIS Grade 2 in specimen.) I got a second opinion on my patholgy. They agreed with everything but called it a grade 2 tumor. What are my chances of having a positive Sentinel lymph node biopsy? What is the probability of needing chemo?
		A:	so sounds like good news so far. stage 1 breast cancer with favorable prognostic factors. you are in a gray area for chemo. ask if oncotypeDX is going to be done to help determine if chemo is or isn't going to be recommended. hopefully you will skate through with just hormonal therapy as your systemic treatment. LS
Question:  #70 1/24/2009		Q:	I have successfully completed four AC treatments and have just had my second of four Taxol/Herceptin treatments. (I am on the dose dense regimen for 1.4cm Stage 1 Grade 3 node negative ER+/PR+/HER2+) -I have experienced neuropathy in the hands after both of the Taxol treatments along with bone pain. The bone pain has been managed by Vicodin, but the neuropathy seems to be the "wild card". My question is really about the neuropathy and how to manage it. I realize the benefit, but I am uncertain I can tolerate another month of this itchy pins and needles sensation in my hands. Any ideas on how to cope? Thank you-
		A:	inquire with your medical oncologist if he/she thinks neurontin would help. LS
Question:  #71 1/18/2009		Q:	I just finished Chemotherapy treatments. How long does it typically take for the drugs to leave my body?
		A:	Unfortunately, your question is not so easy to answer. I am assuming you mean the effects of the chemo and not the chemo itself which typically will only last a few days in the body at most. The effects of chemo will depend on the drugs given, your age, your overall health, and how ones body naturally rebounds from the effects of chemotherapy. In general, most patients return to their normal baseline after a few weeks. Hope that helps.
Question:  #72 1/18/2009		Q:	I was diagnosed with over 4cm of DCIS and LCIS on right breast 5 years ago. Had 2 lumpectomies and radiation. (No sentinel lymph biopsy--which always made me uncomfortable.)Now I have just been diagnosed with IDC on left breast, Grade 1, .9cm, clean margins, er+, pr+, her2 neu neg. Next step is sentinel node biopsy in 2 weeks. Should I ask for Oncotype test? FISH test?(not sure what that is.) Do you think I will need chemo? I also took the BRCA test. Results should come in in about another week. I want to make sure this cancer doesn''t spread. Surgeon doesn''t recommend bilateral masectomies but I am open to it. Have had liposuction on abdomen--and radiation on right breast. Are my reconstruction options grim too? Help Lillie. I don''t know what to do!
		A:	sorry you have to revisit all of this again. good to get genetics done. if positive for a BRCA gene then consider bilateral mast. yes. even for peace of mind you can as well anyway. oncotypeDX-- yes, request it. it can help determine need for chemo or not. grade 1 is slow growing so hopefully you will also have a low oncotypeDX score. reconstruction--- diep flap can't be done but S-GAP can! (buttocks fat) you are welcome to come to us you know... 443-287-2778. we specialize in every form of reconstruction. LS
Question:  #73 1/18/2009		Q:	At stage IV, triple neg, with mets to spine and innumerable mets to liver, tried 2 chemos before Ixempra. After the first round (3 weeks on, one off) the liver enzymes being used for tumor markers were thru the roof, and so chemo cannot be started. I need a straight answer to know if the enzymes can come down as a delayed reaction to chemo already taken, or if this is just bad news, thank you for being there to help
		A:	this sounds worrisome to me. ask if there are plans to do more scans to reassess what is happening. hang in dear.... L
Question:  #74 1/18/2009		Q:	what are the most common and the concerning side effects associated with tykerb,what should be monitored during treatment and is tykerb been studied with gemzar in MBC THANK YOU
		A:	Tykerb has been best studied with xeloda, but many trials with tykerb and other drugs are ongoing and/or being planned. Common serious reactions that have been reported include diarrhea, hand foot syndrome and liver toxicity. There are many others that can occur, but since the drug is fairly new, a lot is still unknown. The best thing to do is to consult your doctor if you are prescribed the medication regarding possible side effects and what to look out for.
Question:  #75 1/12/2009		Q:	Are there circumstances where there is an invasive lobular cancer smaller than .5cm grade 2 with dcis er+ and pr+ HER- node negative bilateral mastectomy that would not warrant the oncotype testing or tomoxifen?
		A:	Oncotype DX is used in many different situations now (and more on the way) so your answer is not easy to directly answer. In general, if a patient feels strongly about not getting or absolutely wants chemo, then there may not be utility in ordering the test. It is a really good test, but no test is perfect. Because of this, oncotype dx, like most tests, needs to be used as a helping tool, rather than an absolute indicator of who should get chemo with hormonal therapy versus who should get hormonal therapy alone. Hope that helped.
Question:  #76 1/12/2009		Q:	Hello:Lillie: I am 58, postmenopausal and was Dx 9/2008, IDC, main tumor was 3cm but there were several other areas of cancer within the same breast, Stage II, Grade 3, Sentinel Node biopsy of one node showed isolated cells, ER+/PR+, HER2- with extensive lymphvascular invasion. I had a mastectomy and was given the choice of dose-dense AC/T 4, two weeks apart) or TC 4X every three weeks. Because of my concerns with the cardiotoxcity of the Adriamycin, I opted for the TC but am now concerned about undertreatment. I''ve asked my oncologist about extending the TC treatments to 6X but b/c there are no studies for protocol, she is relunctant. I learned of a clinical trial starting a Phase III for TAC v. TC that I believe is using 6 cycles. What kind of information would be available for the first to phases of that trial and how would I find it? And do you think that my concern is valid? Thank you for an excellent service
		A:	The choice of chemotherapy is many times not black or white as in your case. TC x4 is a very reasonable option, but if you have already started or completed this, it would be unlikely that you could enroll in a clinical trial examining TAC vs TC x 6 cycles. ALso remember the purpose of a trial is to determine which regimen is best for treatment and side effects. Treating off protocol is often done in oncology, but it sounds like what you really want/need is a 2nd opinion at a major academic medical center or comprehensive cancer center to further explore your options. Hope that was helpful.
Question:  #77 1/12/2009		Q:	Does Johns Hopkins use the OncoType DX test to help determine the extent to which women with one of more positive nodes will benefit from chemotherapy? Thanks for this wonderful service.
		A:	Oncotype DX is used on selected patients now including those with up to 3 node positive disease. ds
Question:  #78 1/12/2009		Q:	I am taking Avastin and Navelbine. Could the Navelbine cause my ALP (liver enyzme)to steadily climb? It is now up to 203. AST is 51, and ALT is 42.
		A:	Great question. Chemotherapy, Avastin, other medications can affect different people differently. There is no way to know 100% whether this is the cause, but your doctors are going to follow this carefully because it may be due to your therapy. Once your chemo is completed and should your alk phos come down, then it may be attributable to this. But because so many different things can cause liver enzyme tests to become abnormal, it is again not possible to determine what the cause is right now. For now, your doctors will follow this carefully and act upon it should it go too high.
Question:  #79 1/12/2009		Q:	Dear Lillie, I have been diagnosed at age 40 with stage IIIa breast cancer. It was a large tumor, mixed lobular and ductal type with 4 positive lymph nodes and HER-2 +++. The ER was 70%, the PR was <5%, and Ki-67 was 20%. Underwent a modified radical mastectomy, chemo (3 courses of FEC and 3 of docetaxel every 3 weeks) and radiotherapy. I just found out that I am positive for BRCA2. Based on that, I plan to remove the other breast and also my ovaries. Will continue Herceptin for a year. Regarding hormone treatment, would an aromatase inhibitor be better than tamoxifen? Is there anything else I can do? I am feeling very upset about the whole thing and worry about my prognosis. Thanks so much.
		A:	I am so sorry to hear this. However, it sounds as if all the right therapies have been instituted. To answer your question, in postmenopausal women, aromatase inhibitors have generally replaced tamoxifen as first line therapy for treating ER and/or PR positive breast cancers, though tamoxifen is still a very good drug to treat these cancers. Hang in there!
Question:  #80 1/12/2009		Q:	I had two blood clots resulting from my port during chemotherapy last year. The port was taken out and put on the "cancer" side so now I have two scars from my two ports. I also still have dark veins in my chest area and arm (the clots were in the juggular and sub-clavical areas). I am nine months past chemo for stage 2b cancer and done with reconstruction. I want to be able to wear more revealing outfits now that I have cleavage again...but the veins are really prominent. Studies have shown the blood flow is okay but when, if ever, will the veins subside and fade a bit? Is it permanent? Thanks for all you do!
		A:	The veins can protrude as you describe for up to a year. Hang in there. ds
Question:  #81 1/3/2009		Q:	Lillie, Five years ago, I was diagnosed with DCIS, LCIS, atypical ductal and lobular hyperplasia in my right breast. I had 2 lumpectomies and radiation. I just finished 5 years of tamoxifen last November 1st. After a surgical biopsy on 12/23 on my left breast, I was told yesterday by a Nurse Practioner that I had invasive ductal carcinoma, Grade 1, 0.9cm, est/prog positive, Her2Neg, and no lymph invasion. The Nurse said they usually recommend radiation and tamoxifen (but I already did tamoxifen and it didn''t work.) Does it make sense to you to do chemo for this? I am also thinking of getting a masectomy because I just can''t go through this anymnore. I wantto take a very aggressive strategy to ensure that I don''t get cancer again. (I also had an early stage melanoma excised in 2000.) Please help me. Tell me what women in my shoes have done to rid themselves of this. My dr. hasn''t even called me about the results yet. I had to get them from a Nurse at the Center. I think they might try to talk me out of chemo and a masectomy. Please give me your thoughts. Also, I had liposuction done on my abdomen several years ago. Does that eliminate the possibility of me doing a DIEP flap? Please help. I am so scared!
		A:	Hang in there. I'm here! let's take this in steps.... so you now have a new diagnosis in the other breast. not sure of your age but when we see breast cancer happen over time bilaterally it ups the odds of there possibly being a genetic link. then you add melanoma and that ups the odds more. so consider genetic testing. If you tested positive for BRCA 1 or 2 then bilateral mastectomies with reconstruction would be in order. Even if you tested negative it is a very reasonable and rational thing to consider doing. Now reconstruction--- diep flap can't be done due to the liposuction. however S-GAPs might be possible... if you have some buttocks fat. This is something we specialize in diep and s-gaps... The odds are in your favor at the moment that chemo may not be needed. this is a small tumor, less than 1cm, hormone receptor positive and HER2neu negative. so oncotypeDX could be done. it also is very slow growing-- grade 1. chemo usually isn't done with grade 1 and small prognostically favorable tumors. If you want to come to us you know you can. it's worth the trip. just call 443-287-2778. we will see you through this, and onto a healthier and happier you for 2009. LS
Question:  #82 1/3/2009		Q:	Hello Lillie...first, let me tell you I just finished your book, Stealing Second Base. I thank you so much for your efforts and time you''ve put into BC. I have ILC, IIIa, bilateral mastectomy, just had axillary nodes removed Tuesday due to sential positive nodes, mass was 6.7 cm. My question...is there any evidence that shows the dose dense A/c 4 rounds than T 4 rounds (all rounds everyother week) is more effective than 6 rounds of TAC every 3 weeks?? So hard to understand web sites explaining the 2. I''ve had 2 opinions, and of course one oncologist wants to do the dose dense a/c, than t and the other oncologist wants to use TAC....any ideas or comments of this. God bless you!
		A:	thanks.. I'm not aware of definitive information available on it yet. if there was it would be found at www.pubmed.com check it out. dose dense is very popular now. this is a big tumor.hoping you also have options for hormone therapy and herceptin. no harm in going to a third medical oncologist either as a tie breaker. you can email me privately and i might be able to assist you with that.
Question:  #83 12/29/2008		Q:	I was diagnosed with bilateral breast cancer and had bilateral mastectomies in October. My tumors were ER/PR positive and Her2 negative. I was node negative and am 44 years old. My right tumor was 5mm and the oncotype score is 14, my left tumor was 1 cm and the oncotype score was 19. My doctor seems to be on the fence about chemo and tamoxifan or just tamoxifan. He says it''s up to me to decide if I want the extra peace of mind that the chemo may bring. Do you have strong feelings about this?
		A:	Dear Jbritton, This is Ben Park MD,PhD from Johns Hopkins, and I received your question from Lillie. Your oncotype scores would suggest that the benefit of chemo is going to be marginal, but I remind all my patients that oncotype has not as of yet, been validated as a predictive marker of response ie whether chemo will add any benefit (a trial is ongoing called tailorx), but only as a prognostic indicator ie the likelihood of recurrence at 10 years. I think most oncologists would be on the fence, but if you want peace of mind, getting a 2nd opinion is always a good idea in my book. Lastly, talk to your oncologist about the possibility of genetic testing for breast cancer (BRCA1 or 2), as having two primary breast cancers at such a young age may qualify you for this, especially if you have a family history of breast cancer. Hope that helps, Best, Ben -- Ben Ho Park, M.D., Ph.D. Associate Professor of Oncology Assistant Director, Medical Oncology Fellowship Training Program The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins 1650 Orleans Street CRBI Room 1M42 Baltimore, MD 21231 410-502-7399 office 410-614-8397 fax 443-287-4480 Lab Please do not seek formal medical advice/second opinion via email/internet. The responses to questions posted on the Hopkins website are not to be used as medical advise or construed as a second opinion. We want you to seek appropriate medical care and consultation as you need to. Thank You.
Question:  #84 12/29/2008		Q:	I am 59, and have recently had a lumpectomy and mastectomy. I am currently taking Aramidex (1 standard dose daily). The indications were a right breast cyst or mass with minor skin dimpling. The HER2 Hercep Test was 2+, the HER2+CEP17 FISH was 1.1, with interpretation as negative. No cancer was found in lymph nodes. The ER was 90%, the PR was 60%, the Ki-67 was <10%. The number of tumor cells counted was 20+20. The avg. HER2 Signals/Nucleus was 4.7 with average CEP-17 Signals/Nucleus of 4.2. I''m concerned about the side effects of chemotherapy. Do the numbers here suggest I''d be better off with just hormonal therapy or that plus chemotherapy? Thank you very much.
		A:	Dear ckrieger, This is Ben Park MD,PhD from Johns Hopkins, and I received your question from Lillie. One cannot tell just from looking at the data sent what would be the optimal therapy for your breast cancer. I'm assuming you had an invasive or infiltrating ductal or lobular carcinoma identified on biopsy and/or lumpectomy? What was the size of the tumor? These are other factors used to make decisions regarding chemotherapy. That said, your breast cancer, from the information provided, does sound better off being treated with only hormonal therapy, but again, it's not possible to tell these things simply using this forum. If you want to be sure, getting a 2nd opinion is always a good idea. Hope that helps, Ben Please do not seek formal medical advice/second opinion via email/internet. The responses to questions posted on the Hopkins website are not to be used as medical advise or construed as a second opinion. We want you to seek appropriate medical care and consultation as you need to. Thank You.
Question:  #85 12/29/2008		Q:	Hi, I was diagnosed at age 36 in 11/07 triple negative no nodes 1.4 cm tumor stage 1 with DCIS approx 3.3 cm. I did ac, taxol and 3 carboplatin ( finished 4/08 ).Surgeon did lumpectomy, clean margins no lymphatic or vasuclar invasion. Finished rads in August 08. Beginning in late August, I have had upper right back/scapula shoulder pain on non cancer side. It feels like a dull ache/muscle pull. I did aleve and muscle relaxers as oncologist believes it is muscular skeletal in Sept and Oct and this seemed to have worked. FYI-I also have a history of carpel tunnel on that same side and tendonitis from years ago. No bone scan or MRI done as the pain went away but came back. Did massage and am going to physical therapy. PT therapists say the area I am complaining about is muscle and that it is wrapped very tight and pulling up ribs causing more aching pain. This was working and pain was almost gone for a month until I went out and shoveled snow again now the ache and pain is back the last week and not going away. Dr was hesitant to order bone scan b/c of more radiation and since pain does seem to go away with massage, heat and pain meds that it is muscular skeletal/joint pain. I also am still in menopause from chemotherapy. Its been 4 months though of this issue ( I didnt have any joint issues on chemo ) and I am starting to worry that it is something worse although I have been told it is ''unlikely'' at this time. The worry is consuming me. It doesnt hurt at night or interfere with anything that I do but it isnt going away. What kind of tests should I insist on? How much radiation is in a bone scan? Would an MRI work? Thank you very much.
		A:	Dear Collette, This is Ben Park MD,PhD from Johns Hopkins, and I received your question from Lillie. It is impossible to know for sure what is going on using this forum, but the persistent nature of your pain does warrant further investigation. There are a number of other questions that I would need to know to truly be able to provide meaningful input (eg were your nodes negative or positive?), but if you don't feel comfortable with the care you are receiving, getting a 2nd opinion is always a good idea in my book. Lastly, at such a young age and given your cancer phenotype, you should really consider genetic testing for BRCA1 and BRCA2 if that was not mentioned to you before. A positive test could have consequences for further prophylactic therapies as well as implications for screening family members. Hope that helped, Best, Ben. -- Ben Ho Park, M.D., Ph.D. Associate Professor of Oncology Assistant Director, Medical Oncology Fellowship Training Program The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins 1650 Orleans Street CRBI Room 1M42 Baltimore, MD 21231 410-502-7399 office 410-614-8397 fax 443-287-4480 Lab Please do not seek formal medical advice/second opinion via email/internet. The responses to questions posted on the Hopkins website are not to be used as medical advise or construed as a second opinion. We want you to seek appropriate medical care and consultation as you need to. Thank You.
Question:  #86 12/21/2008		Q:	I had a partial mastectomy for intraductal papillary carcinoma with IDC 1.2cm, grade 2, ER?PR +ve, HER2 Neg. Node negative. The oncologist recommended chemo 4AC + 4T followed by radiation and tamoxifen. I have asked for the oncotype test but the results will take 3-4 weeks. How long after surgery can I wait before starting radiation? It is already 4 weeks since my surgery and I am worried if that I wait till the oncotype results come back I might be too late to start chemo or radiation.
		A:	it takes 7-10 days to get oncotypeDX results back. genetic testing for BRCA 1 and 2 is what takes 3-4 weeks. so someone is confused. radiation should get underway (if chemo not needed) by week 6 preferably.
Question:  #87 12/21/2008		Q:	I''m 60 and had a lumpectomy for invasive ductal carcinoma. It was stage 1, nodes were clear, tumor .8cm. My ER 9.7, PR 5.2 and HER2 7.6. I was set to have radiation and Arimedex until I got my OncoDX result. It was 23. I''m trying to make a decision about doing chemo. What''s your opinion?
		A:	Hi Celko, This is Ben Park MD PhD and I got your question forwarded to me from Lillie Shockney at Hopkins. You should really discuss these issues with your oncologist or get a 2nd opinion. There is no right or wrong answer to this, and some may advocate chemo with Herceptin for one year, others might offer chemo, others may just say Arimidex alone. Again, your oncologist should go over the pros/cons with each of these scenarios, but the honest answer is that we currently do not know. Incidentally, breast cancers with HER2 positivity are usually a high recurrence score (it's one of the test genes) and generally why we don't order the test for triple positive tumors. Best wishes, Ben
Question:  #88 12/21/2008		Q:	Hi my wife was dx with IDC 1.8 cm grade II, DCIS high to intermediate grade (2cm), neg lymph nodes (0/3), absent vascular invasion at age 31, she is ER+(10%), PR- and HER2-.The doctor has recommended 4 cycles of FEC, radiation and then tamoxifen for 5 years. I am worried that he is not being aggressive enough with the chemo as I heard that the normal course of treatment (nurse told us this) for her diagnosis is 6 cycles? What do you guys think? Is having 6 cycles going to provide the same benefit in her case? Or should be push for two more cycles? Thanks.
		A:	Dear acer 0237, This is Ben Park MD PhD and I got your question forwarded to me from Lillie Shockney at Hopkins. There is no right or wrong answer to this, other than your wife likely should get some chemo. Here at Hopkins we might offer her TAC for 6 cycles, but again, this has a lot to do with personal opinion, and it would be good for you and your wife to get a 2nd opinion (always a good thing in my book). I can't make a full opinion given the lack of details in this forum, but again, I think it is always good to get another opinion in these circumstances. Finally, do make sure your wife discusses genetic counseling about BRCA1/2 as she qualifies since she developed breast cancer at such a young age. Best, Ben
Question:  #89 12/15/2008		Q:	I took one cycle (3 weeks on/one week off) of Avastin and Abraxane. I started losing my sight so the chemo was stopped for over 6 weeks. Now I am on Navelbine and Avastin every other week. My tumor marker doubled the first 2 weeks, then doubled again the next 2 weeks. If I end up having to stop the navelbine, could I (or should I) go back to the Abraxane? I got a modest response from it on the first cycle. I''ve heard you couldn''t (or shouldn''t) go back to a chemo you''ve already had because you would probably be more resistant to it the second time around. Any information on this? Thanks
		A:	Hi Shagger, I think I answered this in your other two questions. Best wishes, BHP
Question:  #90 12/15/2008		Q:	Hi, Lille, hope you are well. Just wondering how to advise someone who wanted to get into a vaccine trial. I understand there are many different ways the vaccines can target cancer cells, i.e., dendric cells, autologous, etc. so how would one know which avenue to turn to? Thanks for all you do and have done for me.
		A:	Hi Pandmisabelle, This is Ben Park MD PhD answering for Lillie who forwarded me your email. All clinical trials have very strict eligibility criteria, including the vaccine trials we have here at Hopkins. The internet is usually a great resource to see what is out there including what is local versus further away. If your friend wants to participate at Hopkins, I could put him/her in touch with someone assuming they meet the eligibility criteria. Best, BHP