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Diagnosed With Multifocal IBC And Had Chemotherapy For Breast Cancer. How Effective Is The Chemotherapy Treatment?

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Posted on Mon, 25 Nov 2013
Question: Hi. I have completed two of four cycles of TC (docataxel and cyclophosphamide) chemotherapy for breast cancer treatment. I am wondering if it would be likely that finishing after three cycles would confer a disadvantage to me for cancer-free survival? I was diagnosed with multifocal IBC, lymph node negative (ER/PR+, Her2-) and had breast conserving surgery which resulted in >1cm margins. My oncotype DX score is 12 and although low, my oncologist recommended chemotherapy based on premenopausal age and multifocal tumours. I am taking zolodex concurrently with chemo in an attempt to preserve fertility. I know that the accepted treatment is 4 cycles of TC, and less than this is not recommended because no trials have been done, however, with low oncotype score, lymph node negative, concurrent zolodex treatment, what is your opinion on the effective difference between doing 3 and doing 4 TC cycles? I know some patients with side-effects have chemo reduced so less than ideal cycling must have some benefit.
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Answered by Dr. Krishna Kiran Kannepalli (2 hours later)
Brief Answer: Take a balanced decision. Detailed Answer: Hi. Thanks for the query. I understand from the information that you have provided that you have a good understanding of your disease and that you like to take informed decisions. As a doctor I appreciate this quality in you. As you are aware your disease falls into the low risk category. The issue is also complex. you did not mention the tumor size(size of the biggest tumor in your case)and your age. However since fertility preservation is important to you, treatment decisions must be balanced. As you are aware there are no data for 3 cycles vs. 4 cycles of TC. But life is not statistics alone. In your case, you can take an informed decision of stopping with 3 cycles knowing that the risk of recurrence by stopping chemo at this juncture is unknown. With each cycle of cyclophosphamide, the risk of ovarian failure increases though the effect is is reduced with zoladex. However, going by you disease' s biology, the risk of recurrence is going to be small in any case. Youcan talk to your infertility specialist to plan your pregnancy. It is generally recommended that a person wait for 2 years before planning pregnancy after breast cancer therapy. But this is not applicable to all. If you are in the late 30's or above the ovarian reserve depletes fast. In addition, since you are ER/ PR positive tamoxifen will be recommended to you and pregnancy is generally contraindicated during tamoxifen use although the real risk of fetal malformations with tamoxifen use is low. In summary, only you can decide whether to stop at 3 cycles or not. I don't think there will be a substantial increase in the risk if you stop at 3 cycles. Take a well thought out and balanced decision after taking into account your age, the real chance of fertility preservation that you are going to achieve. Best wishes.
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Above answer was peer-reviewed by : Dr. Prasad
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Dr. Krishna Kiran Kannepalli

Oncologist, Surgical

Practicing since :2004

Answered : 59 Questions

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Diagnosed With Multifocal IBC And Had Chemotherapy For Breast Cancer. How Effective Is The Chemotherapy Treatment?

Brief Answer: Take a balanced decision. Detailed Answer: Hi. Thanks for the query. I understand from the information that you have provided that you have a good understanding of your disease and that you like to take informed decisions. As a doctor I appreciate this quality in you. As you are aware your disease falls into the low risk category. The issue is also complex. you did not mention the tumor size(size of the biggest tumor in your case)and your age. However since fertility preservation is important to you, treatment decisions must be balanced. As you are aware there are no data for 3 cycles vs. 4 cycles of TC. But life is not statistics alone. In your case, you can take an informed decision of stopping with 3 cycles knowing that the risk of recurrence by stopping chemo at this juncture is unknown. With each cycle of cyclophosphamide, the risk of ovarian failure increases though the effect is is reduced with zoladex. However, going by you disease' s biology, the risk of recurrence is going to be small in any case. Youcan talk to your infertility specialist to plan your pregnancy. It is generally recommended that a person wait for 2 years before planning pregnancy after breast cancer therapy. But this is not applicable to all. If you are in the late 30's or above the ovarian reserve depletes fast. In addition, since you are ER/ PR positive tamoxifen will be recommended to you and pregnancy is generally contraindicated during tamoxifen use although the real risk of fetal malformations with tamoxifen use is low. In summary, only you can decide whether to stop at 3 cycles or not. I don't think there will be a substantial increase in the risk if you stop at 3 cycles. Take a well thought out and balanced decision after taking into account your age, the real chance of fertility preservation that you are going to achieve. Best wishes.