Notes from the 2nd Opinion

I have a lot to consider today and need some space.  I appreciate all the calls and emails and texts wanting to find out what the next step will be but I don't know yet.  In an effort to give you the information we received yesterday, I am copying and pasting Rachelle's notes below.  I think we are leaning toward NYU but again I have some work to do today so please be patient with me.  I love you all and thank you for following my every move to demonstrate your support for me.  xo, E

 

Dr. Seidman - MSK - March 8th, 2011

Notes:

CA = cancer

• 5% of breast CA happens in women < 40 years of age
• 5-10% of breast CA present with metastatic disease at time of diagnosis
• 20-25% of all breast CA is HER2 +
• Randomized trials have produced results that inform current treatment regimens: taxanes (Taxol/Paclitaxel, Taxotece/Docetaxel)
• Carboplatin shown to have a synergistic affect of taxanes in combination with Herceptin
• Partial response = tumor shrinkage vs. complete response = tumor eradication 
• < 5% of scans ever become completely normal (meaning no cancer anywhere)
• Most commonly tumors shrink = remission - then chemo can be stopped while Herceptin is continued indefinitely (keeps CA in remission)
• Remember: tons of research around HER 2+ CA - many new agents in Phase III drug trials - a lot to look forward to!
• Be on look-out for: TDM1 (immunocongugate/"smart bomb")
• Even if getting treatment @ NYU - can still be apart of new studies @ MSK if one comes along in the future
• Recommends baseline MRI of spine - will also follow bone scans
• Will continue to work with Dr. Volm is choose to receive treatment @ NYU
• Recommends Zometa and XGeva for bone strengthening to be given in combination with treatments (minimizes pain, risk of fractures, etc)

Authors of studies:

1. Nicholas Robert - benefit of adding Carboplatin to treatment regimen
2. Edith Perez - benefit of weekly schedule dosing of chemo

Treatment: Abraxane Vs. Taxol (both are taxanes)

• FDA approved new version of Taxol = nanopartical albumin bound (meaning protein coated instead of lipid coated)
• Avoids allergic reactions to drug because the solvent has changed - so if used alone don't need premeds (antihistamine & steroids) - However will be used in combination with Carboplatin and therefore premeds must be used regardless 
• Published in 2010 @ MSK by Dr. Seidman
• Measure its affect after 3 months with PET scan (same as Taxol)

Chemo side effects:

• Chemo affects not only CA cells but other cells in your body that grow and divide rapidly (hair, nails, bone marrow (white and red blood cells)
• 3-5% chance of getting an infection because of decrease in WBCs
• 1% chance of being hospitalized from a serious infection caused by decreased WBCs
• Young people have less risk for chemo induced anemia (2% chance might need blood transfusion for severe anemia)
• Anemia causes fatigue (can expect mild fatigue)
• Temporary decrease in platelets is very low with these chemo agents - "very low chance of bleeding problems"
• Very mild chance of nausea (none of these agents are specifically nausea inducing)
• Muscle/joint aches initially - for which you can take either Tylenol or Ibuprofen

Premedication before Chemo: (decreases possible allergic reaction to chemo agents)

• Antihistamine (Bendadryl)
• Steroids (one time dose on that day) 
• Allergies to Carboplatin usually occur around 7-8th dose (7-8th week) and can include: swelling of face and mouth or tightness in chest - Not subtle - will occur immediately and chemo would be shut off and affects reversed in infusion center (low risk for any of this)

Measuring Response to treatment:

• Scan will plateau when CA has shrunk (tumors will stop changing in size)
• Scan schedule: 1st yr = scan every 3 months

                                  2nd yr = scan every 4 month

                                  3rd yr = scan every 6 months

• If Herceptin stops working as effectively (years down the road): Tykerb (Lapatinib) given orally with Herceptin

Staff:

Dr. Seidman - Oncologist

Doreen - Nurse

Michelle - Secretary

Major differences between providers:

Dr. Volm - NYU	Dr. Seidman - MSK
Will perform physical exam weekly- prior to chemo	Will see you in person twice in next 3 months – (will be followed by nurse Doreen instead)
Weekly treatment for 3 months until repeat PET scan and then taper to 3 weeks on/1 week off	3 weeks of treatment/1 week off starting now
Taxol/Carboplatin/Herceptin	Abraxane/Carboplatin/Herceptin
Recommends Powerport placement	Recommends weekly IV placement
Didn’t discuss further MRI studies at first visit	Recommends MRI of lumbar spine to document baseline