Chemotherapy for triple-negatives?


Question from Lana: How aggressive should the chemo be for triple negatives? I got differing opinions: one said AC x 4 followed by radiation; another said AC x 4, Taxol x 4, all dose dense, followed by radiation.
Answers - Kathy D. Miller, M.D.

The decision about chemotherapy starts with an assessment of the risk of recurrence if you had no chemotherapy at all. That risk of recurrence is influenced by your tumor being ER-negative, progesterone-receptor-negative, and HER2-negative. But the risk of recurrence is also influenced by whether or not the lymph nodes were involved, the size of the tumor, and the tumor grade. So a small tumor that does not have lymph node involvement may receive less aggressive chemotherapy than a larger tumor that involves several lymph nodes, even if the receptor status of those tumors is identical. Oncologists may also give you different recommendations based on their personal philosophy and experience. In other words, they may have a different threshold of risk that may trigger them to recommend more aggressive therapy. I think it's important not just to ask your oncologist what he or she recommends, but to ask why that treatment plan was recommended. That will not only help you understand your treatment better, but it will help you know if your philosophy and thoughts about risk of recurrence and benefits of therapy match those of your oncologist.

Jennifer Armstrong, M.D. I think Dr. Miller just raised some really key points. The original question mentioned getting a second opinion. Sometimes it can be helpful to consider a second opinion with your first doctor. What I mean by that is coming back to your first doctor for a whole new visit to discuss issues you're still grappling with, and that's a perfect time to have a second conversation where you ask what Dr. Miller just suggested—why your doctor is making those particular recommendations. As Dr. Miller mentioned, most treatment discussions are based on a risk/benefit ratio, and that ratio can be impacted by many factors and need to be interpreted in the spectrum of the patient's vision as well.

I have heard a recurrent theme throughout these questions. Patients with hormone-receptor-negative tumors are wishing they could do more. While this sentiment is not unique to patients with hormone-receptor-negative tumors, it is particularly salient. I think a lot of the discussion tonight has talked about all that is available to patients with hormone-receptor-negative breast cancer, be that surgery, radiation, chemotherapy, and lifestyle modifications including exercise, low-fat diet, and alcohol moderation.

We are discovering new avenues, new agents, coming to new understandings that are translating into new treatment strategies so quickly that it's at the same time exciting and can certainly be confusing. And that's where we get together and talk.

On Wednesday, November 19, 2005, our Ask-the-Expert Online Conference was called Hormone-Receptor-Negative Breast CancerKathy D. Miller, M.D., Marisa Weiss, M.D., and moderator Jennifer Armstrong, M.D. answered your questions about a wide range of issues related to hormone-receptor-negative breast cancer.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Copyright 2010. All rights reserved.

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