type tumor

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Hanne1961

Re: type tumor

Bericht door Hanne1961 » do 13 jun 2013, 06:54

Hallo Essie,

Ik had hetzelfde type tumor. Eén van 5,9 cm en één van 1,9 cm.
Dus dat kan niet de reden zijn, denk ik zo.
Ik zou inderdaad eens met de oncoloog afspreken zoals Dees voorsteld.
Bij mij was neo-adjuvante chemo het voorstel van de chirurg.
Ik had toe 4 okselklieren besmet. Na de chemo en OKD bleken deze schoon te zijn en was bestraling niet nodig.
Ik heb vervolgens een directe reconstructie bij de amputatie gehad.
Dit alles was wel iets waar in me als een tijger in vast gebeten had.
Psychisch ben ik voor mijn gevoel daardoor veel beter uitgekomen.

Veel sterkte voor jou en je moeder.
Goed dat je je zo uitgebreid informeert over de mogelijkheden die er zijn.

Gr. Hanne1962

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Lid geworden op: di 15 mei 2012, 08:27

Re: type tumor

Bericht door Dees » do 13 jun 2013, 08:07

Hoi Essie, ik heb zelf ook neo-adjuvante chemo gehad. Ik had een tumor van 10 bij 6 bij 7 centimeter en positieve okselklieren. Mijn tumor was licht hormoongevoelig en Her2Neu-positief.

Dat de tumor v Hannie en van mij Her2Neu-positief was, kan hier wel het verschil in zijn.

Ik vond nog deze informatie over neo-adjuvante hormoontherapie studies (geen idee of dat een beetje leesbaar is hoor):
NEOADJUVANT ENDOCRINE THERAPY TRIALS
Development of multigene expression profiles to predict the degree of benefit from specific therapeutic agents has been challenging; to date, a profile for defining benefit from specific agents has not been established. However the Oncotype DX Recurrence Score assay derived from an algorithm based on expression level of 16 breast cancer-related genes and five reference genes has been shown to consistently identify large subsets of patients with early stage, ER+ breast cancer who have a low-risk for recurrence with endocrine therapy alone.29 The assay also has apparent utility for defining potential benefit from the addition of chemotherapy in node-negative ER+ breast cancers.30 The utility of the assay in this population will be better defined by results of the TAILORx study, which has completed accrual and is in follow-up.31 SWOG is leading an effort (RxSPONDER) to evaluate the utility of the Recurrence Score for defining chemotherapy benefit in women with node-positive, ER+ breast cancers as well.32 Studies evaluating the Recurrence Score as well as other predictive assays have shown many women with early stage, ER+ breast cancer derive little or no benefit from the addition of chemotherapy to endocrine therapy. In view of these findings, it is not surprising that pCR rates in response to chemotherapy are low in these populations and that outcome is not associated with pCR.

Given these observations, the neoadjuvant setting is ideal for evaluating endocrine therapies in combination with newer targeted therapies in appropriate patient populations. Ellis and colleagues conducted a randomized phase II study of four months of neoadjuvant endocrine therapy with tamoxifen vs. letrozole and evaluated post-therapy pathology findings to derive a response-based preoperative endocrine prognostic index (PEPI) to define a subset of patients who do well with endocrine therapy alone.33 The index was validated in an independent cohort of patients from another neoadjuvant endocrine study, the IMPACT trial.34 The authors concluded that “patients with breast cancer with pathologic stage I or 0 disease after neoadjuvant endocrine therapy and a low-risk biomarker profile in the surgical specimen (PEPI score 0) have an extremely low risk of relapse and are therefore unlikely to benefit from adjuvant chemotherapy.“

ACOSOG conducted a follow-up randomized phase II neoadjuvant trial (Z1031) comparing the three approved aromatase inhibitors in postmenopausal women with ER–rich stage II to III breast cancers. They demonstrated an overall clinical response rate of 63% and that breast-conserving surgery could be performed in 50% of patients who presented with disease that would have required mastectomy at presentation. They also demonstrated that a favorable PEPI score was more common in luminal A than luminal B tumors (27.1% v 10.7%; P = 0.004).35

The ALTERNATE trial (ACOSOG Z11103) will be a phase III study comparing anastrozole vs. fulvestrant vs. the combination as neoadjuvant endocrine therapy in postmenopausal women with ER-rich stage II and III breast cancer. The study will also prospectively evaluate the PEPI score as a predictive factor for favorable outcome with endocrine therapy alone. This innovative series of trials has established neoadjuvant endocrine therapy as a valid treatment and research option for ER-rich early breast cancer and will likely be further exploited in the future for combination endocrine/targeted therapy trials.
Bron: Drug Development: Neoadjuvant Opportunities in Breast Cancer- Educational book ASCO 2013

Wat ik op verschillende congressen heb gehoord, is bevestiging van deze quote:
Important to highlight is the fact that pCR was predictive for neither DSF nor OS in low proliferation subgroups such as lobular type, grade 1, and positive ER or PgR status, but predictive in ductal, grade 2-3 tumours and negative ER or PgR status.
Bron: Pathologic Complete Response after Neoadjuvant Chemotherapy - the “pCRness” of breast cancer subtypes

Het is belangrijk om te vermelden dat pCR (dat de tumor compleet verdwenen is) niet voorspellend was in Ziekte vrije overleving of Overall overleving in laag proliferatie subgroepen zoals lobulair type, graad 1 en oestrogeen- en progesteron gevoelige status, maar dat het wel voorspellend was bij ductale (in de melkgangen), graad 2-3 tumoren en met negatieve oestrogeen- of progesteron status.
Groeten, Dees
Gezondheidswetenschapper (Gezondheidsvoorlichting en Geestelijke Gezondheidkunde) * Gewerkt in farmaceutische industrie oncologie o.a. op het gebied van borstkanker * Zelf diagnose borstkanker op 36-jarige leeftijd (2007) * www.caseofdees.wordpress.com

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