Breast is the worst: another, another, ANOTHER case!

[RO28]

Hi, I have one. 36 F, triple positive breast cancer with essentially no response to NA-TCHP. T1c up front and out back, node negative. She had a suspicious axillary node on MRI, biopsy negative and 3 nodes removed at the time of surgery, no treatment effect seen. Will be getting TDM-1. Planning whole breast + boost, how many would be a little generous in the axilla given the poor response to chemo? That would be my inclination.

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[seper]

So node positive or negative?

 

[Ray D. Ayshun]

Hi, I have one. 36 F, triple positive breast cancer with essentially no response to NA-TCHP. T1c up front and out back, node negative. She had a suspicious axillary node on MRI, biopsy negative and 3 nodes removed at the time of surgery, no treatment effect seen. Will be getting TDM-1. Planning whole breast + boost, how many would be a little generous in the axilla given the poor response to chemo? That would be my inclination.

One could argue to be less generous in the axilla (as in, ignore it) as you'd expect it to more likely be positive if it were ever truly positive given the lack of response.

 

[RO28]

So node positive or negative?

negative.

 

[RO28]

One could argue to be less generous in the axilla (as in, ignore it) as you'd expect it to more likely be positive if it were ever truly positive given the lack of response.

ooh, good point. i like this thinking. thanks!

 

[Palex80]

If it was cN0, then no axilla.

 

[deleted1111261]

Breast only

 

[RO28]

Thanks for the replies. I kinda felt like that was a dumb question, but I've also seen some node creep on higher risk patients and wanted some extra input.

 

[taserlaser]

I had a similar case earlier this month and thought similar rational - if there was unaddressed disease this one grew so rapidly we would know about it. Subjective response to AC but doubled in size on paclitaxel. Locally agreed to whole breast plus boost but I did ask some more wisened folks as well. I’m happy to see a similar thought process and synthesis here too.

 

[evilbooyaa]

Moved to its own thread.

Thanks for the replies. I kinda felt like that was a dumb question, but I've also seen some node creep on higher risk patients and wanted some extra input.

Very reasonable question to ask IMO. Poor responders to neoadjuvant therapy in TNBC don't do so great, but if this patient had undergone upfront surgery we'd just be talking about WBI anyways...

 

[Palex80]

Moved to its own thread.

Very reasonable question to ask IMO. Poor responders to neoadjuvant therapy in TNBC don't do so great, but if this patient had undergone upfront surgery we'd just be talking about WBI anyways...

MA.20 showed potential benefits for high-risk, node negative patients. However, she wouldn't have fit into MA.20 due to the primary tumor size.