A 33 year old woman is referred after a wide local excision
and axillary clearance.
Histology:
3.5 cm invasive ductal carcinoma Grade III
1 out of 18 lymph nodes positive
ER negative
HER- 2 positive
Margins clear
What would you recommend?
FEC-T + Herceptin
p
Chemotherapy with FEC-T and Herceptin is recommended
Before starting chemotherapy she is found to be 10 weeks
pregnant.
She h
Sh
has b
been undergoing
d
i ffertility
tilit ttreatment
t
t and
d iis nott prepared
d
to consider termination of pregnancy or mastectomy
What is your treatment recommendation now?
Standard chemo can be given in second trimester so commence
chemotherapy at 13/14 weeks
weeks.
Should not delay until after pregnancy or refuse chemo both are
wrong
D f H
Defer
Herceptin
ti until
til after
ft d
delivery
li
as risks
i k unknown
k
Defer Radiotherapy until after delivery
Should not recommend termination or mastectomyy
Treatment with FEC x 3 cycles followed by Taxotere x 3 cycles
is commenced
FEC
C is well tolerated
She has a reaction to her 1st cycle of Taxotere with
flushing, wheeze ,fever and abdominal pain after 5 mins of
the infusion
infusion.
She fully recovers later following appropriate care
What are your recommendations for further chemotherapy
Re-challenge 1 week later with standard desensitisation regime
( high dose steroids pre-chemo)
Change
g to Taxol acceptable
p
Stopping Taxanes wrong if suggest stopping taxanes ask
What is the absolute survival benefit for taxanes:
5% v FEC alone
She completes six cycles of chemotherapy.
Radiotherapy is planned following delivery of her baby
Comment of the following Radiotherapy Plans:
5cm
5cm
10o