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What Causes Reduced Lymphocyte Count While Suffering From Stage 3B Breast Cancer?
Question: Hi,
This is follow up with for the other thread with you regarding my Mother's breast cancer
http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=169104
Just to refresh memories, she has been diagnosed stage 3B breast cancer and is undergoing neoadjuvant therapy (4 cycles of AC, followed by 4 cycles (12 weekly) of Paclitaxel.
For the first chemo she had, her blood count was very low after first week even after peggrafeel(6mg after 24 hours of chemo) injection and also she had to be admitted to the hospital due to chest infection. During her hospital stay, she was given another peggrafeel injection (3mg X 2) and after which her TLC counts were pretty high
She underwent her second AC on 13th Mar and she had peggrafeel injection on 14th Mar. Her CBC done on 18th Mar is attached.
I have the following questions
1. Even though her TLC is little bit higher than normal, her Lymphocyte count is still quite low (8% differential, which amounts to 900/mm3 (normal range being 1000-4000). Does it take longer for Lymphocytes to recover?
2. How do we make sure that her cancer is not spreading during neoadjuvant treatment. Our biggest worry is what if the cancer spreads and becomes untreatable. Her last PET was done on 2nd Feb and the staging was T4N1M0 (no metastasis).
3. Currently, roughly the size of the tumor is 4cmx4cmx5cm. How long do you think we should wait before the surgery is done (Ofcourse we will always be living in fear that the cancer could spread unless surgically removed)
4. Do you think waiting longer could hinder with the healing process after the surgery is done because the chemo will make the body progressively weaker.
5. Till now, we have done the following tests
a. Mammography
b. FNAC
c. Biopsy (ER 8/8, PR 8/8, Her2Neu -, MBR Grade 3)
d. PET CT (T4N1M0)
Do you think we should do any other tests.
6. What are the recommended dosages for AC and T for 64 year old woman with breast cancer who has history of diabetes and high blood pressure.
Attached are the following
1. CBC/LFT/KFT before second AC chemo
2. CBC on 5th day after AC Chemo
This is follow up with for the other thread with you regarding my Mother's breast cancer
http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=169104
Just to refresh memories, she has been diagnosed stage 3B breast cancer and is undergoing neoadjuvant therapy (4 cycles of AC, followed by 4 cycles (12 weekly) of Paclitaxel.
For the first chemo she had, her blood count was very low after first week even after peggrafeel(6mg after 24 hours of chemo) injection and also she had to be admitted to the hospital due to chest infection. During her hospital stay, she was given another peggrafeel injection (3mg X 2) and after which her TLC counts were pretty high
She underwent her second AC on 13th Mar and she had peggrafeel injection on 14th Mar. Her CBC done on 18th Mar is attached.
I have the following questions
1. Even though her TLC is little bit higher than normal, her Lymphocyte count is still quite low (8% differential, which amounts to 900/mm3 (normal range being 1000-4000). Does it take longer for Lymphocytes to recover?
2. How do we make sure that her cancer is not spreading during neoadjuvant treatment. Our biggest worry is what if the cancer spreads and becomes untreatable. Her last PET was done on 2nd Feb and the staging was T4N1M0 (no metastasis).
3. Currently, roughly the size of the tumor is 4cmx4cmx5cm. How long do you think we should wait before the surgery is done (Ofcourse we will always be living in fear that the cancer could spread unless surgically removed)
4. Do you think waiting longer could hinder with the healing process after the surgery is done because the chemo will make the body progressively weaker.
5. Till now, we have done the following tests
a. Mammography
b. FNAC
c. Biopsy (ER 8/8, PR 8/8, Her2Neu -, MBR Grade 3)
d. PET CT (T4N1M0)
Do you think we should do any other tests.
6. What are the recommended dosages for AC and T for 64 year old woman with breast cancer who has history of diabetes and high blood pressure.
Attached are the following
1. CBC/LFT/KFT before second AC chemo
2. CBC on 5th day after AC Chemo
Brief Answer:
Please refer below
Detailed Answer:
Hi
Thanks for followup.
I think your mom is doing well. My replies...
1. Yes, this is bit low but acceptable in current scenario. As this is only 5th day, it can still go up or further down before going up. Same for neutrophils.
2. As the breast tumor is shrinking, it should not spread at the same time.
3. As the tumor is shrinking, it will be best to finish off the entire chemo before surgery. This gives the best outcome.
4. No this is not a cause for concern.
5. No, I don't think further tests are required now. Before surgery, we can get another PET if felt necessary by treating physician.
6. recommended doses for AC are doxo- 60 mg/m2 of body surface area, Cyclophos - 600 mg/m2 and weekly paclitaxel (T) - 80 mg/m2. For calculating BSA I need patient's wt in kg and height in cm. However, the final dose depends upon lot of factors which only the treating physician should judge.
Regards
Please refer below
Detailed Answer:
Hi
Thanks for followup.
I think your mom is doing well. My replies...
1. Yes, this is bit low but acceptable in current scenario. As this is only 5th day, it can still go up or further down before going up. Same for neutrophils.
2. As the breast tumor is shrinking, it should not spread at the same time.
3. As the tumor is shrinking, it will be best to finish off the entire chemo before surgery. This gives the best outcome.
4. No this is not a cause for concern.
5. No, I don't think further tests are required now. Before surgery, we can get another PET if felt necessary by treating physician.
6. recommended doses for AC are doxo- 60 mg/m2 of body surface area, Cyclophos - 600 mg/m2 and weekly paclitaxel (T) - 80 mg/m2. For calculating BSA I need patient's wt in kg and height in cm. However, the final dose depends upon lot of factors which only the treating physician should judge.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the reply. You have been really very helpful.
1. The doctor gave her the same dosage as you the recommended for AC i.e. doco - 60mg/m2 and Cyclophos - 600 mg/m2. Her height is 150 cm and weight is 54kg. Her BSA was calculated around 1.5, so she has been getting cumulative doco of 90mg and cyclophos of 900mg. Does that seem right?
2. I have been doing quite a research on Chemotherapy and the internet is only full of bad things about chemotherapy. I have also found a lot of studies which seem it does not offer a lot of benefit for as well. e.g. The following links suggest that it only increases the 15 year survival by meager 3% for node positive cancer for women of my mother's age
http://ww5.komen.org/BreastCancer/Table39Adjuvantchemotherapyandoverallsurvival.html
My mother is getting neoadjuvant treatment, so you could say that the above is for adjuvant treatment, but all the papers I have read suggest that the only benefit neoadjuvant may provide is to be able to have breast conserving surgery. In terms of survival, there is not that much of difference, so overall, chemotherapy is adding only 3% survival benefit, which amounts for a few months extra life!!
Do you know of studies which say otherwise?
3. If I think rationally, chemotherapy can't kill 100% of metastized cancer cells and on top of that it kills your immunity which is quite important to prevent metastasis. So, is it really providing any benefit at all?
4. I hope you could provide me some large scale trials reference which you know of which say otherwise.
5. Are there any medications which have concentrated curcuminoids available as prescription in XXXXXXX There are thousands of research papers on the effect of curcumin (turmeric) and cancer and it seems quite promising. In my personal opinion, I think the only reason it is not being followed so aggressively is because of the its not easily patentable.
1. The doctor gave her the same dosage as you the recommended for AC i.e. doco - 60mg/m2 and Cyclophos - 600 mg/m2. Her height is 150 cm and weight is 54kg. Her BSA was calculated around 1.5, so she has been getting cumulative doco of 90mg and cyclophos of 900mg. Does that seem right?
2. I have been doing quite a research on Chemotherapy and the internet is only full of bad things about chemotherapy. I have also found a lot of studies which seem it does not offer a lot of benefit for as well. e.g. The following links suggest that it only increases the 15 year survival by meager 3% for node positive cancer for women of my mother's age
http://ww5.komen.org/BreastCancer/Table39Adjuvantchemotherapyandoverallsurvival.html
My mother is getting neoadjuvant treatment, so you could say that the above is for adjuvant treatment, but all the papers I have read suggest that the only benefit neoadjuvant may provide is to be able to have breast conserving surgery. In terms of survival, there is not that much of difference, so overall, chemotherapy is adding only 3% survival benefit, which amounts for a few months extra life!!
Do you know of studies which say otherwise?
3. If I think rationally, chemotherapy can't kill 100% of metastized cancer cells and on top of that it kills your immunity which is quite important to prevent metastasis. So, is it really providing any benefit at all?
4. I hope you could provide me some large scale trials reference which you know of which say otherwise.
5. Are there any medications which have concentrated curcuminoids available as prescription in XXXXXXX There are thousands of research papers on the effect of curcumin (turmeric) and cancer and it seems quite promising. In my personal opinion, I think the only reason it is not being followed so aggressively is because of the its not easily patentable.
Brief Answer:
my answers below
Detailed Answer:
1. yes, this seems fine
2. No, in her case, with a locally advanced tumor, it has much bigger benefits.
What you have read is that neoadjuvant vs adjuvant in operable (early) breast cancer. Remember, not neoadjuvant vs NO CHEMO and not about locally advanced (inoperable) cancer. For locally advanced, it is an absolute necessity because risks of metastases are high and that needs to be addressed first.
The correct link for your mom's case is http://ww5.komen.org/BreastCancer/LocallyAdvancedInflammatoryBreastCancerStageIII.html
3. true but even with that there is an overall benefit. If we have more effective drugs which cause less adverse effects then nobody would use chemo. But till then it is necessary.
4. You can read this review http://deepblue.lib.umich.edu/bitstream/handle/2027.42/62087/locally%20advanced.pdf?sequence=1
5. yes there is one called adcumin. Not sure about their efficacy.
Regards
my answers below
Detailed Answer:
1. yes, this seems fine
2. No, in her case, with a locally advanced tumor, it has much bigger benefits.
What you have read is that neoadjuvant vs adjuvant in operable (early) breast cancer. Remember, not neoadjuvant vs NO CHEMO and not about locally advanced (inoperable) cancer. For locally advanced, it is an absolute necessity because risks of metastases are high and that needs to be addressed first.
The correct link for your mom's case is http://ww5.komen.org/BreastCancer/LocallyAdvancedInflammatoryBreastCancerStageIII.html
3. true but even with that there is an overall benefit. If we have more effective drugs which cause less adverse effects then nobody would use chemo. But till then it is necessary.
4. You can read this review http://deepblue.lib.umich.edu/bitstream/handle/2027.42/62087/locally%20advanced.pdf?sequence=1
5. yes there is one called adcumin. Not sure about their efficacy.
Regards
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Above answer was peer-reviewed by :
Dr. Pradeep Vitta
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