Few days back did a second opinion consultation. The husband and son had come with some reports.
The history started from May 2009. The lady had a lump in the right breast which was confirmed as malignant by Fine Needle Aspiration cytology (FNAC). The next report they had was a discharge summary from (HCG) Health Care Global Hospital, Bangalore which was dated October 2009. The discharge summary indicated a metastatic disease with metastasis in mediastinal lymph nodes, hilar lymph nodes and lung.
They did not mention what they did from May to October! My guess is that they would have taken either ayurvedic or homeopathic medicine and are now shy to tell about it.
She received 6 cycles of docetaxel+adriamycin+cyclophosphamide at HCG with partial response. Her ejection fraction had also dropped to 40. Possible a side effect of adriamycin. During the work up, they mention that, HCG missed getting estrogen, progesterone and Her 2 marker. After few chemotherapy the tests were done and she was found to be Her 2 positive and negative for hormonal receptors. But they did not add any trastuzumab or lapatinib.
As she had lump in her breast they consulted Dr.Raghavan. He started her on Lapatinib (Tykerb), Letrozole and Zoledronic acid (Zometa). Zometa was added prophylactically as she did not have bone metastases at that time, February 2010. According to their narration, Dr.Raghavan wanted them to take medicines directly from him and also get admitted for zoledronic acid administration. Zoledronic acid can be administered on an OPD (out patient) basis.
The good part was that PET scan done in September 2010 showed complete resolution of disease. There was no evidence of disease anywhere in the body.
The story gets murkier here. They did not have any reports post this and did not divulge any information regarding what medical decision was taken at that time. They mentioned that they took Tykerb for one more year but did not have any prescription for that period. It would have been a challenge to advice on the appropriate course of action in September 2010.
Fast forward to August 2013.
She has visited HCG again. She has local recurrence and now the disease has also spread to hilar lymph node, mediastinal lypmh node, lung, brain (right parietal and left temporal region), and also metastases in dorsal and lumbar spine. She is symptomatic for spinal metastases (she has pain). She is asymptomatic for brain metastases.
A new set of doctors have advised her gemcitabine+paclitaxel chemotherapy with pegfilgrastim support! They have mentioned that, if required, they will treat the brain metastases with Cyberknife!!
What did i counsel or suggest them?
Priority wise
1. Whole Brain Radiation 30Gy in ten fractions and RT to spine (involved areas)
2. Restart Tykerb, as it was taken 2 years back.
3. Consider Capectiabine oral chemotherapy.
I referred them to Dr.Vadiraj at Manipal or to Dr.Siddanna at Kidwai.
I am yet to hear from them...
The history started from May 2009. The lady had a lump in the right breast which was confirmed as malignant by Fine Needle Aspiration cytology (FNAC). The next report they had was a discharge summary from (HCG) Health Care Global Hospital, Bangalore which was dated October 2009. The discharge summary indicated a metastatic disease with metastasis in mediastinal lymph nodes, hilar lymph nodes and lung.
They did not mention what they did from May to October! My guess is that they would have taken either ayurvedic or homeopathic medicine and are now shy to tell about it.
She received 6 cycles of docetaxel+adriamycin+cyclophosphamide at HCG with partial response. Her ejection fraction had also dropped to 40. Possible a side effect of adriamycin. During the work up, they mention that, HCG missed getting estrogen, progesterone and Her 2 marker. After few chemotherapy the tests were done and she was found to be Her 2 positive and negative for hormonal receptors. But they did not add any trastuzumab or lapatinib.
As she had lump in her breast they consulted Dr.Raghavan. He started her on Lapatinib (Tykerb), Letrozole and Zoledronic acid (Zometa). Zometa was added prophylactically as she did not have bone metastases at that time, February 2010. According to their narration, Dr.Raghavan wanted them to take medicines directly from him and also get admitted for zoledronic acid administration. Zoledronic acid can be administered on an OPD (out patient) basis.
The good part was that PET scan done in September 2010 showed complete resolution of disease. There was no evidence of disease anywhere in the body.
The story gets murkier here. They did not have any reports post this and did not divulge any information regarding what medical decision was taken at that time. They mentioned that they took Tykerb for one more year but did not have any prescription for that period. It would have been a challenge to advice on the appropriate course of action in September 2010.
Fast forward to August 2013.
She has visited HCG again. She has local recurrence and now the disease has also spread to hilar lymph node, mediastinal lypmh node, lung, brain (right parietal and left temporal region), and also metastases in dorsal and lumbar spine. She is symptomatic for spinal metastases (she has pain). She is asymptomatic for brain metastases.
A new set of doctors have advised her gemcitabine+paclitaxel chemotherapy with pegfilgrastim support! They have mentioned that, if required, they will treat the brain metastases with Cyberknife!!
What did i counsel or suggest them?
Priority wise
1. Whole Brain Radiation 30Gy in ten fractions and RT to spine (involved areas)
2. Restart Tykerb, as it was taken 2 years back.
3. Consider Capectiabine oral chemotherapy.
I referred them to Dr.Vadiraj at Manipal or to Dr.Siddanna at Kidwai.
I am yet to hear from them...
