Treatment Cycle 6 - Day 1

Treatment was easy once again today - and now we're done with neoadjuvant chemo!!!

Prior to the infusion, we saw Maddie for my checkup. She was very pleased with how my tumor is feeling, very soft with no discernible margins. I asked her if she thought it was still even a tumor or just scar tissue, and she said, "Dead tumor." The only good tumor is a dead tumor! Of course, we won't know for sure that mine is really dead until the pathology report from my surgery is completed, but now both Patients #1 and #2 are confirmed to have "pathologically complete responses" - no cancer.

We also saw Dr. Hurvitz and questioned her about MARIANNE. She said that no one knows anything yet because the underlying data wasn't released, only the top line results. Roche had to release the top line results due to an SEC requirement that they disclose information that could affect stock value (which these did) - but the detail wont be announced until a future medical conference. She is on a conference call tomorrow morning where the impacts of the study will be discussed, but she said that she doesn't expect to find out much more until the next important breast cancer conference, which is in March, or even the next one after that, in June. Even then, because MARIANNE was looking at the metastatic setting, the results won't be directly transferable to early-stage patients like me. And looking at the bright side, she said that since the study found that T-DM1 was "non-inferior" (study-speak for equal) to the standard of care, these results should have no effect on our study, KRISTINE. If T-DM1 had been found to be inferior, they might have had to put a hold on KRISTINE, which in turn might have meant that my post-surgery treatment would have been changed to standard chemo with Herceptin - not a desirable outcome for me. 

In other news, my surgery is now finalized: skin-sparing/nipple-sparing bilateral mastectomy with Dr. Funk and reconstruction with expanders with Dr. Trott on Wednesday, January 28 at St. John's in Santa Monica. The surgery typically takes around 8 hours, and I will be under general anesthesia the whole time. Most patients spend two nights in the hospital after this procedure (although a third night is possible if I'm still in a lot of pain) - so most likely I will be discharged on Friday, January 30. After that, recovery. Two of my support group friends who had the same surgery told me that they were pretty out of it the first week but doing well by the end of the second week, which is also when they take the drains out (drains are long tubes that are inserted into the breast area to collect excess fluid that can accumulate in the space where the tissue was). Both Drs. Funk and Trott said to assume it will take three weeks to be really functioning again, including driving, which I can't do until they clear me. Just in case, I am planning to take four to six weeks off work, and we'll see how it goes - but I'm a good healer and I plan to be on my feet again as soon as possible. There are a lot of reasons why I want to recover quickly, but one of the most important is so that I can resume chemo and get done with treatment!

I am also having something called a nipple delay procedure on Monday, January 19 at Pink Lotus. This procedure, which in my case will be performed nine days prior to the actual mastectomy, was developed by Dr. Funk for patients who want a skin-sparing/nipple-sparing mastectomy, to reduce the risk of skin necrosis. It uses the planned mastectomy incision and lifts half of the skin off of the breast surface. This recruits extra blood flow to the area, lessening the chance of nipple and skin loss due to insufficient blood supply after the mastectomy. Additionally, a small disc of the tissue directly behind the nipple and areola is also removed and analyzed by a pathologist to rule out the presence of any cancer directly behind the nipples, which would make preserving them dangerous. Since she started using this technique in 2008, Dr. Funk's loss of skin and nipple after mastectomy has decreased to less than 2%, versus the industry standard of about 10%. 

I'm not looking forward to any of it, but I'm very much looking forward to getting it over with!