Chemo with one kidney

R

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Good evening

I am a regular poster but would rather stay anonymous for now.

My Mom (early 70s) was diagnosed with breast cancer. Stage 2, but had not traveled to lymph nodes.

They did a lumpectomy and in reviewing the reports decided to go in one more time to male sure it was really clean.

They had also done a test to see if there was a genetic component to it - not so much "will this pass on" but to see if chemo would be needed - to make sure it doesn't come back. Apparently if you take a lump out that DID NOT travel, radiation should be enough, unless the genetic markers are high enough to warrant chemo.

So we were hoping it would be radiation only, but, now it looks like chemo will be needed. Unclear on what numbers were, but apparently they were pretty high and doctor said chemo is a good idea along with radiation (I think also, unclear if both or just chemo).

Big issue: Mom had kidney cancer in 1994. They took out a kidney and she has been clean as a whistle ever since - meaning 18 years.

However, she has ONE kidney. Won't the chemo be really hard on it? Are there degrees of chemo? What can be done to mitigate damage?

Thank you.
 
My mom had that about 2 years ago, surgery went fine and then they put her on one of the new ones, forgot what it's called, but it was a lot tougher than anything else on her, damned near killed her and was unnecessary. She still isn't completely over those meds yet.
 
Been through the BC thing with my bride. At age 50 my wife decided on a double mastecomy. There is simply no dancing with cancer. We decided to go for broke, rebuild what was left, and skip radiation and chemo. Got two new hooters out of the deal. ;)

Did your mom have a mastectomy or a lumpectomy?

I agree with Henning. Chemo tough stuff.
 
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Hello again,

Thank you for those thoughts. Apparently what the doctor told her today was that if the cancer did come back, it could go anywhere. Brain, lungs, etc. The next time wouldn't necessarily be breast cancer.

I asked my Dad to find out the name of the genetic marker they were talking about, and how high her numbers were.

Supposedly the doc said that if this were not treated by chemo, based on her numbers, it could have a 35% chance of recurring - anywhere.

I don't know what the worse risk would be - not having chemo, and at least having a functioning kidney until "the next time" which might never happen (35% chance of happening) or risking it all, right now, to go through with chemo that would reduce that 35% chance down, but a higher chance of toasting her only kidney.
 
I think your gonna want to review the BRCA 1 and BRCA2 gene analysis testing.

I seriously doubt she would be given a nephrotoxic chemo with only one kidney. Remember the liver is a big detoxifier in your body.

However it is true, chemo is a poison. Many do well with obvious side effects being hair loss and nausea but many tolerate the current regimens very well especially when they go into it with a great attitude.:yes:

I wish her the best and am sure she will do great!
 
Unregistered said:
Hello again,

Thank you for those thoughts. Apparently what the doctor told her today was that if the cancer did come back, it could go anywhere. Brain, lungs, etc. The next time wouldn't necessarily be breast cancer.

I asked my Dad to find out the name of the genetic marker they were talking about, and how high her numbers were.

Supposedly the doc said that if this were not treated by chemo, based on her numbers, it could have a 35% chance of recurring - anywhere.

I don't know what the worse risk would be - not having chemo, and at least having a functioning kidney until "the next time" which might never happen (35% chance of happening) or risking it all, right now, to go through with chemo that would reduce that 35% chance down, but a higher chance of toasting her only kidney.
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35% chance of recurrence in a septuagenarian to me sounds like a good deal compared to what my mom went through with IIRC, Arimadex <sp?>, that stuff screwed her up something serious. I know it's a crappy reality, but she is over 70 and the fact remains, we will all die one day and 70 is the current life expectancy. At this point I'd be looking at quality of life as well, that is where the real risk lies at her age.
 
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Hi Henning

Thanks. That is where I am on this, as well. However, her Mom lived to almost 92, in fact she only died a few years ago. Tough old bird. I was kinda hoping Mom would be around at least through her "good years" of her 70s if not a lot longer. She's very spry and in decent shape - gets around great, good energy, we have a lot of fun together.

Her closest cousin (well, there were only handful of them) died at age 65 just this past spring - breast cancer. After three years of all sorts of treatments and misery.

Thank you JT, we will look into all of this. I want her to have a good chance, but not if it means having a sucky last few years of her life. She would be better off having a good year or so and then dying, instead of a bad two years.
 
Unregistered said:
Hi Henning

Thanks. That is where I am on this, as well. However, her Mom lived to almost 92, in fact she only died a few years ago. Tough old bird. I was kinda hoping Mom would be around at least through her "good years" of her 70s if not a lot longer. She's very spry and in decent shape - gets around great, good energy, we have a lot of fun together.

Her closest cousin (well, there were only handful of them) died at age 65 just this past spring - breast cancer. After three years of all sorts of treatments and misery.

Thank you JT, we will look into all of this. I want her to have a good chance, but not if it means having a sucky last few years of her life. She would be better off having a good year or so and then dying, instead of a bad two years.
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in r.e: ONE kidney: Depends on what is in the Chemo. "Chemo" can be any of 10-15 things for this sort of tumor. NOT ENOUGH INFO.
 
I recall when my FIL had Chemo for Lymphoma they gave him meds, Steroids IIRC to help protect his kidneys. My best wishes for your moms full recovery.
 
Unregistered said:
Hi Henning

Thanks. That is where I am on this, as well. However, her Mom lived to almost 92, in fact she only died a few years ago. Tough old bird. I was kinda hoping Mom would be around at least through her "good years" of her 70s if not a lot longer. She's very spry and in decent shape - gets around great, good energy, we have a lot of fun together.

Her closest cousin (well, there were only handful of them) died at age 65 just this past spring - breast cancer. After three years of all sorts of treatments and misery.

Thank you JT, we will look into all of this. I want her to have a good chance, but not if it means having a sucky last few years of her life. She would be better off having a good year or so and then dying, instead of a bad two years.
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Yeah, especially if the surgery was early, she has 65% chance of never seeing it again and having some more healthy years, while OTOH, the Chemo offers no assurance of no return either as with her cousin. Cancer is a ***** like the rest of life, these decisions always suck, it's not like there is a "Good Option" you have to choose from, they all suck.
 
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bbchien said:
in r.e: ONE kidney: Depends on what is in the Chemo. "Chemo" can be any of 10-15 things for this sort of tumor. NOT ENOUGH INFO.
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Agree with Dr Bruce... a lot of old stuff was systemic poisons and the gamble was the cancer would take more of a hit than the normal tissue.

Newer stuff out there, especially targeted biologic therapies are like hunting cancer with a sniper rifle instead of a shotgun.

Not enough information here to offer an opinion, other than IF its nephrotoxic, there are things that can be done to mitigate the impact, the biggest one being hydration... They will take into effect her age and solitary kidney status... and evaluate labs that indicate her renal function... and perhaps refer to a nephrologist for management if needed.
 
One of my consistent complaints about the medical profession is the treatment of diseases rather than patients. A woman in her mid 70's, already a cancer survivor with a new neoplasm. What do you do?

From the information given I wouldn't be surprised if there was a tumor suppressor mutation floating around in the family somewhere. Might not have come from her mother's side, then again I could just be blowing smoke. A genotype is an easy thing, I'm surprised it hasn't been done already. That tells one a lot.

The incidence of cancer goes up, not down with age. The odds of a 75 year old cancer survivor with a tumor mutation to live cancer free into her nineties are slim at best. On the other hand, the chemo could be the only thing keeping metastases at bay. Really, really tough call.

Were it my mother I'd be asking hard probing questions about the chemotherapeutic agent they're planning to use. Is is really worth it to put someone through that kind of regimen, especially someone elderly, for a potentially limited payoff?

Now the disclaimer. I'm no MD, have never played one on TV, and didn't stay at a Holiday Inn last night. Nor do any of us have enough information to say anything for certain. Not that we could easily do that in any case.
 
Hello again

Thank you everyone for the thoughts. I'm sorry that there are so many of us having to watch our families go through this.

What kinds of questions should we be asking? We literally found out an hour before I posted, and my Mom was still recovering from the anesthesia from the surgery when the doctor told her.

Number one is "what is the name of the test, and what were the actual numbers and what do they mean" and number two is "what drug do you plan on giving me".
 
They are most likely talking about the HER2/NEU testing which is a gene for a receptor that is implicated in breast cancer. The drug they can use when this test is positive is called herceptin. They usually also test for estrogen and progesterone receptors which means that hormonal therapy will be beneficial. Occasionally other genetic factors are tested, so I would ask her doctors for more details.

I would expect that the oncologists will be aware of her renal status and take this into consideration.

I'm sorry your family is going through this. Breast cancer us one of the few cancers that I've seen a very good rate of complete remission, so her odds are pretty good, especially with negative nodes.
 
HER2 mutations are an important part of the current neoplasm and can dictate treatment for it, but germ line mutations in a tumor suppressor like BRACA1 or 2 are game changers globally.
 
Unregistered said:
What kinds of questions should we be asking? We literally found out an hour before I posted, and my Mom was still recovering from the anesthesia from the surgery when the doctor told her.
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The questions you should ask:

- Looking at moms lab data, is there any sign that her kidney function is impaired (many patients with only one kidney have near normal overall kidney function as we are built with 'over-capacity' and the remaining kidney can ramp up its function to compensate for the loss of its partner.)

- After all the data is looked at, what difference for her expected survival will the addition of chemotherapy to the regimen make (breast cancer is so common that there is good data for the different treatment pathways, your mom may decided that a couple of percent change in the odds is not worth the hassle and risks of chemo. Her medical oncologist should be able to give her those numbers based on her tumor type, type of surgery, lymphnode status etc.)

- What is her hormone receptor status, will it afffect the recommendation for or against chemotherapy ?

- Are there alternate chemotherapy regimens that are not likely to affect her kidney function ?

- What would you recommend to YOUR mom ?

I am sitting in a lecture about lung cancer staging as I type this. I deal with the diagnostic side of BC in my daily work, so I can't say much about the different chemo regimens. Yet every female in my family over 50 has been through the BC wringer, so I have had those conversations a couple of times. If you pm me an email address, I'll keep your ID in confidence but may be able to give you more detailed pointers based on the information you may be willing to share.
This is not a decision that has to be made today or tomorrow. You and your mom will have time to collect the relevant data and come to a decision she is comfortable with.
 
After reading the OP again, I'm not sure if you are talking about her2/NEU or not.

There are other tests such as gene expression profiles that are not as widespread in their use but can be used to guide adjuvant therapy decisions. I am not as knowledgable about those tests.

BRCA1 and 2 are obviously important given the risks they indicate. However it is not routinely used to decide adjuvant therapy as far as I have seen although this is being actively investigated.
 
Good evening everyone

Mom had to go back for another surgery as there were still some cells showing. However, the results are back from THAT surgery and there are STILL cells showing so now she wants a mastectomy. Apparently in order to get a double mastectomy the insurance company wants her to have a mammogram. Not sure if they would allow her to have both taken IF the mammogram shows the other breast does not currently have cells.

What is annoying about this is that IF she had had the mastectomy right out of the gate, first surgery, she'd be done - now, as it stands, by the time the third surgery is done it will be a full month since the first surgery. Not sure why that didn't happen, I hope it wasn't an insurance call.

And, some other results:

Her-neu2 (if I got that right) is negative.

Her oncodx is 51. Apparently that is pretty high.

More, as I learn more. Sigh.

Thank you again for any thoughts.
 
Unregistered said:
What is annoying about this is that IF she had had the mastectomy right out of the gate, first surgery, she'd be done - now, as it stands, by the time the third surgery is done it will be a full month since the first surgery. Not sure why that didn't happen, I hope it wasn't an insurance call.
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Yeah, in all the effort to operate 'breast conserving', sometimes patients end up with a more complicated surgery than with a mastectomy right from the start. Also has the advantage of never needing another mammogram on that side (post-lumpectomy, that breast has to be checked more frequently than the normal screening mammograms, sometimes the post-surgical changes are difficult to interpret and require further follow-up). Some older breast surgeons still offer mastectomy to patients who otherwise could have lumpectomy+radiation. They are often attacked and ridiculed by the more fervent supporters of breast conservation. But when the options are laid out to the patient, particularly older women will often choose the 'done and over with' solution rather than the salami tactic.

And no, without a reason to believe that there is cancer in the other breast (MRI, stereotactic biopsy), a bilateral mastectomy would only rarely be done for limited disease on one side (pretty much only for patients with a high genetic risk, BRAC1/2 carriers for example).
 
Thank you Weilke

Do those numbers look bad? Apparently anything above 31 means "high risk, and chemo will outweight the side effects" according to my google-fu.
 
Unregistered said:
Thank you Weilke

Do those numbers look bad? Apparently anything above 31 means "high risk, and chemo will outweight the side effects" according to my google-fu.
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How about talking to the oncologist for that one. It can't be apporpriate to give advice by webboard....the question expects a "fixed" answer, that that's tough to begin with, even with full information....which we can't really have in this setting.... :no:
 
Fair enough, understood. Thanks.

Once I find out what chemo they will be using I'll post again.
 
OK. New news:

Mastectomy soon. Four-six weeks later, chemo. Doc said it will up her survival rate to 92% if she does chemo.

The regimen will be "T.C" which I googled and found it is Taxotere-Cytoxan + Neulasta.

Supposedly the liver filters this drug, not the kidney.

Afterwards, she will be on tamoxifin.

This is all I know, right now...

Thank you again, everyone... sigh. My poor Mom.
 
Unregistered said:
Thank you again, everyone... sigh. My poor Mom.
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75 ain't a bad run, I've known lots that didn't make it that far, including my old man. Heck, I get to go visit my ma at the daffy old folks home tonight. I bet she'd have preferred to die of cancer at 75 instead of what's happened.
 
Unregistered said:
OK. New news:

Mastectomy soon. Four-six weeks later, chemo. Doc said it will up her survival rate to 92% if she does chemo.

The regimen will be "T.C" which I googled and found it is Taxotere-Cytoxan + Neulasta.

Supposedly the liver filters this drug, not the kidney.

Afterwards, she will be on tamoxifin.

This is all I know, right now...

Thank you again, everyone... sigh. My poor Mom.
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From here on in it's as much attitude as anything that makes a difference in which way it goes.
 
Dr. B, is that chemo a tough one? I know they are all tough, but where does that one scale?
 
Unregistered said:
Dr. B, is that chemo a tough one? I know they are all tough, but where does that one scale?
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7/10. It is all about the dose of Taxotere. One of the pioneer oncologists, Dr. Harvey Golomb, explained "that unless the patient gets some side effects, you aren't doing the patient any favors". That was a very commanding and local way of reminding the team that the alternative is pretty awful, too.

Cytoxan is not so bad, but also is a dose-->side effect situation.
 
All

Thank you for the information you have given me so far. My Mom is now on day 8 of the first round of chemo.

She also had a Neulasta shot on Monday. She had a huge amount of pain in her hip(s) last night. She could barely walk she said. She is able to walk today.

I also found out she has to be on a drug after the chemo is done, for five years. Tamoxifen?

I guess she is on day 8, of four chemo rounds that will be three weeks apart. Which means on day 63 it will be her last round of chemo, but then of course XYZ days after day 63 will be recuperation from her last round of the T&Cs.

How many days before she even feels halfways normal, assuming all goes well?

This sucks. My poor Mom.
 
Unregistered said:
All

Thank you for the information you have given me so far. My Mom is now on day 8 of the first round of chemo.

She also had a Neulasta shot on Monday. She had a huge amount of pain in her hip(s) last night. She could barely walk she said. She is able to walk today.

I also found out she has to be on a drug after the chemo is done, for five years. Tamoxifen?

I guess she is on day 8, of four chemo rounds that will be three weeks apart. Which means on day 63 it will be her last round of chemo, but then of course XYZ days after day 63 will be recuperation from her last round of the T&Cs.

How many days before she even feels halfways normal, assuming all goes well?

This sucks. My poor Mom.
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No idea, but best wishes to your mom...
 
Thanks Henning. She isn't feeling too bad, mostly just can't taste her food. Her hip pain went away for the most part.

Dr. B, after her round of chemo, why does she need to be on Tamoxifen for 5 years? She will be 72 in October, is it really worth it to be on a drug for a good chunk of her 70s - is it really that effective? How bad will she feel on Tamoxifen? What if she says "one year, mo more" to the drug? Or just "no"?
 
Unregistered said:
Thanks Henning. She isn't feeling too bad, mostly just can't taste her food. Her hip pain went away for the most part.

Dr. B, after her round of chemo, why does she need to be on Tamoxifen for 5 years? She will be 72 in October, is it really worth it to be on a drug for a good chunk of her 70s - is it really that effective? How bad will she feel on Tamoxifen? What if she says "one year, mo more" to the drug? Or just "no"?
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Tamoxifen interferes with the estrogen receptors on the cancer cells, and is good for long term suppression. It's not a "cell killer" cancer drug per se, like the others.

It would be really silly to put up with the major chemotherapy as she is doing now, to just walk away from "a pill a day". There are very few side effects of the tamoxifen alone.

I know it's hard to see that when she's in the middle of multiple rounds of the killer stuff. Life will not be nice for a few months :(
 
Thanks Dr. B. No, sigh, it won't be. But at least it is winter, so she is not wasting good weather on all of this. Her last treatment will more or less coincide with daylight savings time starting, which means she will hopefully start feeling better as spring progresses.

I passed on your message, thanks again.
 
Unregistered said:
Dr. B, after her round of chemo, why does she need to be on Tamoxifen for 5 years? She will be 72 in October, is it really worth it to be on a drug for a good chunk of her 70s - is it really that effective?
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The reason WHY it was recommended for her to be on it is because the tumor was found to have estrogen receptors. Those typically promote growth of tumor cells. By blocking those receptors with tamoxifen, that pro-growth effect can be eliminated. In real survival terms, it reduces the number of relapses over those 5 years by about a quarter. It is tolerated very well by most patients, so the downside is low, the benefit is measurable. Would I recommend it to my mom: Hell Yeah (in fact I did back then).
 
Ok folks, thanks so much for the hand holding. More questions now.

The doc said that he wants her on arimidex instead of tamoxifen. Good/bad? Pros and cons for one or the other? I just scrolled above and saw Henning had a really bad experience with his Mom on that. Perhaps she should stick with tamoxifen if arimidex is that bad.

What do you think ?
 
Ps. She already has issues with osteoporosis and does tolerate the drugs to combat that.
 
But she has issues with osteoporosis and the list of side effects is scary...
 
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