How is the efficacy of adjuvant chemotherapy evaluated?

Hi all,

I am 33 years old and I was diagnosed with grade 3 ER+ breast cancer in October. I had a lumpectomy done in November and started chemotherapy in December (4xEC + 4x taxol). The pathology report from the surgery showed a positive lymph node (1/1) with a 4mm metastasis and extensive LVI. I was advised to have a mastectomy and axillary lymph node removal which will be done after chemotherapy. I was wondering how is the efficacy of chemotherapy evaluated since my tumor was already removed? And also I was wondering if anyone knows what is the % of responders? I will ask my consultant all of this in the next appointment but in the meantime if anyone has an idea that would be helpful.
Thanks a lot and have a nice day :slightly_smiling_face:


I’m sorry to hear you are going through all this. It’s not easy, is it! Grade 3 indicates that all the adjuvant therapies will be considered and, obviously, you are undergoing the first. The results/effects of chemotherapy can be seen in different ways but it’s generally assumed that you’re going through enough without further invasive investigations.

Everyone carries blood markers because they are indicators of various diseases. However, if blood markers are high, it is assumed cancer is present. If your blood markers have dropped and are remaining stable as a result of chemo, that’s an indication that the chemotherapy is successfully controlling any cancer activity. The numbers themselves are irrelevant - mine started at 128 but I know of someone who was close to 1000. Her drop is ‘only’ to 400 but what a drop. Mine plummeted with chemo to 18 and have stayed there.

Some hospitals don’t use blood markers because they aren’t a fully reliable indicator of what’s going on but, if the markers remain stable, it’s a good sign. If the markers don’t respond or continue to rise, you’d be moved to another chemotherapy option. There are also tumour markers and, since you’re having a mastectomy after this, it’s possible that your blood also has tumour markers which can be detected and measured. They have different codes (eg CA-125) according to the characteristics of the cancer.

After chemo, you will probably be scheduled for a CT scan or an MRI which will identify any remaining problem areas. There should be none which is proof the chemotherapy has worked. It’s probable that, following recovery from your mastectomy and axillary clearance, you’ll have a further adjuvant therapy - radiotherapy, an additional precaution - and probably one of the hormone therapies as your cancer is oestrogen responsive. These treatments are essential as even the slightest metastasis is less easy to control.

You ask about % response. I foolishly googled one of my scores once treatment had finished. I truly regretted it (I’ve outlived it already) and it took a superb breast care nurse to put it into terms I could respond to. Now with secondaries, I don’t even ask. Similarly, my oncologists have never gone into detail or even indicated what they consider to be my prognosis. Statistics are meaningless. If one is told there’s a 75% success rate, huge anxiety sets in that one might be in the unlucky 25%. It’s futile. No one can know what will happen so why think and worry about it? Because a lot of patients do that. You can be sure your team is doing everything right for your particular cancer and trust is essential.By all means ask the oncologist, who may have the answer, but be really sure you want to know and can deal with any doubts or distress the knowledge throws up. Once heard, it can’t be unheard.

On that happy note, I wish you well with your treatments and recovery. 

Jan (an ostrich) x