IBC and Chemotherapy

Hi there.  My mother has been diagonosed with Inflammatory Breast Cancer (this was a recurrence).  She was taking the chemo combination of docetaxel and epirubicin, once every 4 weeks.  (She received her 2nd cycle Dec. 26 2001) And a Lupron injection for her hormones once every month. What are the benefits of Lupron and will it be effective and stop cancer cell growth?  Yesterday she went to her oncologist.  He said that he is going to stop giving her epirubicin because it is bad for the heart but he will keep giving her docetaxel once every 4 weeks.  Why do you think he changed her chemo treatment? Her breast was responding to the treatment. There are signs of improvment; the redness on her breast is gone, the warmness is gone, and the swelling is becoming better. My mother has no past history of heart problems. And is there too much time between each treatment of chemo?  Also she was taking Tamoxifen and yesterday he took her off Tamoxifen and put her on Femara.  Her Her-2  status is positive.  Shouldn't he be giving her Herceptin? Also her onc. said in order to control the diease she may have to be on chemo forever.  Is that possible?! Can someone acutally receive chemo forever? I will be waiting for your response.

[CCF-RN,MSN-rf]

Dear oceanblue:  Obviously, without knowing the whole story, it is difficult to speculate on your mother's physician's rationale for all treatment decisions.  It is true that epirubicin can be cardiotoxic - there is a lifetime maximum for these types of drugs.  The maximum of epirubicin may be lower if she has had doxorubicin or another cardiotoxic drug in the past.  This is true regardless of any cardiac history - although that would certainly complicate matters. The frequency of chemotherapy is determined by research and does not seem out of the realm of normal.  Lupron is an LHRH antagonist.  It has been used in combination with tamoxifen and aromatase inhibitors, particularly in premenopausal women.  It is unclear whether the combination of tamoxifen and lupron are superior to tamoxifen alone.  The question of her hormone therapy may best be posed to her physician.  If her tumor expresses the her2/neu antigen, you could certainly ask about the use of herceptin.  When her doctor said "chemo forever," I suspect he meant that inflammatory breast cancer is considered a systemic - almost chronic - disease that is difficult to cure.  He probably was suggesting that your mother may need constant chemotherapy in order to control the disease.  This would mean that chemotherapy would continue until the disease disappears (which it may not) or your mother is unable or unwilling to tolerate additional therapy.