Small Tumour & Herceptin Studies

[dlamanuzzi]

Hi all;

My wife, 44 years old, has recently completed her chemo 4 doses of AC. She is ER+, PR + and Her2Neu 3+. In the beginning her onclogists did not recommend Herceptin, however changed his mind after having the slides reviewed. He feels her tumour is just over 1 cm and left the decision for us to make. We are not sure if the risk outweight the benefits.

Are there any studies that show the benefits of using Herceptin on small tumours?

All comments are appreciated

Thank You Dominic

[Sheila]

Dominic
My tumor was 0.7cm, and when I was diagnosed Herceptin was not available for early stage...I wish I could of had it, 1 1/2 years later I was stage 4...I would say go for it, the risks are small compared to the benefits!!!

[karenann]

Dominic,

My tumor was 1.3cm, node negative, er/pr+, grade 3 and Her2+++. I did dose dense, ACx4 and Tx4, 34 rads and five years of Aromasin. My doc did not think that I needed, Herceptin, but I did. I am going to finish my one year of Herceptin in July.

Karen

[chrislmelb]

The risks are small compared to the benefits. Take it.
Christine

[dlamanuzzi]

HI All;

I want to take this opportunity to thank you all for your quick response.

I am sure my wife (Tina) will have some follow up questions to ask. I will show her the responses when she comes home.

Thanks Dom

[Becky]

There are no studies on small tumors in general but all the clinical trials used women who had tumors that were 1 cm or greater. Your wife's tumor is slightly larger than 1cm. She is also young and has a lot of life to live. Herceptin is an easy drug to take (the first 2-3 are tiring but it is a breeze drug) and because she is young (and presumably very healthy otherwise), the chances of having cardio problems is low. And if it occurs, they just stop the Herceptin as the problems are reversible.


I was 45 (47 now) and although my tumor was larger (1.9cm) I did not hesitate in order to see my daughters grow up and my potential grandchildren. The every 3 week dosing does not get in the way of lifestyle at all and it boosts the survival rate by 52% (and you can't beat that).

Kindest regards

Becky

[JohnL]

The proportionate benefit for small tumours is the same as for others. The HERA study included a large sample of small tumour node-negative patients.

Thus even with a post-chemo relapse in the 10% to 15% range, the gain in halving that is well worth taking given that the risks associated with hereceptin are quite low if your wife is otherwise healthy.

My wife (45) with a 1.4 cm tumour N0 had FEC(100) x 2 and Taxotere x 4 plus Herceptin for a year. So a bit more of an aggressive approach taken, largely on the basis of her relatively young age.

Good luck

John L

[jsattaw]

Hi Dominic --

I was node negative with 4 small tumors (together about 2 cm). I am glad to be getting 1-year of Herceptin as a prevention to recurrence. The heart risks can be monitored with testing and affect such a small proportion of those on the drug. Also, I've had no side effects and just pretend I'm at the spa when I go in every 3 weeks for the infusion. I use the time to read a book or magazine that I wouldn't normally read and must admit to feeling a little guilty that I'm relatively healthy compared to those who are getting the harsh chemo drugs.

I'm 45 also with a 5-year-old son and want to do everything I can to live a long and healthy life!

Good luck with your decision.

Jill

[atdec05]

my tumors together were 1.05cm, er/pr-, (also premenopausal) and herceptin was recommended. Herceptin has been shown to make a signficant impact on recurrence rate for stage 1 women as well as later stages, so I thought it was worth it.

Since your wife is also hormone receptor positive that also affects her treatment options and recurrence rates.

[RobinP]

It would be nice to know your history more completely. What are the following:
1. grade tumor
2.any lymphovascular invasion
3. any positive nodes
4. what was your risk after chemo for relapse on adjuvant online?

You know if your risk of relapse is very low and your odds of cardiac risk(s) with Herceptin are greater than relapse and you feel compelled to do Herceptin, perhaps you could consider the option of abbreviated therapy, such as 9 weeks which had no evidence of cardiac risk with comparable disease survival benefits as longer therapy. Nobody really knows yet if prolonged therapy of a year or more really is beneficial or not over the shorter 9 week therapy. But we do know the 9week FinHer trial, had no cardiac risk in three year follow-up. Beyond 3 years, we do not have data. The only thing we can look to for cardiac long term risk are some of the long term survivors on herceptin...

PS. Hormonal positives relapse for her2+bc is much less than Negative for the first few years. We don't know if that will hold true for longer followup in the Hera trial or if that will just relapse later than her2 hormonal negatives. See my post from Dec 2005 to see the break down of relapse...

Excerpts from my Dec 2005 post:

I found it particularly interesting that in the HERA discussion, node negative her2+ er,pr+ subtypes only had a 9% risk of recurrence of bc in two year follow up. This risk was so low that the investigators will be watching this group in follow-up to determine if Herceptin is indicated in this subtype. On the other hand, node negative er, pr negative, her2+ subtype relapse risk was at an alarming 18%! The break down of risk for relaspe in 2 yr. f/u is as follows:

ER,PR Negative, her2+
Node Negative 18%
1-3 nodes 25%
greater 4 nodes 33%

ER,PR positive, her2+
Node Negative 10%
1-3 Nodes 12%
greater 4 nodes 33%

[atdec05]

It would be nice to know your history more completely. What are the following:
1. grade tumor - 3
2.any lymphovascular invasion - no
3. any positive nodes - no
4. what was your risk after chemo for relapse on adjuvant online?

Also pre-menopausal, er/pr-
My recurrence rates jibbed with what you posted in dec 05.
Basically, with AC & Herceptin my recurrence rates dropped to almost the same as someone Stage 1, er/pr positive.

- Anna

[RobinP]

Note the above rates that I posted for relapse were from the Hera trial where tumor size was at least, from what I THINK- please check yourself to be certain, 2cm or node positive.In other words, the hera trial relapse results can be misleading for someone with a small- under 2cm and node negative her2+bc. Still, it does say something about how much more aggressive hormonal negative her2+ bc is compared to hormonal positive her2+ bc.

[atdec05]

Hi Robin,

I think those recurrence rates apply to stage 1 as well, because those numbers are what my onc. told me. Basically, other than being early stage, all my tumor characteristics were agressive, fast-growing, and I was pre-menopausal. So that's why I went for the chemo.

Of course, only later trials will pinpoint how long we really need to take Herceptin. The Finnish test is promising, but it was done on a small group of women.

[RobinP]

Yes, it would be nice to have a larger study trial.Still, the 9week FINHER trial, albiet small, does say something and the study size was over 120, i believe, making it have statistical significance. Also, the Hera trial did have actually longer follow-up than the HERA and NCI adjuvant trials.