Herceptin used when node neg?

[Tara]

I am wondering if I should use herceptin? I was first dx w/ bc back in 1999 on my left breast. I was 25 years old. It was stage 2, er neg, no nodes involved. I did a lump., 4 rounds chemo(a/c), radiation. Now, 6 years later I have been dx'd once again-this time to my right side. This cancer is slightly different. I am ER neg, stage 2, no nodes involved, but I am Her2 positive this time. I had a bil. mast. 3 weeks ago. I go in tomorrow for a heart ultrasound. This is the issue-my oncologist is concerned about heart failure. He wants me to do 4 rounds of chemo again (a/c). He is not sure about the herceptin as he is not sure about any studies out there that show it being effective for node negative women. He feels like the risk of heart failure may not be worth the benefit as I have no node involvement. He is going to research this some more before finalizing a treatment plan for me. Has anyone been given herceptin in a case similar to mine w/ no nodes involved? I am so confused. I know this is an aggresive type of cancer. I don't want it spreading to my bones or lungs-but I also don't want heart failure. Any advice would be greatly appreciated. Thanks

Hi Tara,

I was diagnosed in Jan with stage 1, node negative, er/pr+, 1.3 cm tumor, Her2+++. I did AC &T dose dense, 34 rads, Aromaisn for 5 years and Herceptin for 1 year. My doctor said the same thing about the risk of congestive heart failure out weighing the benifit of herceptin with my early stage disease. I pushed and got the Herceptin. I have an ekg and echo every 3 months and so far, so good.

I hope this helps you with your decision.

Karen

[DeborahNC]

This is my second time around with BC. First DCIS in 2003 with rads and lumpectomy.

This time after bilateral mast I am Stage 1, node neg, ER+/PR-, IDC, Her+++ and doing 6 cycles of Taxol with Herceptin; will continue Herceptin for 1 year.

My onc said she would have considered me 'cured' after the mastectomy had it not been for my Her+++ status. She offered me an aggressive regime and is convinced that I will benefit from Herceptin despite being node neg.

All the best to you.

[suzan w]

I was dx'd in May 2005, invasive lobular, left breast. Had bilateral mast., node neg., 7mm (small) tumor, ER+,PR+,Her2+...my onc. also said she would consider my treatment ended with mast. if not for the Her2+( with tamoxifen for the ER+)). I also had an Oncotype DX test done, that showed a high-intermediate risk for recurrence. That convinced me to go for chemo and herceptin. I did 4 rounds of A/C and am now into my year of herceptin. I am also on Arimidex. From everything I hear about recurrence...and Her2+, I am going to do everything available to prevent recurrence! I am grateful to all the women in the trials and for all the feedback on this site.

[JohnL]

In the UK they are giving it to node negative patients on the basis that HER2+++ N0 still have a meaningful level of recurrence. Node Negs were part of the HERA adjuvant trial. My wife was N0 and had FEC then T + Herceptin.

You are younger and therefore incur a somewhat higher risk of recurrence, so I would have though you had good grounds to push for Herceptin - particularly considering it is your second time around. Also, being younger the cardiac risks may be lower.

Patients on Herceptin are monitored closely for any cardiac effects and as far as I understand it, these effect only a minority - and that proportion is smaller than in the early trials where screening for cardiac efficiency was not done before treatment.

First sign of a problem, they stop the Herceptin. Though having said that I have heard it said that a lot of Herceptin's efficacy occurs early in the treatment regime. So even if you only got Herceptin for 3 or 6 months of a 12 month course, that might confer most of the benefit considering you are N0.

If you are reasonably healthy otherwise, Herceptin is a lot more benign than most conventional chemo cocktails.

There is a good Herceptin presentation for clinicians on adjuvantonline.com. I would expect your Onc knows about this site.

Good luck.

John L

[RhondaH]

and was dx 2/1/05. Did partial mastecomy 2/7/05, 6 rounds of dose dense TEC (Taxotere, Epirubicin and Cytoxan), 33 rads and began 1 yr of every 3 week Herceptin 8/18/05. My onc originally wasn't going to to give it too me, but after the ASCO conference, decided too after I was done w/ rads, he had changed his mind. Had an ECHO 8/16/05 and need to find out when my next one will be.

Rhonda Hoffman

[panicked911]

I was diagosised 9/14/05 , lumpectomy 10/5 - multi focal, node negative, vascular negative and strongly er and pr + as well as Her 2+++ saw threeoncologosts and all three said no question do herceptain 1 year 1x a week - as has already been said - more beign to your body than chemo - works with the immune system rather than the central nervous system as chemo does and only attacks her2 cells and leaves the healthy ones alone.

As long as you are healthy, heart issues should ot be a problem but you have to be monitored very carefully- sign of a problem stop - i have had three doses so far and all is well except for a perpetually runny nose it seems.

I am also going to start rads this month, doing luprene shots and tomaxifen for now.

Hope this helps ....

[RobinP]

Welcome to HER2support Tara. I knew when I referred here, that the people would be helpful. I hope these responses have aided you somewhat in your decision making process. Just remember adjuvant Herceptin reduced relapse by nearly 50% in the early stage her2+ , er, pre negative bc adjuvant herceptin trails with only 0.5 cardica mishaps in the after adjuvant trials and 3-4% cardiac risk with herceptin plus chemo trails. Of course, your oncologist will be monitoring your heart if you would get Herceptin. Good luck with your decision.
Robin

See conclusions of below study
1] Phase III randomized trial comparing doxorubicin and cyclophosphamide followed by docetaxel (ACT) with doxorubicin and cyclophosphamide followed by docetaxel and trastuzumab (ACTH) with docetaxel, carboplatin and trastuzumab (TCH) in HER2 positive early breast cancer patients: BCIRG 006 study.

Slamon D, Eiermann W, Robert N, Pienkowski T, Martin M, Pawlicki M, Chan M, Smylie M, Liu M, Falkson C, Pinter T, Fornander T, Shiftan T, Valero V, Mackey J, Tabah-Fisch I, Buyse M, Lindsay MA, Riva A, Bee V, Pegram M, Press M, Crown J, on behalf of the BCIRG 006 Investigators. UCLA, Los Angeles, CA; GBG, Munchen, Germany; US Oncology, Dallas, TX; Maria Sklodowska-Curie (MSC) Centre, Warsaw, Poland; GEICAM, Madrid, Spain; MSC Institute, Krakow, Poland; Mount Hospital, Perth, Australia; Cross Cancer Institute, Edmonton, Canada; Sun Yat-Sen Cancer Center, Taipei, Taiwan; University of Alabama, Birmingham, AL; Petz Aladar County, Gyor, Hungary; OnkologyKliniken, Stockholm, Sweden; Sharp Healthcare, San Diego, CA; MD Anderson Cancer Center, Houston, TX; Sanofi-Aventis, Paris, France; IDDI, Brussels, Belgium; CIRG, Paris, France; USC, Los Angeles, CA; ICORG, Dublin, Ireland

Background: This study evaluates the benefit of two trastuzumab-based (H) regimens in HER2 amplified breast cancer with the intent of integrating H to maximize efficacy and minimize known cardiotoxicity.
Material and Methods: HER2 amplified (centralized FISH) patients with axillary lymph node (LN) positive or high risk LN negative were randomized to either AC (60/600 mg/m2 q3wk x4) followed by T (100 mg/m2 q3wk x 4) or two H-containing regimens; AC followed by T with H x 1 year (q1wk during chemo/q3wk during FUP) or TCarbo (75 mg/m2 / AUC6 q3wk x 6) with H x 1 year. Patients were prospectively stratified by positive LN (0, 1-3 vs 4+) and hormone receptor (HR) status. Patients with HR+ tumors received hormonal therapy for 5 yrs after chemotherapy. The primary endpoint was disease-free survival (DFS) with 80% power (0.05 significance level) to detect an absolute difference of 7%. Secondary endpoints included OS, safety, including cardiotoxicity (symptomatic events -CHF, gr3/4 ischemia/infarction, gr3/4 arrhythmia- and asymptomatic LVEF decline). We report the results of the first planned, protocol-mandated interim analysis conducted after 322 events (breast cancer relapse, second primary malignancy or death).
Results: A total of 3222 pts (1073 in AC-T, 1074 in AC-TH and 1075 in TCH) were recruited between Apr 2001 and Mar 2004. At a median follow-up of 23 months, the two H-containing arms have both met the DFS endpt: hazard ratio of 0.49 with AC-TH, p-value=0.00000048 and 0.61 with TCH, p-value=0.00015 (as compared to AC-T). At this time, there is no statistically significant difference btw the two H-containing arms perhaps due to the small number of events currently separating them. Symptomatic cardiac events: AC-T: 1.2% vs AC-TH: 2.3%, p-value=0.046; AC-T vs TCH: 1.2%, p value=1.00. Absolute LVEF decline >15% and below lower limit of normal occurred in 0.6% pts in AC-T, 2.4% in AC-TH and 0.4% in TCH arms respectively (AC-T vs AC-TH (p=0.001); AC-T vs TCH (p=0.54).
Discussion: Result of this trial confirms the benefit of H when combined with docetaxel (AC-TH) or with docetaxel and carboplatin (TCH) without an anthracycline. There are fewer severe cardiac adverse events when H is administered without prior A. Longer follow-up is needed in order to confirm whether non-A-based adjuvant H regimens will have efficacy comparable to A-based regimens

[Tara]

Thanks for the info. I am going to request herceptin. After getting more info on this-I think it only makes sense. Thanks!

Tara