all her2+ ER+s take note (especially Jean)

[Lani]

Jean has waited many years for validation that it was her2 positivity and NOT size that mattered when it came to deciding how to treat her her2+ER+ breast cancer. She sought several opinions as I recall. For years, many if not most oncologists told patients that if they were ER+ and their tumor was only T1aor b, node negative and without distant mets they were going to do well no matter what and certainly with just antihormonals.

Statistically they were right in that the majority of patients did well, but there was an almost four fold increased risk of DEATH even in these supposedly low-risk patients. 10 year survival rates were 74% for her2+ er+s and 89% for her2-ER+s

From this study it seems that it turns out that size doesn't matter, but biology (subtype, what is driving the tumor) does.

How best to treat Her2+ER+ remains somewhat of a mystery (as well as how many subtypes of the subtype there are)--- but the fact that one can make an enormous (percentage-wise) difference in not just recurrence rates, but mortality, with antiher2 therapy even in the smallest group of them does not seem to be.


Cancer Med. 2014 Jan 10. doi: 10.1002/cam4.167. [Epub ahead of print]
HER2 overexpression a major risk factor for recurrence in pT1a-bN0M0 breast cancer: results from a French regional cohort.
Rouanet P, Roger P, Rousseau E, Thibault S, Romieu G, Mathieu A, Cretin J, Barneon G, Granier M, Maran-Gonzalez A, Daures JP, Boissiere F, Bibeau F.
Author information

Abstract
The management of pT1a-bN0M0 breast cancer remains an area of controversy. Data from 714 patients classified as having pT1a-bN0M0 breast cancer and treated, from 1999 to 2004 in the Languedoc-Roussillon France, were analyzed. The human epidermal growth factor receptor 2 (HER2) status analyses were centralized. The objective of this study was to describe the prognosis of pT1a-bN0M0 breast cancer according to HER2 distribution and hormonal status. The median follow-up was 6.4 years. Ten-year overall survival was 94%. HER2 overexpression was observed in 6.1% of the patients. The 10-year prognosis of patients with HER2-positive tumors was worse than that of those with HER2-negative (disease-free survival 73% vs. 89%, P < 0.0001). Tumor size (T1a/T1b) was not a relevant prognostic factor. The co-expression of HER2 with hormonal receptors (HR) was associated with high recurrence at 10 years. In both univariate and multivariate analyses, the most relevant prognostic factor for this population was HER2 amplification. In multivariate analysis, patients with HER2-positive tumors had higher risk of mortality (HR, 3.89; 95% CI, 1.58-9.56). In pT1a-bN0M0 breast cancers, HER2 amplification or overexpression is a risk factor for recurrence. In HER2-positive breast cancers, HR expression is associated with a poor prognosis despite the hormone therapy. For this population, a personalized management may be required.
© 2014 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
KEYWORDS:
HER-2 positive tumors, small breast carcinoma

PMID: 24407937

[AlaskaAngel]

Thanks, Lani. What were the treatments that were used? Were any treated with trastuzumab without chemo, or were they all treated with chemo regardless of size, or what?

[suzan w]

I was in this same dilemma... however my oncologist in Seattle was involved in the trials and KNEW that herceptin was critical for early stages...even though chemo was a prerequisite, she prescribed herceptin off label for me. 5 months into my treatment, the FDA approved it for early stage.

[Pamelamary]

Thanks Lani - as a Her2+, ER+ person who has moved to stage 4 after nearly 8 years, WITHOUT chemo or Herceptin. Oh well!
Pam.

[caya]

Thanks Lani.
I was diagnosed in Oct. 2006, and Herceptin had already been approved in Canada for early stagers. I was stage 1 triple+, node negative and there was no question that I was getting Herceptin, as well as chemo (FEC) with Taxotere. At the time, my oncologist said that was the best treatment for me.
I am over 7 years out now.

all the best
caya