HRT for HER2+, ER-, PR-

JohnL · 05-04-2006, 12:40 PM

My wife Monica (47) finished her Chemo and 12 months Herceptin about 6 months ago.

We've been talking to her Surgeon and Onc about Hormone Replacement Therapy - which they are quite keen to do to prevent bone density loss etc and feel that the risks are probably 'low' compared to the long-term benefits.

Theoretically, being ER/PR- she should be free of any increased risk of recurrence - but there is only a smattering or research on this and I don't think either of them have significant direct experience amongst their own patients.

So I wondered if anyone out there with a similar profile is on HRT or how it is handled elsewhere?

Regards

John L (UK)

Becky · 05-04-2006, 03:07 PM

Dear John

Although I am not on HRT (as I am mildly ER positive as well), on the ASCO site in the last few months, there has been a tremendous amount of data in regard to breast cancer risk while on HRT or birth control pills, especially in women who are lean.

There was also a paper (quite a bit back) that eluded to the fact that Her2+ disease that is ER/PR negative MIGHT begin by the body being in a hyper estrogen state (perhaps during the perimenopausal period with HRT or during pregnancy). Mind you, the article was not a clinical trial or anything.

I am sure there are others who are more knowledgeble than me (especially those on HRT).

Kindest regards

Becky

al from Canada · 05-04-2006, 03:20 PM

John,
There is very limited research on this subject but if we put together the bit of literature:

1. Herceptin prevents re-occurrance in about 56% of patients. This leads me to believe that there are cancer cells out there waiting to be destroyed

2. We know that cancer cells can morph into both HER2+ and ER+ from their negative counter parts.

3. We know that one's own immune system will also kills cancer cells.

Conclusion (my opinion): There may be a remote possibility that there are a few ER+ cancer cells circulating in your wifes system, waiting to be activated. That said, I don't know if I would chance it however, if you investigate DIM and I3C, which are supplements which modify estrogen metabolism, i certainly wouldn't take one without the other. ie, HRT without DIM or I3C.

I think you are treading on thin ice.

Good luck,
Al

Lauriemn · 05-05-2006, 04:30 AM

Hi John, I am 38 and just finishing up my year of Herceptin. My endocronologist wanted me to start Hrt, but my onc and gyno both said no. They said I should wait at least 2 or 3 more years before even considering it. Right now, I am using an estrogen cream for vaginal dryness,which was ok'd by all of my drs.. I also take fosomax for bone loss and I did start taking a low dose of testosterone.

I will probably never go on estrogen. I think I will continue to treat whatever problems that crop up because of being in menopause.

Laurie

RobinP · 05-05-2006, 07:23 AM

See Dr. Susan Love's website,she answers some questions like yours concerning HRT on the frequently asked question section.

JohnL · 05-08-2006, 06:56 AM

Thanks for the response. That has given us a lot more to think about. I didn't know about the HER2 cells morphing into somthing else, or the estrogen surge theory.

More research required. And a cautious approach.

If I find anything interesting I'll post it here.

John L

mamacze · 05-10-2006, 08:28 PM

John, I just logged on and saw your thread; I want to add my voice to the be cautious chorus. I am stage 4, Her2 +++ and ER/PR negative. 3 oncologists, my gynocologist and 2 surgeons all advised, with no hesitation, no hormone replacement whatsoever. I have been hormone free now for 2 years and once I got past the hot flashes it is not so bad. Hang in there, I know it is not easy sorting all of this out.
Kim from CT

Monique M · 05-12-2006, 11:42 AM

John:

I am also HER+++ and ER/PR negative. My onc said absolutely no to any HRT.

Monique

Jade · 05-12-2006, 12:19 PM

I'm also Her2+++, ER/PR- like Monique above, and was told by both my family doctor and oncologist that HRT would not be a wise consideration for me, not an option. Good luck,
Jade

tousled1 · 05-13-2006, 06:08 AM

I was on HRT (estrogen only) when I was diagnosed with Stage III breast cancer. My oncologist immediatedly took me off the estrogen. I am HER2+++ and ER/PR-.

juanita · 05-13-2006, 08:02 AM

I am er/pr - and her2 +, all of my doctors said no hrt. They said the hot flashes etc would eventually go away. Not much help for now, but it's better than an increased risk of recurrence.

JohnL · 05-13-2006, 11:12 AM

Dear All

Well now, here is an interesting divergence of medical views. Let me quote an extract from a letter we have just received from Monica's consultant.

'Monica is T1 G3 N0, ER negative, PgR negative HER2+++ and has completed surgery, chemo and Herceptin........ As she is ER negative and PgR negative, she has really no significant risk of being on a form of HRT such as Kliovance or a continuous combined preparation of your choice........ I am very supportive of her decision to go ahead with HRT...'

Now this consultant is a specialist in this area and in one of the world's leading breast cancer hospitals. Another professor of breast oncology has also confirmed the view that if ER/PR-ve, there's no problem with the low doses involved in HRT.

Obviously, we have discussed with them the earlier response of our GP (in fact two different members of the practice) both of whom said effectively, 'HRT and breast cancer - one precludes the other'.

The view of the breast oncologists was that most generalists are clinging to the received wisdom pre specific tumour typing that you just don't give HRT to people with a breast cancer relapse risk. That, or they are working on the basis that until someone stands up with a huge epidemiological study which says 'It's safe, here's a hard bit of research, nobody can sue you now', then they will stick to the safe option of just not doing it.

Our Onc isn't a natural risk taker, so we're assuming that for him and a colleague to be comfortable with this, they have to have been made comfortable by something.

So here's the thing. Could it possibly be that many HER2 patients brought into early menopause could now be happy and healthier on HRT?

Who is right here, because if Monica's team are correct then this could be an important treatment option that may have been unecessarily denied to many readers of this site.

If you are hormone -ve not on HRT and would like to be, maybe it's worth reasking the question and pushing for a clearer answer as to why 'no' and not 'yes'.

Is timing an issue. Is 2/3/4/5+ years post surgery long enough to be able to say, OK why not your background list has declined to background level?

If we get those answers back, I'll be feeding them to Monica's onc and I will certainly let you know what their response is.

Monica is seeing an endocronologist who works with cancer patients in the next few weeks, so get those responses in and I'll be giving him a printout of this string and taking a note of what he says.

John L