recommended reading for all newly (and formerly) diagnosed with T1a or b NO MO her2+

[Lani]

bc--has info in it I had not seen before in SABCS papers, etc

unfortunately not open access

Clin Adv Hematol Oncol. 2009 Sep;7(9):591-8.
HER2-neu positivity in patients with small and node-negative breast cancer (pT1a,b,N0,M0): a high risk group?
Chavez-MacGregor M, Gonzalez-Angulo AM.

Division of Cancer Medicine, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas, USA.
Human epidermal growth factor receptor 2 (HER2-neu) is an important prognostic factor associated with worsened disease-free survival and overall survival in breast cancer patients; however, the prognosis of T1a,b,N0,M0 HER2-neu positive breast cancer has not been clearly determined. Trastuzumab has become a critical component of the treatment of patients with HER2-neu positive tumors, but the effect of treatment in patients with small tumors and node-negative disease has not been evaluated in clinical trials. Current guidelines have category 3 recommendations to consider the use of adjuvant trastuzumab in women with node-negative tumors that are 0.6-1.0 cm, and state that physicians should balance the risks associated with the known trastuzumab toxicities and the uncertain benefits that may exist with such therapy in this group of patients. The available data regarding the prognosis of patients with T1a,b,N0,M0 HER2-neu positive breast cancer is very limited. The purpose of this manuscript is to review the available literature in order to evaluate whether this group of patients represents a high risk group. Retrospective studies suggest that HER2-neu status is a powerful independent prognostic factor in T1a,b node-negative breast cancer. We believe that prospective studies and randomized clinical trials are strongly needed to clearly assess the impact of HER2-neu positivity in node-negative and subcentimeter tumors, and to determine if this group of patients can benefit from adjuvant trastuzumab treatment.

PMID: 20020671

[Laurel]

Well, duh.....I mean why not see if what you are recommending is effective? Bad for business if it isn't....and for us.

[mcgle]

I fulfilled this criteria, receiving neither chemo nor herceptin - just surgery, rads and tamoxifen.

Additionally, I take daily flaxseed, and like to think this contributes to my NED status, four years down the line.

Mcgle (UK)

[mcgle]

Am I the only one? Definitely FISH positive.

Mcgle (UK)

[Jaimieh]

I was a t1c (1.3)but I thought that MDA did a study on smaller her2+ tumors ??

[Laurel]

Mcgle (UK),

You are definitely not alone (plz see my signature). I would love to see new stats on the validity of chemo and Herceptin for Stage 1 folks like us. Is it worth the agony vs benefit? I will be awaiting the answer.

[mcgle]

Laurel

Four years ago, I had extreme reservations about my treatment plan; now - I think it was right.

No one wants to go through chemo / herceptin unnecessarily.

Thanks for your response.

Mcgle (UK)

[Lien]

Me too! I did 5 yrs of Zoladex/Arimidex and am currently NED. Down to once a year checkups. Hope Ned stays with me for as long as I live!

My doc said that he sees quite serious side effects and would still hesitate to prescribe H. for me.

Jacqueline

[Laurel]

As you can see from my signature, I chose to go the most aggressive route out there which is the ACTH. Nasty stuff all of it! I think studies are absolutely necessary for women to make a truly informed decision. When I had to decide I looked at the stats and chose to toe up to the line and be poisoned 8 times. If I were to discover that it provided very little or no benefit in terms of overall survival, I doubt that I would chose that course a second time. However, you must live with what you knew at the moment you are confronted with the decision. I have no intention of beating up myself or the medical community that promoted the treatment. I do, however, firmly believe studies with stage 1 Her2s need to be compiled quickly to resolve the nagging question of treatment efficacy. Should we find a substantial benefit than so be it, continue the treatment recommendation. I have noted several stage 1 gals on this site who did not receive Herceptin and advanced to stage iv. It may be purely anecdotal, but still it gives me pause. This risk to progress is definitely present, just how much chemo & Herceptin mitigate the risk is unproven as yet.

[MJo]

I was T1b and was aggressive. My oncotype score was high.