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Old 06-28-2014, 02:10 AM   #1
Lani
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Thumbs up Music to your ears....Dr. Sledge's prediction on her2+ breast cancer

J Community Support Oncol. 2014 Mar;12(3):78-81.
Is the era of HER2 over? Pertuzumab in the neoadjuvant treatment of early HER2-positive breast cancer.
Samuel TA1, Stone E.
Author information

Abstract
At the ASCO Breast Cancer Symposium in San Francisco last year, the keynote speaker, Dr George Sledge, chief of oncology at Stanford University School of Medicine and a preeminent breast cancer researcher, gave his 5 predictions for the state of breast cancer care in 10 years. One of his more startling predictions was that in 10 years, he believed that the era of HER2/neu would be over. He predicted that 3-year disease-free survival for patients with HER2/neu-positive disease would more than 92%, approximating outcomes in other good prognosis malignancies such as testicular cancer. In view of that expectation, he believed that the main research questions regarding HER2- positive disease would eventually involve decreasing toxicity and costs rather than the improving efficacy of HER2-targeted therapy. Essentially, HER2/neu-positive disease would cease to be a public health issue. In view of this remarkable but likely prescient statement, we note the recent publication of 2 trials (NeoSphere and TRPHAENA) that examined the efficacy and safety of the use of pertuzumab in combination with trastuzumab and chemotherapy in the neoadjuvant treatment of early-stage HER2-positive breast cancer.
PMID: 24971410
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Old 06-28-2014, 08:27 AM   #2
Lauriesh
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Re: Music to your ears....Dr. Sledge's prediction on her2+ breast cancer

I wish they would look farther than 3 years out. There are many women who are diagnosed with mets later than 3 years, myself included. I would be included in this impressive 92%, yet it means little at this point.
I hope this doesn't mean an end of new treatment options for those of us ( and the future women) who have mets.

Laurie
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diagnosed stage 2- 3/2005
4.5 cm & 2+ nodes , er/pr- & HER2+
4 AC
12 taxol/Herceptin
Year of Herceptin
liver mets- July-2010
7 taxotere/Herceptin
RFA- Feb.2011
NED
U of Wa vaccine trial-oct 2011-Feb 2012
Herceptin/tykerb
Ned - 2 1/2 years
Herceptin & perjeta
Ned 3 years
Herceptin- reducing treatments , due to s/e, to 5-6 a year
NED- 3 1/2 years
Ned - 4 years
2/15- stopped herceptin - on no treatment
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Old 07-09-2014, 02:19 PM   #3
norkdo
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Re: Music to your ears....Dr. Sledge's prediction on her2+ breast cancer

Laurie: ditto.
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fall 2008: mammo of rt breast worrisome so am asked to redo mammo and have ultrasound of rt breast.I delay it til january 2009 and the results are "no cancer in rt breast. phew."
found plum sized lump in right breast the day before my dad died: April 17th 2011. saw it in mirror, while i was wearing a top, examining my figure after losing 10 lbs on dr. bernstein diet.
diagnosed may 10 2011

mast/lymphectomy: june 7 2011, 5/20 cancerous nodes. stage 3a before radiation oncologist during our first mtg on july 15th says he found cancer on the lymph node of my breast bone. Now stage 3b.
her2+++, EN-, PN-. Rt brst tumors:3 at onset, 4.5 cm was the big one
chemos: 3fec's followed by 3 taxotere, total of 18 wks chemo. sept: halfway thru chemo the mastectomy scar decides to open and ooze pus. (not healed before chemo) eventually with canasten powder sent by friend in ny (illegal in canada) it heals.
radiations:although scheduled to begin 25 january 2012, I am so terrified by it (rads cause other cancers) I don't start til february, miss a bunch, reschedule them all and finally finish 35 rads mid april. reason for 7 extra atop the 28 scheduled is that when i first met my rads oncologist he said he saw a tumor on the lymph node of my breastbone. extra 7 are special kind of beam used for that lymphnode. rads onc tells me nobody ever took so long to do rads so he cannot speak for effectiveness. trials had been done only on consecutive days so......we'll see.....
10 mos of herceptin started 6 wks into chemo. canadian onc says 10 mos is just as effective as the full yr recommended by dr. slamon......so we'll see..completed july 2012.
Sept 18 2012: reconstruction and 3 drains. fails. i wear antibiotic pouch on my job for two months and have 60 consecutive days visiting a nursing centre where they apply burn victims' silver paper and clean the oozing infection daily. silicone leaks out daily. plastic surgeon in caribbean. emergency dept wont remove "his" work. He finally appears and orders me in into an emergency removal of implant. I make him promise no drains and I get my way. No infection as a result. Chest looks like a map of Brazil. Had a perfectly good left breast on Sept 17th but surgeon wanted to "save another woman an operation" ? so he had crashed two operations together on my left breast, foregoing the intermediary operation where you install an expander. the first surgeon a year earlier had flat out refused to waste five hours on his feet taking both boobs. flat out refusal. between the canadian health system saving money and both these asses, I got screwed. who knows when i can next get enough time off work (i work for myself and have no substitute when my husband is on contract) to get boobs again. arrrgh.


I have a blog where I document this trip and vent.
www.nora'scancerblog.blogspot.com . I stopped the blog before radiation. I think the steroids made me more angry and depressed and i just hated reading it anymore
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Old 07-10-2014, 08:37 AM   #4
'lizbeth
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Re: Music to your ears....Dr. Sledge's prediction on her2+ breast cancer

I was a bit shocked at this post. If this is the attitude of the leading researchers, then we need to find new researchers that strongly believe cancer patients should be cured and live for decades. If a 92% survival rate for 3 years is considered acceptable by the individuals that we support with huge funding for cancer research - well I can only borrow a phrase from Donald Trump "You're Fired!"

The era of focused Her2 neu research seems to be winding down significantly. We have been lucky enough to be the golden girls of breast cancer research for decades.

I strongly applaud treatments with reduced toxicity, but expect much more.

I am eagerly waiting for the results of the Neuvax trial that had a subgroup of Her2 low expressors who had 100 percent Disease Free Survival for 48 months and 94 percent for 60 months in a Phase II. This is the results that we as survivors want.

92 percent for 3 year survival is unacceptable.
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Diagnosed 2007
Stage IIb Invasive Ductal Carcinoma, Pagets, 3 of 15 positive nodes

Traditional Treatment: Mastectomy and Axillary Node Dissection followed by Taxotere, 6 treatments and 1 year of Herceptin, no radiation
Former Chemo Ninja "Takizi Zukuchiri"

Additional treatments:
GP2 vaccine, San Antonio Med Ctr
Prescriptive Exercise for Cancer Patients
ENERGY Study, UCSD La Jolla

Reconstruction: TRAM flap, partial loss, Revision

The content of my posts are meant for informational purposes only. The medical information is intended for general information only and should not be used in any way to diagnose, treat, cure, or prevent disease
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Old 07-11-2014, 04:58 AM   #5
Aussie Girl
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Re: Music to your ears....Dr. Sledge's prediction on her2+ breast cancer

I suspect this is just a badly framed announcement. I'm sure Dr Sledge is as eager for long term survival for HER2 breast cancer patients as we are. He's thinking about the natural history of the disease and the way in the past it took people rapidly and used the 3 year figure (because that's from a recent study and longer term data on Perjeta etc isn't out yet). I think it was a rah-rah "isn't it great what's been achieved, let's keep going" message to inspire the symposium delegates, rather than a "that's good enough - move on to other diseases now" message.

Aussie Girl
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31mm Infiltrating duct carcinoma
Grade 3, ER/PR-, HER2+, Neg Sentinel nodes x 5
49mm field of DCIS
17 June '13: Screen detected impalpable mass, Mammogram neg, US.
25 June '13: Diagnosed after multiple biopsies and MRIs
28 June '13: Left lumpectomey
4 July '13: Left Mastectomy
12 August '13: Commenced TCH chemo
Mid December '13 : TCH finished. Herceptin continuing three weekly.
4 August 2014- Herceptin infusions finished.
END OF THERAPY - YAY!
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Old 07-12-2014, 01:15 PM   #6
suzan w
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Re: Music to your ears....Dr. Sledge's prediction on her2+ breast cancer

I agree about the longer than 3 years outcome...however, this is still a mighty fine tune and I am singing along!!
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Suzan W.
age 54 at diagnosis
5/05 suspicious mammogram-left breast
5/05 biopsy-invasive lobular carcinoma with LCIS,8mm tumor,stage 1 grade 2, ER+ PR+ Her2+++
6/14/05 bilateral mastectomy, node neg. all scans neg.
Oncotype DX-high risk
8/05-10/05 4 rounds A/C
10/05 -10/06 1 yr. herceptin
arimidex-5 years
2/14/08 started daily self administered injections..FORTEO for severe osteoporosis
7/28/09 BRCA 1 negative BRCA2 POSITIVE
8/17/09 prophylactic salpingo-oophorectomy
10/15/10 last FORTEOinjection
RECLAST infusion(ostoeporosis)
6/14/10 5 year cancerversary!
8/2010-18%increase in bone density!
no further treatments
Oncologist says, "Go do the Happy Dance"
I say,"What a long strange trip its been"
'One day at a time'
6-14-2015. 10 YEAR CANCERVERSARY!
7-16 to 9-16. Extensive (and expensive) dental work done to save teeth. Damage from osteoporosis and chemo and long term bisphosphonate use
6-14-16. 11 YEAR CANCERVERSARY!!
7-20-16 Prolia injection for severe osteoporosis
2 days later, massive hive outbreak. This led to an eventual dx of Chronic Ideopathic Urticaria, an auto-immune disease from HELL.
6-14-17 12 YEAR CANCERVERSARY!!
still suffering from CIU. 4 hospitilizations in the past year

as of today, 10-31-17 in remission from CIU and still, CANCER FREE!!!
6-14-18 13 YEAR CANCERVERSARY!! NED!!
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Old 07-16-2014, 09:08 PM   #7
mamacze
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Re: Music to your ears....Dr. Sledge's prediction on her2+ breast cancer

Music??? To my ears this is a symphony! Thank you Lani for sharing another good tidbit.
__________________
2001 - Stage 0, lumpectomy, radiation, tamoxifen

2004 - Stage 4, mets to 4 lobes of lungs and liver, lumpectomy, er/pr -, her2 neu+++, Herceptin and Navelbine then Herceptin only.

2005 - Breast Ca vaccinations with the Tumor Vaccine Group in Seattle

2011 - Still Herceptin only and NED


2011, June - STOPPED Herceptin and kicked up my heels!

2012, February - 1 small tumor came back to haunt me in my lungs - back on Herceptin only, tumor stable.


2015, November - tumor on lungs removed (Segmentectomy), back on Herceptin only
Received U of W vaccine clinical "booster" Vaccine


2022 On Herceptin and NED continues - WOOT WOOT!
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Old 07-16-2014, 11:58 PM   #8
'lizbeth
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Re: Music to your ears....Dr. Sledge's prediction on her2+ breast cancer

Are we talking stage III and IV? Because these numbers do not make sense. The survival statistics for stage I and II was already in the mid to high 90s for 5 years prior to neoadjuvant TCHP.

Is it acceptable that 8 of each 100 women diagnosed will be dead in 3 years?
What if you are one of the eight women? Too bad, so sad?

While I applaud the advances from the TRPHAENA and neoSphere trials, I'm extremely uncomfortable with Dr. Sledge's statements.

However, I'm sure there are other researchers out there who strongly believe in building on the advances in Her2 research and also feel there is no acceptable death rate from cancer.
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Old 07-17-2014, 12:53 AM   #9
michka
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Re: Music to your ears....Dr. Sledge's prediction on her2+ breast cancer

3 years: Ned
4 years: Stage IV.... I hope Dr Sledge doesn't think this is a success.

I have the uncomfortable feeling that with Herceptin, Tykerb, Kadcyla and Pertuzumab many research centers are happy. But we know here that we still need more options.
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08.2006 3 cm IDC Stage 2-3, HER2 3+ ER+90% PR 20%
FEC, Taxol+ Herceptin, Mastectomy, Radiation, Herceptin 1 year followed by Tykerb 1 year,Aromasin /Faslodex

12.2010 Mets to liver,Herceptin+Tykerb
03.2011 Liver resection ER+70% PR-
04.2011 Herceptin+Navelbine+750mg Tykerb
06.2011 Liver ned, Met to sternum. Added Zometa 09.2011 Cyberknife for sternum
11.2011 Pet clear. Stop Navelbine, continuing on Hercpetin+Tykerb+Aromasin
02.2012 Mets to lungs, nodes, liver
04.2012 TDM1, Ned in 07.2012
04.2015 Stop TDM1/Kadcyla, still Ned, liver problems
04.2016 Liver mets. Back on Kadcyla
08.2016 Kadcyla stopped working. mets to liver lungs bones
09.2016 Biopsy to liver. no more HER2, still ER+
09.2016 CMF Afinitor/Aromasin/ Xgeva.Met to eye muscle Cyberknife
01.2017 Gemzar/Carboplatin/ Ibrance/Faslodex then Taxotere
02.2017 30 micro mets to brain breathing getting worse and worse
04.2017 Liquid biopsy/CTC indicates HER2 again. Start Herceptin with Halaven
06.2017 all tumors shrunk 60% . more micro mets to brain (1mm mets) no symptoms
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Old 07-17-2014, 12:47 PM   #10
Mtngrl
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Re: Music to your ears....Dr. Sledge's prediction on her2+ breast cancer

On the one hand, I do appreciate the positive outlook. On the other, I share the concerns others have expressed.

Of course, a substantial number of HER-2 cancer patients are metastatic from day one. I've known several in that category who were diagnosed a very short time after "clean" mammograms. So even a good treatment is not good enough. We need prevention.
__________________
Amy
_____________________________
4/19/11 Diagnosed invasive ductal carcinoma in left breast; 2.3 cm tumor, 1 axillary lymph node, weakly ER+, HER2+++
4/29/11 CT scan shows suspicious lesions on liver and lungs
5/17/11 liver biopsy
5/24/11 liver met confirmed--Stage IV at diagnosis
5/27/11 Begin weekly Taxol & Herceptin for 3 months (standard of care at the time of my DX)
7/18/11 Switch to weekly Abraxane & Herceptin due to Taxol allergy
8/29/11 CT scan shows no new lesions & old lesions shrinking
9/27/11 Finish Abraxane. Start Herceptin every 3 weeks. Begin taking Arimidex
10/17/11--Brain MRI--No Brain mets
12/5/11 PET scan--Almost NED
5/15/12 PET scan shows progression-breast/chest/spine (one vertebra)
5/22/12 Stop taking Arimidex; stay on Herceptin
6/11/12 Started Tykerb and Herceptin on clinical trial (w/no chemo)
9/24/12 CT scan--No new mets. Everything stable.
3/11/13 CT Scan--two small new possible mets and odd looking area in left lung getting larger.
4/2/13--Biopsy of suspicious area in lower left lung. Mets to lung confirmed.
4/30/13 Begin Kadcyla/TDM-1
8/16/13 PET scan "mixed," with some areas of increased uptake, but also some definite improvement, so I'll stay on TDM-1/Kadcyla.
11/11/13 Finally get hormone receptor results from lung biopsy of 4/2/13. My cancer is no longer ER positive.
11/13/13 PET scan mixed results again. We're calling it "stable." Problems breathing on exertion.
2/18/14 PET scan shows a new lesion and newly active lymph node in chest, other progression. Bye bye TDM-1.
2/28/14 Begin Herceptin/Perjeta every 3 weeks.
6/8/14 PET "mixed," with no new lesions, and everything but lower lungs improving. My breathing is better.
8/18/14 PET "mixed" again. Upper lungs & one spine met stable, lower lungs less FDG avid, original tumor more avid, one lymph node in mediastinum more avid.
9/1/14 Begin taking Xeloda one week on, one week off. Will also stay on Herceptin and Perjeta every three weeks.
12/11/14 PET Scan--no new lesions, and everything looks better than it did.
3/20/15 PET Scan--no new lesions, but lower lung lesions larger and a bit more avid.
4/13/15 Increasing Xeloda dose to 10 days on, one week off.
7/1/15 Scan "mixed" again, but suggests continuing progression. Stop Xeloda. Substitute Abraxane every 3 weeks starting 7/13.
10/28/15 PET scan shows dramatic improvement everywhere. All lesions except lower lungs have resolved; lower lungs noticeably improved.
12/18/15 Last Abraxane. Continue on Herceptin and Perjeta alone beginning 1/8/16.
1/27/16 PET scan shows cancer is stable.
5/11/16 PET scan shows uptake in some areas that were resolved on the last two scans.
6/3/16 Begin Kadcyla and Tykerb combination
6/5 - 6/23 Horrible diarrhea from K&T together. Got pneumonia.
7/15/16 Begin Kadcyla only every 3 weeks.
9/6/16 Begin radiation therapy on right lung lesion that caused the pneumonia.
10/3/16 Last of 12 radiation treatments to right lung.
11/4/16 Huffing and puffing, low O2, high heart rate, on tiniest bit of exertion. Diagnosed as radiation pneumonitis. Treated with Prednisone.
11/11/16 PET scan shows significant improvement to radiated part of right lung BUT a bunch of new lung lesions, and the bone met is getting worse.
11/22/16 Begin Eribulin and Herceptin. H every 3 weeks. E two weeks on, one week off.
3/6/17 Scan shows progression in lungs. Bone met a little better.
3/23/17 Lung biopsy. Tumor sampled is ER-, PR+ (5%), HER2+++. Getting Herceptin and Perjeta as a maintenance treatment.
5/31/17 Port placement
6/1/17 Start Navelbine & Tykerb
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