treatment for stage 1

LAURIE · 05-30-2009, 07:57 PM

a friend of mine was just recently diagnosed. Stage 1. She had 2 small tumors removed and sentinel node done, with no positive nodes. She is 39 years old. BRCA negative. her 2 +, er+. I was surprised onc wants to do 4 a/c, 12 taxotere, year herceptin. I was mostly shocked about a/c without posisitve nodes. she also will be having rads b/c of having a lumpectomey. does it seem like her docs are being a little too aggressive?

caya · 05-30-2009, 08:14 PM

Laurie, I was stage 1 , no nodes, 2 tumours - I told my onc. to hit me with everything out there. He wanted to, as Her2 is nasty and sneaky, and we wanted to do everything to avoid recurrence. I did 3 x FEC, 3 x Taxotere, then the year of Herceptin. Your friend is young, and this could be another factor with her onc. being aggressive.

I understand that many BC patients are now treated with the TCH chemo/herceptin combo, maybe your friend could discuss this option with her onc. It is supposed to be easier on the heart.

all the best,
caya

juanita · 05-30-2009, 08:26 PM

i was doing the tac with my first onc with a similar diagnosis. i couldnt handle them and ended up doing cmf.

beverlyhr · 05-31-2009, 03:20 PM

Hi! I was dx 11/08 with stage 1 ERPR+, Her2neu 4.3 +, am 55 years old, had lumpectomy 12/5/08, removed smal 0.6cm tumor, checked sentinel nodes, no positive nodes.
Began 6 cycles of TCH 1/7/09, and am continuing herceptin for a year. Having 33 rads to be finished 7/2/09. Having hormone studies done 6/24/09 to decide which pills I'll be on for the next 5 years.

I thought it was a lot also, but from what I've gleaned the herceptin is the key?

Hope and pray that your friend does well with her treatment.

Beverly

Patb · 05-31-2009, 03:55 PM

Three years ago I had stage I, no nodes Er+, Her2
positive and I was given 4 AC and a year of herceptin
and 36 rads as I had lumpectomy. I am now on
Arimidex. The Her2 was the reason to treat it aggressively the Dr. said at the time. I wish your
friend the best care and treatment. I did lose all
my hair but mine was not a difficult treatment.
patb

MJo · 05-31-2009, 04:46 PM

My oncologist calls Her2 "evil". I heard one of his partners give a talk about BC and he said he is aggressive when treating early stage breast cancer because "you have a chance to cure it." I went after my BC with every weapon available. I hope it never comes back.

Jean · 05-31-2009, 04:57 PM

Hi Laurie,
Back in 2005 the standard of care for early stage was lumpectomy, radiation and if ER + a hormonal treatment, depending on status, if post menopausal an AI treatment.

It is important to know that size is now not the determination to treatment. Back a few years ago
If a woman had a small tumor often times the standard of care was once again, lumpectomy, radiation etc.
Node negative would also have the same treatment unless the tumor was 2CM in size.
While a larger tumor often had more time and cells to shed it is now understood that size should not be the decision marker for treatment. A very tiny tumor can be very aggressive. Prior to 2006 even if a patient was HER2 and early bc she would have the same treatment as a patient who was HER2 negative.

Then in 2006 the FDA approved herceptin for early stage patients with HER2 node negative. While having negative nodes is a favorable dx. it is not a 100% for certain that a cell did not pass thorugh the node sytsem or enter via the blood system. The grade of the tumor is important also, but again not the determination for treatment.

I had a tiny 6MM tumor node negative but my KI67 level were high and I had my tumor tested and it came back very high for recurrence. I went off label for treatment back in late 05 early 06, prior to FDA approval (it was appoved about 6 months) after I began treatment.
I had TCH and herceptin for one year and I was very glad that I did not accept the first dx and second.
I finally went out to see Dr. Slamon.

Your girlfriend is young and HER2 likes to travel and is a very aggressive form of bc. Today chemo/herceptin is now standard protocol. Her dr. may have decided on A/C due to other medical reasons we do not know, but she could consider the TCH - have her ask her dr. about it and why he prefers the A/C.

I wish your friend all the best.
Kindest Regards,
Jean

WomanofSteel · 05-31-2009, 05:24 PM

I think that when it comes to Her2 there is no such thing as too aggressive. We have to be more aggressive than it is to outsmart and outlast it.

suzan w · 05-31-2009, 05:55 PM

as you can see by my statistics, I had A/C with no positive nodes. I, too, wanted to hit it with everything available. Almost 4 years now...

Becky · 05-31-2009, 06:00 PM

Your friend is young and she should want to hit this with both guns blazing. I was stage 2 but none the less, kill it now. You don't want return engagements.

Laurel · 05-31-2009, 06:15 PM

Laurie,

It is my understanding that even in Stage I, node negative, Her2+ breast cancer the recurrence rates are too high to not treat it very aggressively. That said, I do question A/C with radiation to follow. If it is her left breast the chance for heart damage is much greater if radiation, especially whole breast radiation, is performed post lumpectomy. I opted to have a mastectomy rather than increase my chances for heart damage from the AC and from the added Herceptin. If I recall correctly, having radiation post A/C therapy increased your risk for leukemia regardless of which breast is involved.

If I were your friend, I would opt for TCH or just TH and forgo the Adriamycin/Cytoxan combo. You can see from my signature that I did dose dense ACTH. That was before I knew that oncologists are now using just TH in many early Her + gals like myself and your friend.

Jaimieh · 05-31-2009, 06:21 PM

I was diagnosed 12/24/08 as stage 1 BC but I am er/pr- but HER2 + and I did TCHx 6 and herceptin for the year. I did the TCH because of the heart issues that AC can cause.
I wish your friend well and I am sorry that she had to join us

LAURIE · 05-31-2009, 07:30 PM

I guess I was hoping she did not have to go through all that, like most of us did. I know in my case the onc would still recommend a/c today just like he did almost 3 years ago. She goes for a muga this week, maybe treatment will change, depending on results. I am sure she can handle it, I just know it extends the treatment schedule. I cannot wait for the day when we don't have to worry about breast cancer anymore. Come on researchers, lets work; harder, faster and smarter. There has to be a better way.

Lien · 06-01-2009, 02:52 PM

I had a similar path report and didn't do chemo. Had to ask for hormonal tx. If the tumor had been over 1 cm they would have recommended both. 39 is young and she has many years ahead in which she might recur. Irrespective of Her2 status, her risk of recurrence would be about 20 percent. As 3/4 of recurrences are metastatic according two 2 docs I've spoken to, that would mean that for every 20 women who recur, 15 would be battling mets.

Now I'm still NED after 5 years, but I'm not sure I wouldn't want chemo if I had to choose again. It wasn't an option in 2004. Perhaps your friend can ask her doc what the expected benefit would be.

Jacqueline