Early Stage Breast Cancer and Herceptin????

[RalphIII]

Hello All,

I posted this in the Herceptin thread also but it doesn't seem to get as much activity, so I'm posting here also. I hope the mods don't mind. Anyhow....

Has anyone elected to take Herceptin who had early stage BC with the following condition.

Estrogen +
Progesterone +
Her2 +
Tumor 1cm or less
Lymph node -- (negative)

The Herceptin website seems to rule out the use of their product under those conditions? A patient with those conditions would only be a candidate for their drug had there been one "high risk factor", which is a tumor "greater than 2cm". See HERE

In contrast, BreastCancer.org cites a study stating it can be beneficial to early stage breast cancer patients even if the cancer is less than 1cm. See HERE

All input is appreciated.

God Bless,
Ralph

[kittyqueen]

Hi Ralph111

Yep I tick all those boxes. 9mm Grade 3 IDC no spread to lymph nodes, clear margins..er/pr 6/8 KI-67 50%. Had 4 x EC and 4 X Taxotere strated Herceptin with the taxotere...just had my 12th Herceptin and am facing my first annual check up next week .

KQ
xxx

[jaykay]

Hi Ralph,

Herceptin and chemotherapy are typically recommended for all Her2+++ breast cancers, regardless of the stage.

Her2+++ is an aggressive cancer but there are many drugs available to treat it.

I am Her2+++/ER+/PR- currently and was the same 13 years ago. Herceptin was not approved for Stage 1 back then, so I did not have the option to use it.

Best,
Janis

[RalphIII]

Hello kittyqueen,

Yes, my wife's KI-67 was denoted as 50% also.

She had a lumpectomy last Friday and we are scheduled to see the doctor today in going over the final pathology results. Praying it holds to be 1cm or less tumor and lymph node negative. They actually removed two lymph nodes during surgery because they couldn't determine which one was first in line.

How are you doing with your treatment and Herceptin? Does it leave you sick or very weak? My wife is 43 and I'm hoping she copes well with the long term treatment which isn't determined yet. I'm just trying to study up on all of this.

God Bless,
Ralph


P.S. This is her second bout with cancer. 4 years ago she was having abdominal pains that we self diagnosed as gaul bladder issue. It indeed was a gaul bladder issue but they discovered a cancerous tumor growing off her kidney when they performed the ultrasound. It was 7mm but early stage 1b and fully contained. They were able to save virtually all of her kidney and she didn't have to take treatments. The doctor said it was the type that would have gone undetected, so the gaul bladder issue was a true Blessing...

[kittyqueen]

Hi Ralph,

I was fine with the treatment no real probs at all. So far (fingers crossed) no SE's with the Herceptin either. I also had 19 sessions of radiotherapy too and that was no prob either. I guess I was very lucky as I managed to work all through too. Jaykay is correct in saying Her2+++ is very aggressive but lots of treatment available. Please wish your wife all the very best from me xxx

KQ xx

[RalphIII]

Hello Jaykay.

After the biopsy showed my wife was (ER+/PR+/Her2+) I began researching/studying everything I could; especially in regards to Her2+. It was my initial conclusion also, that she would receive Herceptin no matter and possibly some Chemo.

However, if you read the Herceptin site they have some specific guidelines for treatment, which rules out some early stage patients, unless they have an additional "high risk" factor. Such as a "tumor >2cm, age<35, or tumor grade 2 or 3".

So it suggests some early stage patients would not be recommended for Herceptin? We don't know the grade of tumor as yet (will this afternoon) but I'm leaning toward encouraging my wife to undertake it no matter. That's why I would like some personal input or other insight.

Question: To clarify, when you say Her2+++, do you mean the tests showed Her2+ categorized a 3 (scale 0-3)?

take care,
Ralph

[LeahM]

Ralph, the way I understand it there is HER2+ (which means your not HER2 posive) HER2++ (which means you might be HER2 positive) and HER2+++ (which means you are HER2 positive). I think that just for an easy way of saying it, we HER2 positive folks just use one "+" sign. Know what I mean? Did I explain that well??
I can honestly say I did not do much Herceptin research before I started it but I am under the impression that ALL HER2+ patients recieve it, regardless of stage. I wonder how old the info you are looking at is? The Herceptin causes my nose to run (continously, obnoxiously, relentlessly) but that is all I can say that is negative about it. I have been recieving Herceptin alone since chemo ended in Oct 2012.
Best wishes to you and your wife, you are both in my prayers and I am sure that after you meet with the MD tomorrow you will have a lot of the answers you are looking for. This is the hardest time period...just breathe...
Leah

[RalphIII]

Hey LeahM,

Yes, partly why I wanted to inquire here is because much of the information I've come across is several years old. Since posting, I did speak with a nurse rep at Herceptin in inquiring about their criteria. We are actually meeting the surgeon in a few hours for finals results, btw. Your explanation was very good also in regards to Her2+.

My Dad was a supervisor at a Hospital System for 30+ yrs and we have/had many many close ties there. I'm used to that atmosphere, so it's not entirely a stress issue, though that is a part of it. I'm just one that likes to be informed in every regard but wanted some personal accounts in regards to Herceptin, as I can only get here.

God bless,
Ralph

[Lani]

There is always a gap between guidelines, the most recent literature and practice

Guidelines do not yet cover the quandary as to how small a her2 + tumor should receive herceptin. If you go to the search function on the burgundy bar above and type in small tumors and Lani I am sure I have posted on this (or search pubmed and SABCS and ASCO meeting indexes) Neil Love's audio series often questions leading on oncologists on how they treat "small"her2+ tumors.

That said, I just wanted you to know that if your wife is premenopausal the magnitude of her Ki67 varies with what phase of the menstrual cycle she was in when the biopsy/surgery was done.

Lots of things go into the "cost/risk/benefit" analysis of adjuvant herceptin--including your risk aversion and how you weigh each risk ie, cardiac dysfunction from herceptin(usuallly reversible) vs doing everything possible to guard against recurrence.

Hope this helps

[RalphIII]

UPDATE:

We met with the surgeon today and got the final pathology report. There was one dissapointing aspect but truly minor and as it errs on the side of caution. The surgeon achieved clear margins but one part wasn't to the degree he desired. So we are scheduled to undergo surgery again next Friday to remove a little more of the area where the tumor was. The surgeon wants to insert an IV port and will do so at that time also. So it really isn't much of a set back. We just weren't prepared to hear that at the moment but feel better about it now.

Final results:

Estrogen +
Progesterone +
Her2 + (3)
Ki-67 (IHC) 50%
Tumor .9 cm
Lymph nodes(2 tested) -- (negative)

Grade III (8-9) (Nottingham) 2,3,3


__________________________________________________ __________________

Questions:

1) We are very involved in tennis (league/tournaments). Were y'all able to continue with normal such activity given a Herceptin regimen with/without Chemo?

2) What Chemo did any of you with similar conditions use in conjuntion with Herceptin and what was your regimen schedule? Did you also undergo hormone or radiation treatments at the same time?

God Bless,
Ralph

[Jackie07]

Hi Ralph,

For a while, FEC (Fluoruracil, Epirubicin, Cytoxan) was used (still are standard in England, I think) in place of the harsh AC (Adriamycin, Cytoxan). Then TCH (Texatere, Carboplatin, Herceptin) was widely adopted after Herceptin was found to be 'the' weapon for Her2 breast cancer. Lately a schedule of AC+TH has been adopted by some cancer centers. All are followed by Herceptin to make a total of 1 year treatment.

Below is the link to a recent thread that contain several members' schedule and comments:

http://her2support.org/vbulletin/sho...sed#post288570

[LeahM]

Ralph I had the Taxotere, Carboplatin, Herceptin chemo cocktail. I had that infused once every three weeks for a total of 6 infusions. (18 weeks). While that was going on I had the Herceptin infused weekly for 20 weeks and am now on a once every three week schedule with the Herceptin. I unfortunately did not handle the chemo (TC) well. I lived a very active lifestyle before cancer and couldn't maintain it during chemo treatments. "Standards of care" vary from treatment center to treatment center tho so you will know more once you meet with the medical oncologist.
I think tho that (and I could be wrong) HER2+ folks who have a lumpectomy have radiation treatments after chemo is done. I did rads too (34 treatments)...even tho I had a BMX...and I handled that much better then chemo.
Because I am also ER+ I started on hormone therapy after radiation was complete.
One step at a time. Chemo. Rads. Hormone therapy.
As for my active lifestyle pre cancer...I am slowy getting that back. I have joined a gym and hope to be mud running ready by May and kayaking ready by June. All this treatment to get well again really can take a toll on a persons body and I have learned that I needed to accept that and remember that it is (God willing) only temporary.
Keep us posted as you meet with the doctors.
Best Wishes.
Leah

[Lani]

fyi
J Cancer Res Clin Oncol. 2013 Feb 15. [Epub ahead of print]
Recurrence risk in small, node-negative, early breast cancer: a multicenter retrospective analysis.
Gamucci T, Vaccaro A, Ciancola F, Pizzuti L, Sperduti I, Moscetti L, Longo F, Fabbri MA, Giampaolo MA, Mentuccia L, Di Lauro L, Vici P.
Source
Medical Oncology Unit, ASL Frosinone, Via Armando Fabi, 03100, Frosinone, Italy.
Abstract
PURPOSE:
Recurrences and deaths are known to occur, even if less frequently, in small, node-negative breast cancer patients, and decision on adjuvant treatments remains controversial. In the present analysis, we evaluate recurrence risk in patients with pT1 a, b, c, node-negative, breast cancer, accordingly with some prognostic biological factors.
METHODS:
We retrospectively evaluated 900 node-negative patients (pT1a, b, c) surgery treated between 2000 and 2009 in four Italian oncologic centers. We defined 3 different cohorts: ER positive (ER+); Her-2 positive (Her-2+); and triple negative (TN).
RESULTS:
pT1a was seen in 7.6% of patients, 37.7 % pT1b, 54.8 % pT1c. Concerning the 3 different cohorts, 58.2 % were ER+; 10.8 % were Her-2+; 8.2 % were TN. Overall, chemotherapy was given to 3.0 %, 27.2 %, 69.8 % of pT1a, b, c, respectively, and to 22.7 %, 58.8 %, 68.9 % of ER+, Her-2+, TN subgroups. At a median follow-up of 67 months, 5-year DFS was 96.3 %, 89.2 %, 89.4 % in pT1a, b, c, respectively (100 %, 93.6 %, 89.8 % in ER+; 100 %, 78.7 %, 85.0 % in Her-2+; 100 %, 76.8 %, 85.2 % in TN) (p = ns). At multivariate analysis, histologic grade and Ki-67 resulted independent prognostic factors. Overall, 5-year OS was 98 %, without differences among pT1a, b, c, or among the 3 cohorts.
CONCLUSIONS:
Overall, 5-year DFS was very favorable in this series of small, node-negative breast cancers, but Her-2+ and TN cohorts have a higher recurrence rate than ER+ cohort (p < 0.0001); pT1c, but also pT1b, in Her-2+ and TN subgroups, have a worse outcome, and effective chemotherapy treatment should be considered in these unfavorable subgroups.
PMID: 23411686