Adequate treatment?

[Rich]

My mom is recovering from a simple mastectomy. She is 67,
T2,N0(SenLymBiop), Grade 3, er+ and her-2+. She had attachment to pec
major but they say that it didn't get to intercostal muscles.
Current local offerings range from just chest wall rads & Arimidex to
adding AC at the head. I am concerned about the safety of AC since it
seems many feel epirubicin is safer.The facility she has used so
far(Wisconsin) doesn't ever use epirubicin. These tools seem like they
may not be enough. I have seen information regarding M.D. Anderson's
off protocol treatment using herceptin/chemo in the adjuvant setting
and am investigating whether my mother might qualify. I am also
wondering whether they have come up with a way to test for PTEN levels
which seem to determine responsiveness to Herceptin. Seems like every
advance in treating her-2 comes out of M.D. Anderson.
I'm so afraid at this point.

[al from canada]

Hi Rich,
Unless I'm behind the times, AC + Taxol (T) is STILL the gold standard in chemotherapy; true it is a more agressive approach however, in view of the fact that your Mom's cancer has was starting to attach itself to other than breast tissue plus she is HER2+, I wouldn't take many chances. That being said, the node (N0) result is a good thing. I would certainly push for Herceptin as an adjunct . I would hazard to guess that most on this board would have given anything to get the opportunity to get herceptin as chemo adjuntc. I pushed for it with my wife and was turned-down flat!
Hope all goes well and the most important thing you can do is what you are doing right now; that is, being your Mom's advocate.
All the best,
Al

[al from canada]

Hi Rich,
Unless I'm behind the times, AC + Taxol (T) is STILL the gold standard in chemotherapy; true it is a more agressive approach however, in view of the fact that your Mom's cancer has was starting to attach itself to other than breast tissue plus she is HER2+, I wouldn't take many chances. That being said, the node (N0) result is a good thing. I would certainly push for Herceptin as an adjunct . I would hazard to guess that most on this board would have given anything to get the opportunity to get herceptin as chemo adjuntc. I pushed for it with my wife and was turned-down flat!
Hope all goes well and the most important thing you can do is what you are doing right now; that is, being your Mom's advocate.
All the best,
Al

[scott]

Rich,
Many times when women are older, chemo is sometimes skipped due to their inability to tolerate the regimen and/or their limited long term benefit due to their age. She could simply go to hormonal therapy with Arimidex, but being Her2 positive, she should probably have Herceptin as it carries few side effects (except for a small % of patients who develop cardiac toxicity). If her oncologist won't order off label Herceptin get a second opinion, or enroll in a study that includes adjuvant Herceptin in the non-metastatic setting.
A popular regimen currently is Herceptin, Carboplatin and weekly Taxol. She could try this and if it is too much she could just continue with the Herceptin and go on to Arimidex.
Adriamycin/Epirubicin are anthracyclines which are very effective and considered the standard of care in many centers, but that is being challenged by the taxanes, and they definitely carry the risk of cardiac toxicity, so much so that Herceptin is never administered at the same time as Adriamycin due to the combined toxicity.

Good luck!

[anonymous]

I must strongly disagree with Scott's response. There have been numerous studies in older women that show they can tolerate chemo quite well. With a T2 lesion that has attached itself deep to the pec muscles and is her 2 pos, going on arimidex alone is not adequate.

The taxol carboplatin herceptin regimen mentioned has only been studied as first line therapy in metastatic breast cancer not primary breast cancer. Has your mom had scans to be sure she has no metastatic disease? She should have a bone scan, CT of the chest abdomen and pelvis and a brain MRI as her 2 pos cancers are at risk for brain mets.

If all these scans are neg, as Al mentioned the gold standard is AC, followed by either taxol or taxotere ( which is probably more effective than taxol ). Herceptin is not given concurrently with adriamycin and depending on your insurance you might or might not get coverage for it.

Someone should also evaluate her for chest wall rads. If her bc is on the left side, sometimes, they are reluctant to radiate because of the heart. I guess alot would depend on how clean the margins were.

It never hurts to get a second opinion before she starts treatment from a breast oncologist. There are many excellent ones across the country.

One last thing, when she is done with treatment she should go on hormonal therapy and femara has been shown to be slightly more effective than arimidex and is now approved for primary bc.

Good luck.