Questions on chemo and herceptin

[Joe]

<!-- / icon and title --><!-- message -->Copied from an earlier post:
Hi

I am very new to the whole chat room scene. Although I have been reading for the past week. I am looking for information on whether to do chemo and Herceptin or just herceptin alone.
I was diagnoised with early stage bc through mammogram, no lump was detected. Had a lumpectomy Nov. 1st. They found foucal microinvasion, took 2 node neg. ER,Pr neg but her2 3+, I will start radiation the first week in Dec. and go for 7 weeks.
Found out Thursday, the day the FDA approved herceptin for early stage bc that the onc wanted to do 4 session of chemo and 1 year of herceptin. I am looking to do only heceptin. Also the onc is having the genetic testing done on the her2 gene to see how agressive it is. Has any ones onc suggested this test and what have they found out?
Thanks This has been a great site.
DianneM
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[suzan w]

perhaps she is referring to Oncotype DX test? If so, I had it done after surgery...and the results surprised my oncologist. She was not going to recommend chemo and wasn't sure about herceptin. But the oncotype put me at a high-intermediate risk for distant recurrance within 10 years. I did chemo, then herceptin! DOn't know if this is any help!!

[MJo]

If she is referring to the Oncotype, it's possible that ALL Her2 tumors will test high risk. Johns Hopkins Ask an Expert describes the Oncotype DX as a test for node-neg stage 1 tumors that are NOT Her2+. I bet that no Her2+ tumor has ever tested other than high risk, though I don't have the data to prove it.

[panicked911]

ditto on what MoJo said. ALL HER2 comes back high even those who are triple positive. the HER2 factor weighs two heavily for it not to come back. the test is also very expesive $3,000 and not all insurance is paying for it. Oxford does not and I am currently in a level 3 appeal to get it covered.



Susanne

[SusanV]

Dianne,

So sorry that you have joined the crowd here, but it is an awsome place for support, information and expertise. Just wanted to give you my treatment history if it helps. My dx is similar, but not exactly the same as yours. I am also node negative, with two small tumors, but I am ER/PR +. I think the decision to add chemo to herceptin is very personal, but one you should not take lightly. Do as much research as you can, and ask your onc to provide you with some numbers for your exact % of recurrance, which will be based on your specific information to include your age, health history, tumor size, ER/PR status etc. I did decide to add the chemo, and will begin herceptin on 11/27. I am glad that I did it, and most importantly I feel that it will give me a little piece of mind that I am fighting back with what is available. Her2 is aggressive and I wanted to treat it that way !

Good luck, I know the decision is not an easy one to make.

Thinking of you

[Bev]

Hi Dianne,

The protocol in the past has been for herceptin to be combined or used after chemo even for early stage. It has synergy with taxol. It's more complicated than I can understand, but your test results may suggest chemo is warranted. Standard operating procedure has been changing quickly though.

There are a couple of people on board doing Herceptin only. Herceptin works on 50% of Her2+. So...if you're not one of them, you've missed out on the benefits of chemo. If you are one of them, you've avoided side effects of chemo which ranges greatly. Problem is in the past we haven't known who benefits. They are working on this.

Before Herceptin, I think it would have been rare to do chemo for stage I. I think you should get a 2nd and 3rd opinion. Inquire with all 3 if there are any studies you can participate in. Let us know what the test results are, so the others can give you a more informed opinion.

Best of luck and smooth sailing. BB

[Dianne M]

Thank you all for your thoughts. there is so much information and I'm not sure always what to ask. I did find out the since I am not Er,PR + the test I was looking at doen not pertain to me. So I am somewhat back to square one. chemo no chemo. Bev what is Taxol use for?
Thanks again
Dianne

[astrid]

As you are node negative you may want to consider the clinical study CALGB 40101

www.cancer.gov/clinicaltrials/view_clinicaltrials.aspx?version=healthprofessiona l&cdrid=69444 (http://www.cancer.gov/clinicaltrials/view_clinicaltrials.aspx?version=healthprofessiona l&cdrid=69444)

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Standard chemo treatment is 4 rounds of doxorubicin (Adriamycin - A) with cyclophosphamide (Cytoxan - C), and 4 rounds of Paclitaxel (Taxol) T. So, this clinic study wants to see if node negative women who do not need aggressive chemo treatments will do better with A or T as dose dense standalone chemo treatments for 4 or 6 rounds.

[Hopeful]

DianeM, Did your pathology report have information on something called Ki-67? This is a factor that shows how fast the cancer is growing. It is used to determine the aggressiveness of the disease. Also, does the report contain information on the grade of cancer? There is grade one (low) grade 2 (intermediate) and grade 3 (high). Usually, the higher the Ki-67 score and the higher the grade, the better the response to chemo.

Best of luck to you with your treatment plan.

Hopeful

[rinaina]

My diagnosis is the same as yours...stage I er/pr- her2+ but I was told that her2+ is a very aggressive form of bc and that I would need chemo as well as herceptin. I thought I remember reading that all her2+ is considered highly risky and chemo is pretty much protocol but I could be wrong. Chemo isn't fun but we all make it through. I for one had a bit of a rough time with it but feel terrific now. Handling herceptin so far very well. Good luck to you.

[Bev]

Hi Dianne, taxol and it's cousins paclitaxel, and taxotere have been around for quite awhile. It's from the yew plant and for what it's worth it inhibits (cancer) cell replication and microtubule formation. Many of us have done AC(the big guns) followed by taxol and herceptin combined. Studies show T + H are very good together. I have also run across studies for other cancers that show taxol radiosensitizes tumor cells. Helps them die during radiation. Taxol will cause your lashes, brows and sundry head hairs to fall out. Quite a few experience pain in their extremeties.

I don't know the answer. You could do AC + TH or just TH or just H. Astrid's study looks interesting. As I said they are still trying to figure out exactly who these treatments work for.

It's so very hard to digest all this and make a decision. I know you don't have endless time to learn about and exhaust all options. Initially when I resisted chemo, I had 3 docs saying chemo was the way to go, I said Ok. 1-1/2 years later, I'm just beginning to understand.

So I can't say for your case. There's no right or wrong answer. Be open to what they tell you. We are all on the same side. You, are at this point, an open ended experiment, but I'm sure you want to select a course of treatment that gives you the best survival chances.

When you have time read the studies Lani has posted and Articles of Interest. Best of luck. It gets easier as time goes on. Bev