Herceptin four years later- any point???

[tricia keegan]

Hi Everyone,

A lady I know has just found out she was wrongly diagnosed as her2 neg rather than positive and is four years out.
She has a new onc who suggested she take it now and obviously she's very undecided on whether it would help at this stage.
Any thoughts??

[StephN]

Dear Tricia -
Wow, how did she find out she was wrongly diagnosed? Did the new onc have her slides retested?

With the new evidence coming out that Herceptin can go after dormant cells that are just lying in wait to activate perhaps years down the road, I think that if she can get Herceptin now she may stave off a recurrence or something later.

Has you friend asked her onc's reasoning for his suggestion that she take it? She should know that it is an easy drug on the body and side effects when taken alone are very minimal.

[AlaskaAngel]

Hi Tricia,

As one who "missed out" by being "too far out from original treatment", I don't have an answer for you. Quite a few here who also missed out opted to do treatment late, some choosing to do an abbreviated version.

In talking this fall with an onc, one advantage in not doing late treatment that stands out to me is that by not doing treatment as a preventative "late", at the time of any recurrence the knowledge base will be greater than it would if I did the treatment now. In the onc's opinion, my choices would be much wider if I have a recurrence and if I didn't do it as preventative treatment now.

I have also definitely noticed in looking at clinical trials that often when the latest and greatest drug is being tested along with trastuzumab, one is not eligible if one has already had trastuzumab once.

Just some thoughts to consider.

A.A.

[Joe]

This is more common than I realized. See my post"Hard o Believe"

Regards
Joe

[tricia keegan]

Thank you for replying everyone, I'll pass on all comment I receive here to her.
Steph, she was originally pos, not sure why her onc at that did not give her the herceptin but this new onc had everything re tested and wants her to do it:)
I honestly was'nt sure if it was worthwhile at this point which is why I posted to get some advice:)

[ElaineM]

Can she ask for a Her2 serum test to see how strongly her2 positive she is? Then she and her doctor can make an informed decision. If it were me I would agree to get Herceptin for a certain period of time after discussing the issue with my doctor.

[hutchibk]

Yes, I would say if she can get it, she should by all means get it since it comes with very little side effect and could contribute to avoiding recurrence. I am not a doctor, but I think it's an opportunity for her if it's available for her.

[Joan M]

Tricia,

At four years out from diagnosis, your friend could very well be in the clear based on the drop-off in the rate of recurrence after two years, according to the Herceptin trials. However, since we don't have crystal balls to predict whether the cancer might come back even after four years, I would suggest going for it now with the chance that if it were destined to come back, the Herceptin could be the silver bullet in the adjuvant setting.

Joan

[Barbara2]

I would definately take late herceptin if given the chance, and I did. Cancer can return after any number of years. Taking herceptin, even "late", may prevent any lurking cells from kicking in setting up shop again, sometime later in time. No one really knows for sure but logically it makes sense to take herceptin, even if it is "late".

Here is what Dr. Pegram said to me when I asked him about late herceptin back in 2007:

Good for you! I think that’s the right thing even though there’s no data. I think you definitely should do it. Can’t hurt. You have nothing to lose. We know that it works when you take it up front when first diagnosed. We also know that it works in terms of even prolonging survival if you wait until after you develop metastasis, it works, so what are the odds that it doesn’t work in between those 2? I’m sure it does. I think it works. I would have done it if I were you. There’s even a study of that right now (late Herceptin); there’s a trial that’s open. I think you have to have finished adjuvant therapy within 2 years. The study isn’t random; they’re treating everybody. The study is just underway, so it will take a long time for the results (and there are not that many people that would be taking the study; after May 05, everyone started getting Herceptin.)

[tricia keegan]

Thank you everyone, I'm sending the link to this thread on to her right now so she can read it herself:)

[hutchibk]

Lani just posted this today... maybe this will also bolster the argument for her:

at ASCO breast meeting currently in SF


Abstract 228 Poster Discussion: Systemic Mgmt. Thursday, October 8, 2009 6:00-7:00 PM PST
Lead Author: Heather L. McArthur, MD, MPH Memorial Sloan-Kettering Cancer Center New York, NY
Women with small node-negative HER2+ breast tumors appear to benefit from adjuvant trastuzumab (Herceptin) treatment: Based on a review of approximately 500 records of patients treated between Jan. 2002 and Dec. 2008, researchers found that women with small (2 cm or less) HER2-positive breast cancers that had not spread to lymph nodes who received trastuzumab-based treatment after surgery had significantly better outcomes than a comparable population of women treated before trastuzumab was available (Jan. 2002 through May 15, 2004). In the trastuzumab-treated group, there was only one death and no recurrences. In the trastuzumab-naive group, there were ten locoregional recurrences, nine distant recurrences and six deaths. In the U.S., adjuvant trastuzumab is FDA-approved in combination with chemotherapy for the treatment of node-positive or high-risk, node-negative, HER2-positive breast cancer; however, whether women with lower risk, HER2-positive breast cancer derive benefit from trastuzumab has not been established.
“This is a provocative analysis suggesting a significant benefit in disease- free survival for patients with Stage I breast cancer who received trastuzumab,” said Lori Pierce, MD, Professor, Radiation Oncology, University of Michigan School of Medicine.“It will be important to test this hypothesis prospectively to be sure the potential benefit of trastuzumab is not over-estimated in this low-risk patient population.”

[tricia keegan]

Thanks for drawing my attention to this Brenda, I'll pass it on to her. She's still trying to make a decision but this new onc is more than happy for her to have it now.

[chrislmelb]

I'd get it. I had mine late too, 18 months after chemo finished and i had it for 2 years as part of HERA trial. It was so easy to tolerate so why not if if puts off a death sentence??