Hi folks,
I feel so petty right now. I should be glad about the adjuvant herceptin announcement but..my mom (67 stage 2.er/her2 pos))was consistently steered away from any chemo for,(depending on the doctor) various reasons(low yield, not beneficial to "elderly", emphysema risk). I felt in my bones that she should go for it and get in the 9831 trial but was scared to recommend it after 4 oncs said go with Rads and hormonal. Mom is on her last week of Rads and will meet about hormonal therapy next.
1) Any way this new info might influence her next move?
2)Is there any reason other than potential radiated skin inflammation to not do the chemo after rads?
3) Any thoughts on Aromasin and Lapatinib? Seems like that would be a good combo for women who aren't chemo candidates.

I would like to add that my father has been diagnosed with spreading prostate cancer. if anyone here has info on that, please let me know.

And lastly, the blissfull ignorance about cancer that I previously had, despite losing a sister in law in October, is quite the curiousity to me now. I certainly have to be thankful my mother has a pretty good attitude thus far. I feel like a baby these days. You folks are very courageous.
Rich

I wouldn't be too terribly upset. Chemotherapy doesn't generally work as well in hormone positive patients. In fact, in Europe if you have hormone sensitive early breast cancer, even her2neu positive disease, their protocol is to treat with hormone therapy as they feel it has been consistently shown to be more effective than their usual standard chemo in Europe(CMF)--refer to this year's St. Gallen meeting.

About 20 percent of breast cancers are truly her2neu positive in a way that herceptin helps--only a percentage of the 2+ by IHC, most of the 3+ by IHC if the test is done well. The best test is if she is FISH positive (even better if she has a FISH score greater than 5).
Only 10% of these truly her2pos breast cancer patients is supposedly hormone receptor positive, making them 2% of all breast cancers. My guess is it is going to take a long time before they figure out the best treatment for such a small subgroup of patients.

What would be nice is for an oncologist to consider giving Herceptin with aromatase inhibitors (many her2neu tumors show relative insensitivity to tamoxifen) or give it as monotherapy. to patients with early breast cancer. Allison Jones of the Royal Free Hospital in London(find her article in pubmed) is giving hormonal plus Herceptin treatment to patients with metastatic breast cancer as is Matthew Ellis of Washington University, I think.

As Herceptin can be cardiotoxic in some patients for reasons they do not understand, they are nervous to do so in someone who might not recur , especially in someone your mother's age.

How strongly er positive and pr positive is your mother? Many her2neu patients have very few hormonal receptors ( absolute numbers, not necessarily percent). Good article on this by Mark Pegram, MD OF UCLA (look up in PubMed). An interesting article on combining Letrozole and Herceptin in patients with metastatic breast cancer by Matthew Ellis, MD (formerly of Duke, now of Washington University in St. Louis). Where is your mother located?

Were her lymph nodes positive?--how many?

If they were negative, there is a $3500 test by Genomic Health to see how likely it would be that chemo would help in any way. There is not yet any such test on the market to see how helpful aromatase inhibitors might be, or which one. An interesting new paper by RR Love of the University of Wisconsin is raising the possibility of combining tamoxifen and exemestane, although this is far from being generally accepted. And don't forget about vaccines.

Post a little more info on your mom-- tumor size, lymph node status, how strongly er and pr, whether she has preexisting heart disease.

I am not an oncologist but might be able to help stear you to more info...

There is a lot of good info on prostate cancer out there--probably more than on breast cancer.

How about if her2support would count how many of their participants in the message boards are her2 positive and also estrogen and/or progesterone receptor positive (and include whether you were her2positive 2plus or 3 plus by IHC or her2positive by FISH).. This is a small subset of breast cancer patients, but one where understanding the biology of the her2neu receptor protein and the estrogen and progesterone receptor may help determine the best treatment which MAY NOT EVEN INVOLVE any chemical which is not specific at worst and tailor-made at best to treat only the cells in the cancer ( smartbombs).


Good luck!

Mom had a 2.1 cm primary invasive ductal and a 1cm lobular in same, left breast. I think only the 2.1 was her 2 pos and was 8 out of 12 er+. FISH wa s1.89 on biopsy and 2,1 on surgery(primary tumor)
She is being treatedf in Madison UW hospital so I should check on the Aromasin tamoxifen issue although Arimidex has been suggested so far. She is node negative but the primary is severely media which, I have read, makes the sentinel node biopsy less accurate.
Grade on primary was 3 on bloom richardson or 1 on nottinghame=..different labs, different standards/results

No known heart disease although ef on muga was 51 which I think is not great.
thank you for responding
Rich

Rich,
As far as your father, i would look into Provenge study. They are getting very good results with this. It's Dendreon that's doing the studies.

Rich,
I don't know about Aromasin + Lapatinib BUT Lapatinib has been shown to re-sensitize tamoxifen resistant tumours.
My comment about your father would be the same as Michele's.
I'm very sorry to hear about your father's (and mother's) misfortune and struggles. Stay strong and follow your gut on these things.
Take care,
Al

Problem is..my gut is just churning. This feels so impossible. I wish there were age stats out for the study. Supposedly many chemos aren't as effective in older patients. But then other studies say they are. On the one hand, on the other hand..in my mom's case..at every turn.
Anyone know where 51 ranks in terms of ejection faction?

Rich, I am also HER2 +++ estrogen+ . I was diagnosed as stage IV with 8/16 nodes positive and one spot on my liver. I had Carboplatin/Taxotere/Herceptin every three weeks for 6 cycles. I then had 33 radiation treatments. I am currently on Letrozole/Herceptin/Lupron since December 2004. I am 37 years old which is why I have the Lupron to shut down my ovaries. I am sceduled to have an oopherectomy in about a month. . My bone density is low in my spine so I figured I'd get rid of the Lupron. I don't know if any of this helped but I just wanted you to know that your mom is not alone. Like that article said, Only 2% of all breast cancer is HER2+++ and estrogen+. Good luck with your mom an dad. Sally

An EF of 50 or over is normal. NOT bad. Normal.

Having said that, I have to add that I think you may be jumping the gun a bit. I understand that you are frightened and anxious, but your mom may not need chemo at all at this point. You need to sit down and BREATHE, and then discuss it calmly w/ the oncologist. The fact that she's ErPr+ is a good thing--there are MANY more options for her. Her2+ is not a death sentence in and of iteself. And Herceptin is not a cure.

Your mom's age may actually be a benefit for her as it is believed that older people tend to have slower-growing tumors. If she has NED at present, then one of the anti- hormonal drugs may be all she needs. Not because she is 'old' (I don't think 67 is old) or even because she has emphysema; just because that's all she needs now.

We all tend to want to give the disease a knock-out punch. I've heard people say, "Hit it heavy and hard'" as if that will guarantee something. But we should all know by now there are no guarantees w/ this disease. I think the new Herceptin + chemo findings are stunning. Wish I'd had the chance to go that route when I started. But there are other drugs in the pipeline, and IF your mom needs them eventually, a couple of them will be there.

I guess my main concern is that even the makers of Arimidex say data is mixed wrt her2+. One study I read(Korea) suggested er+ her2 is twice as likely to relapse. Of course, we don't know how many er+ were in the trial or how they fared.