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dlaxague · 11-16-2008, 01:21 PM

Hi,

Prophylactic ovary removal would actually be to prevent ovarian cancer. But that's a technicality and I do know what you're asking.

I think that it helps to have some numbers. Have you and your onc ever used Adjuvant! online? You can enter in your details of diagnosis, and get a prediction of your risk of recurrence after five years of Tamoxifen. There is not currently the option to include HER2 as part of the information but Peter Ravdin says it will be in there, soon. He says that he thinks increasing the prognostic figures by about 1.5% is about right, for HER2 positivity. But then you'd also have to adjust for Herceptin's benefit, if you received Herceptin. Probably better to just leave the HER2 out of it for now, and assume that Herceptin trumps the HER2, leveling the playing field so to speak, and that the figures are fairly accurate.

He also says that "initial chemo does not affect late events", which confuses me but is apparently true. We do not (yet) know if this is true for Herceptin or not.

With that number (your risk of recurrence after five years of Tamoxifen), you can know more closely what benefit the AI (with oophorectomy) would offer.

Just using round numbers for clarity, say your risk of recurrence now (as opposed to your initial risk) was 10% (10 of 100 with your diagnosis now at risk of recurrence). Ravdin uses 40% as the relative benefit of AI (letrazole) after Tamoxifen. So 40% of 10 would be 4. It would offer you a 4% reduction in risk of recurrence (from 90/100 chance of survival to 94/100). Some people would jump at that, others would say it's too small to be worth it.

On the other hand, using it the same way but for someone whose risk of recurrence was now very high, say 50%, it would decrease their absolute risk now by, uh, 20%? Yes, I think that's right (40% of 50% is 20%). So their chance of survival would jump from 50% to 70% and most people would probably go for that.

Using Adjuvant!, I have to enter in all very bad details to get that risk up as high as 50%, after completing five years of T. Most will be at less risk, hence will reap less benefit from an AI after Tamoxifen.

There's also the option to stay on Tamoxifen. There is recent evidence that there may be a benefit to that, after all, from last year's SABCS: http://www.medscape.com/viewarticle/567735 or google "peto tamoxifen after five years" and you'll lots of hits.

'Wish that there were a clear and easy answer. Others will have more to say about their experience. Herceptin has not been standard adjuvant treatment for very long, so there are not many women, so far, who've had Herceptin and are now completing five years of anything, alas-for-knowing-answers.

Debbie Laxague
(I almost deleted this and didn't respond at all because I feel like all I've done is make things more confusing. But things ARE confusing, so I guess it's helpful to know that?)

11-16-2008, 01:21 PM	#2
dlaxague Senior Member Join Date: May 2006 Posts: 221	Hi, Prophylactic ovary removal would actually be to prevent ovarian cancer. But that's a technicality and I do know what you're asking. I think that it helps to have some numbers. Have you and your onc ever used Adjuvant! online? You can enter in your details of diagnosis, and get a prediction of your risk of recurrence after five years of Tamoxifen. There is not currently the option to include HER2 as part of the information but Peter Ravdin says it will be in there, soon. He says that he thinks increasing the prognostic figures by about 1.5% is about right, for HER2 positivity. But then you'd also have to adjust for Herceptin's benefit, if you received Herceptin. Probably better to just leave the HER2 out of it for now, and assume that Herceptin trumps the HER2, leveling the playing field so to speak, and that the figures are fairly accurate. He also says that "initial chemo does not affect late events", which confuses me but is apparently true. We do not (yet) know if this is true for Herceptin or not. With that number (your risk of recurrence after five years of Tamoxifen), you can know more closely what benefit the AI (with oophorectomy) would offer. Just using round numbers for clarity, say your risk of recurrence now (as opposed to your initial risk) was 10% (10 of 100 with your diagnosis now at risk of recurrence). Ravdin uses 40% as the relative benefit of AI (letrazole) after Tamoxifen. So 40% of 10 would be 4. It would offer you a 4% reduction in risk of recurrence (from 90/100 chance of survival to 94/100). Some people would jump at that, others would say it's too small to be worth it. On the other hand, using it the same way but for someone whose risk of recurrence was now very high, say 50%, it would decrease their absolute risk now by, uh, 20%? Yes, I think that's right (40% of 50% is 20%). So their chance of survival would jump from 50% to 70% and most people would probably go for that. Using Adjuvant!, I have to enter in all very bad details to get that risk up as high as 50%, after completing five years of T. Most will be at less risk, hence will reap less benefit from an AI after Tamoxifen. There's also the option to stay on Tamoxifen. There is recent evidence that there may be a benefit to that, after all, from last year's SABCS: http://www.medscape.com/viewarticle/567735 or google "peto tamoxifen after five years" and you'll lots of hits. 'Wish that there were a clear and easy answer. Others will have more to say about their experience. Herceptin has not been standard adjuvant treatment for very long, so there are not many women, so far, who've had Herceptin and are now completing five years of anything, alas-for-knowing-answers. Debbie Laxague (I almost deleted this and didn't respond at all because I feel like all I've done is make things more confusing. But things ARE confusing, so I guess it's helpful to know that?)