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Debbie L. · 03-13-2009, 06:10 PM

I don't know the answer to the question about booster doses of Herceptin (and probably no one does).

But my guess is that boosters would not fit into the theory about how adjuvant treatment "works". At primary diagnosis, it is hoped that surgery cures everyone and no viable cancer cells remain. But since we can't know who those cured-by-surgery people are, adjuvant treatment is done in case there are stray cells out in the body that could be capable of setting up a metastatic site. The purpose of adjuvant treatment is to kill those cells and prevent metastisis.

So adjuvant treatment is done with curative intent. We can argue (and many do) about whether at least some adjuvant treatment merely delays the onset of metastatic disease. But as we know/understand it right now - its intent is curative (whether or not the result is cure).

So I think that the response to the booster question would be that after adjuvant treatment, one is either cured, or they are not. If one is cured, there's no point in further treatment. If one is not cured, treatment can be started when the recurrence becomes evident. So I hear you asking - but what about those who were not cured - wouldn't it keep it at bay longer to give the booster doses of Herceptin? Maybe it could keep it at bay forever! I think that's a reasonable question and who knows (no one) maybe the answer is "yes". But say we use HERA's most recent stats - we'd be giving booster doses to 74% of women who had no need of them, and we have no evidence at all to even suggest that booster doses would offer any advantage to the 36% who do recur (and that's only in the first 4 years). This stat discussion is assuming that at an average of 4 years out, HERA has seen most of the recurrences they are going to see (HER2 typically recurs early). But we don't really know that for sure, either. Maybe Herceptin-treated HER2 has a different timeline and we're not far enough out to know it yet. SO many questions.

It is truly a mystery to me - the difference between adjuvant treatment and its ability to achieve cure with no cancer ever seen again - and metastatic treatment where even if it's just one small site of mets that appears to be treated until it's gone, still it's extremely unusual for it to stay gone. What is different about primary vs. small-and-isolated mets? Is it that only the primaries that are incabable of spreading are the ones that respond to primary treatment and are cured? It doesn't seem so at this point - some of us with pretty dismal primary diagnoses do seem to be cured, and others with reasonably good (relatively) pathology details go on to metastasis.

No answers, just more questions ...

Debbie Laxague

03-13-2009, 06:10 PM	#9
Debbie L. Senior Member Join Date: Jul 2006 Posts: 463	pure speculation I don't know the answer to the question about booster doses of Herceptin (and probably no one does). But my guess is that boosters would not fit into the theory about how adjuvant treatment "works". At primary diagnosis, it is hoped that surgery cures everyone and no viable cancer cells remain. But since we can't know who those cured-by-surgery people are, adjuvant treatment is done in case there are stray cells out in the body that could be capable of setting up a metastatic site. The purpose of adjuvant treatment is to kill those cells and prevent metastisis. So adjuvant treatment is done with curative intent. We can argue (and many do) about whether at least some adjuvant treatment merely delays the onset of metastatic disease. But as we know/understand it right now - its intent is curative (whether or not the result is cure). So I think that the response to the booster question would be that after adjuvant treatment, one is either cured, or they are not. If one is cured, there's no point in further treatment. If one is not cured, treatment can be started when the recurrence becomes evident. So I hear you asking - but what about those who were not cured - wouldn't it keep it at bay longer to give the booster doses of Herceptin? Maybe it could keep it at bay forever! I think that's a reasonable question and who knows (no one) maybe the answer is "yes". But say we use HERA's most recent stats - we'd be giving booster doses to 74% of women who had no need of them, and we have no evidence at all to even suggest that booster doses would offer any advantage to the 36% who do recur (and that's only in the first 4 years). This stat discussion is assuming that at an average of 4 years out, HERA has seen most of the recurrences they are going to see (HER2 typically recurs early). But we don't really know that for sure, either. Maybe Herceptin-treated HER2 has a different timeline and we're not far enough out to know it yet. SO many questions. It is truly a mystery to me - the difference between adjuvant treatment and its ability to achieve cure with no cancer ever seen again - and metastatic treatment where even if it's just one small site of mets that appears to be treated until it's gone, still it's extremely unusual for it to stay gone. What is different about primary vs. small-and-isolated mets? Is it that only the primaries that are incabable of spreading are the ones that respond to primary treatment and are cured? It doesn't seem so at this point - some of us with pretty dismal primary diagnoses do seem to be cured, and others with reasonably good (relatively) pathology details go on to metastasis. No answers, just more questions ... Debbie Laxague __________________ 3/01 ~ Age 49. Occult primary announced by large (6cm) axillary node, found by my husband. 4/01 ~ Bilateral mastectomies (LMRM, R elective simple) - 1.2cm IDC was found at pathology. 5 of 11 axillary nodes positive, largest = 6cm. Stage IIIA ERPR 5%/1% (re-done later at Baylor, both negative at zero). HER2neu positive by IHC and FISH (8.89). Lymphovascular invasion, grade 3, 8/9 modified SBR. TX: Control of arm of NSABP's B-31 adjuvant Herceptin trial (no Herceptin, inducing a severe case of Herceptin-envy): A/C x 4 and Taxol x 4 q3weeks, then rads. Raging infection of entire chest after small revision of mastectomy scar after completing tx (significance unknown). Arimidex for two years, stopped after second pathology opinion. 2017: Mild and manageable lymphedema and some cognitive issues.