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Dear Nikki,
Please forgive me for this comment but your oncologist needs a bit of help with his "people skills." Stated in U.S. vernacular, he has the personality of a "STOP" sign. As a person who has done a bit of research in the HER-2 breast cancer area, I can assure you that nothing, absolutely nothing, is "inevitable." Your excellent question of "can I do more" is the right approach. Keep asking that question!
A few thoughts on the positive --
1. Yes, node positive, HER-2 positive breast cancer patients do survive. You may want to take a little time to review the survival stories of a few inspirational women like Christine Druther (website founder), Ginger Empey, and Barbara Bradfield. Their stories are posted on the website. It appears that these women also failed to understand the meaning of the word "inevitable." Also note that each woman is a text-book case in the lesson of "persistence."
2. Your thought to enter the HERA trial is excellent. If for any reason you do not obtain Herceptin in that trial, there are U.S. HER-2 vaccine programs potentially available to you.
3. Even if your "worst case" scenario of "no adjuvant herceptin" comes true, Herceptin would be available to you if you have a recurrence. For many women (at least half and likely many more if the historic stats were based on FISH HER-2 status testing alone), herceptin is used to control the disease for many years.
4. Assuming Herceptin is not effective, drugs such as GS572017 and APC8024 are potentially available now, and drugs such as Omnitarg may be available in the near future. Keep in mind that most of the targeted therapeutic drugs being developed in the U.S. breast cancer area are aimed at HER-2. If your breast cancer is estrogen positive by chance, that's a plus as well from a drug perspective (e.g., tamoxifen, arimidex, femara, aromasin, and faslodex).
5. In "Silicon Valley" California, the computer techs refer to a concept known as "Moore's Law." Developed in 1965, the concept theorized that computer chip speed would grow expotentially for the foreseeable future. In the end, Moore was correct, because the speed of a computer chip doubles every 2 to 3 years. Based on my limited research, it will not be long until Moore's Law applies in the biocellular science area. We are fast approaching the time when medical statistics that are greater than five years old will be considered obsolete. That is, by time a doctor wants to see statistical results on a particular drug, a newer and better drug will replace the one being considered. This hope is fast becoming reality.
Sorry for the long post, but with respect to your doctor's concept of "inevitable" -- I would set it aside for now and take it as a very bad description of the "state of play" in the area of HER-2 positive breast cancer. Just think how silly your doctor is going to look in eleven years when your then-teenager son is asking YOU for the keys to car.
On a lighter side, tell your doctor that UCLA recently discovered that vodka and diazapam is synergistic with herceptin. Hang in there Nikki. You have a lot to live for, and remember, nothing in the area of HER-2 breast cancer is "inevitable."
Warmest regards,
Paul
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