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As someone with bc who is also ER+ PR+ HER2+++ and who was treated with CAF x 6 and am more than 12 months out, I wonder what the best choices are too.
Since we have never had a taxane, I wonder mostly if we would get the greatest benefit from doing a taxane simultaneously with Herceptin for a dose or two, rather than doing say, Herceptin for a year or for the rest of our lives. Combination therapy is supposed to work better than just Herceptin, and doing a dose or two makes better sense economically as well. Since there is no data on this but there are an awful lot of us in the 12-month-plus group out here who either got CEF (FEC) or CAF (FAC) before the taxanes were as commonly used, I would think this would be a logical choice for oncologists to consider in doing a clinical trial.
The more high-risk factors you have, the more seriously you should consider Herceptin. You and I are high-risk because of being HER2+++ but we are at lower risk because we are steroid-receptor positive. However, node-positive also raises the risk in the same way that being ER/PR negative would raise the risk. I personally favor the most aggressive approach.
The farther out you get the better, but at the same time, the farther out you are the less this may end up being your choice to make until better clinical data is established.
So... for me there are 2 questions involved. Should anyone who has completed treatment without Herceptin or a taxane be treated with combination therapy rather than just Herceptin, and get just a few doses, or should we be treated with just Herceptin on a longer-term basis? The qusetion there is, would Herceptin long-term be worse on hearts that have already had either Adriamycin (docycycline) or epirubicin, or would a short run of combination therapy be worse?
Another alternative would be for you to ask an onc about having the Bayer Serum test (thanks Joe/Christine and StephN), to try to see if that helps indicate whether you are at more of a risk.
AlaskaAngel
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