For Becky

[Jean]

Hi Becky,
Have a thought and a question:

High Grade DCIS...Her2 positive... non invasive...what are your thoughts
for treatment with herceptin?

In light of all we heard in SA with early stagers and treatment
this is real unchartered terrority...knowing your DCIS in the other
breast was HER2 neg. what are your thoughts on this.

Sending you a big Hug,
Jean

[Lani]

here is the first one I found using the search--
Clinical trial of herceptin+radiation therapy for ER- her2+ DCIS at MD Anderson
1: Breast J. 2007 Jan-Feb;13(1):72-5.
Novel clinical trial designs for treatment of ductal carcinoma in situ of the breast with trastuzumab (herceptin).

Gonzalez RJ,
Buzdar AU,
Fraser Symmans W,
Yen TW,
Broglio KR,
Lucci A,
Esteva FJ,
Yin G,
Kuerer HM.
Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Because ductal carcinoma in situ (DCIS) avidly expresses Her2/neu, the target of the monoclonal antibody trastuzumab, and because trastuzumab has been shown to be effective against invasive breast cancer, trastuzumab may be effective for reducing the tumor burden and abrogating or reversing the hypothesized transition from in situ to invasive disease in patients with DCIS. To test this hypothesis, a trial of neoadjuvant trastuzumab for DCIS has been opened at our institution. Because trastuzumab has been shown to act as a radiosensitizing agent for Her2/neu-overexpressing cancer and because there are currently no systemic treatments for estrogen-receptor-negative DCIS, it makes sense to investigate whether use of trastuzumab concurrently with postoperative radiation therapy improves local control of DCIS. The National Surgical Adjuvant Breast and Bowel Project (NSABP) is planning a trial to test this hypothesis. The risk of cardiac toxicity associated with the doses of trastuzumab planned for these trials (cumulative doses of 8 mg/kg for our trial and 14 mg/kg in the NSABP trial) is believed to be minimal, but the safety profile of these approaches will need to be closely monitored.
PMID: 17214797 [PubMed - in process]

[Lani]

Medical hypotheses journal --two other interesting articles


one suggests using intraductal herceptin for DCIS

the other intrathecal herceptin for schizophrenics

just food for thought!

[Jean]

Glad you are tracking me....

As you know I am always on the soap box about early stage / and/ treatments. So many misunderstand the DCIS dx. as nothing to be
concerned about...not so! But, we just do not have completed data at
this time...which is so frustrating. Knew about your earlier post.
Also linked him to other posts we have had.

I am extremely interested in Becky dx. since we recently discussed this
in SA...and we have a new memeber who has been dx. with DCIS
and some posts have been going back and forth and I wish for him
to be armed with information before he meets with his onc.

Big question for him is should he have treatment with herceptin since he is strongly HER2 positive.

Thanks,
Jean

[Becky]

After getting wide clean margins, I believe slides must be scrutinized by several large cancer centers (like Sloan, Johns Hopkins, MD Anderson or the like) to absolutely ensure there is no invasive component. I am not sure that any DCIS that can be palpated or is high grade is truly DCIS - period. What do the clean margins look like too - lots of atypical hyperplasia? The pathology report can tell you this. This is not cancer and is truly precancer but has a good - no great, chance of becoming DCIS/IDC. So you cut out the DCIS but the precancer is left behind to change to DCIS - if high grade, this will happen especially if there are no lifestyle interventions (I believe that your fate can be changed if you change - maybe not a 100% assurity but it can happen - it does with clogging arteries and this is "clogging" ducts). So, high grade Her2+ bc should be treated with radiation and I think Herceptin too. The trial Lani describes is great. As with cancer, DCIS are different diseases too. For example, less than 2 cm tumors that are only ER/PR+, low to intermediate grade in older women only get an AI (and they think this is the case if 1-3 nodes + in the future too), but that could never be if you are Her2+ cancer so.........

High grade is different and high grade might be invasive without anyone knowing.

[Melissa]

Hi,
Back to my question about the inbetween surgeries. If the breast cancer cells are in the ducts, can they leak after surgery,especially if there is not clean margins??? Or is this a silly question?

[Jean]

Meissa,
If the DCIS is in the ducks it is not invasive - but to best answer your questoin....DCIS can break out of the ducts at any time and become
invasive depending on the type of DCIS.

Jean
PS no question is silly...

[Jean]

Becky,
Thanks for your post...as I thought Her2 changes the game.

Jean

[AlaskaAngel]

Jean, what Melissa may be asking is whether, when surgery is done, do the ducts cut in the process of doing surgery release the DCIS to then develop into IDC? In other words, although DCIS is ductal originally, can surgery release it from the ducts and would it then logically possibly be more capable of evolving into breast cancer? Or is there something about the development of DCIS that causes it generally to not become IDC even if it manages to be released by surgery from the duct?

Interesting question.

AlaskaAngel

[Jean]

Hi AA, and thank you, I misunderstood the question.

Well, Since DCIS must be removed with clean margins and most dr.
recommend additional treatment such as radiation I would say yes,
that the odds of developing an invasive is there. The surgery itself
should not/or/ would not be the culprit, rather the doctor not achieving clean margins. (leaving behind trace amount) Treating DCIS is to reduce the risk of an invasive cancer.
If the DCIS is not invasive at the time of surgery - that does not
mean it cannot return as an invasive cancer later on. So the best answer to the question is if the DCIS is not invasive it is not considered cancer, but a pre-cancer. All DCIS can and is capable of evoling into breast
cancer. Dr. still do not understand the sub types of DCIS...what
is so concerning to me is that most if not all dr. treat DCIS with HER2
just like DCIS without HER2...and as Becky pointed out it is not so
easy via pathology to define the invasive portion and anything left
behind will have the strong chance of changing to IDC. So the answer is yes.

Jean

[hutchibk]

Good gosh you are some smart ladies... I love you. Need I say more?

[Believe51]

As you know my Mother, 'lilAcorn has had her lumpectomy and is scheduled radiation. She has not updated her bio nor posted due to computer issues. I am so happy that these threads are here for her to read, Thank You Fine Ladies!! It is just what she needs right now because her journey has just started and we want to follow all the details. This is of major concern for her. These posts voice some answers to my concerns and at a time best needed too. Thanks>>Believe51

[penelope]

that is if surgery could have caused the invasive component in my breast.

I originally presented myself to the drs with a small "thickening". I had had a mammo at age 27 which was negative due to the fact my mother died of bc as did her mother. At 35, I went back with this thickening, and had another negative mammo, but this time I asked for an ultrasound. On the ultrasound they decided I should have a biopsy, given family history, but was 99% assured it was a fibradanoma. They went in 6 times to take 6 core samples, each time pulling tissue in and out.

Nope, no luck high grade dcis. I took the pathology to an expert on dcis Dr. Lagios in San Fran who looked it over and said for sure it was just that dcis but suggested I get a mri on a dedicated breast machine, which I did. The mri came back that I had a larger area of dcis but no invasive component. Went on to have a PET/CT, again, small area of dcis no invasive component. And so with that I decided to have a bilateral. I was assured lumpectomy and radiation was enough but after research, and mom who incidently they said was 98% cured, I was uncomfortable with that option.

On the advice to Dr. Lagios, I went to UCSF which is a dedicated breast center. After surgery I had 4.2 cm dcis and a 7mm idc. I have often wondered if the biopsies themselves caused the small cells to be pushed out of the ducts. Once cells are outside of the ducts they are considered invasive. I know that human cells are sticky, per my sister who works extensively in hematology. How can patologists be sure that cells were not manually moved, or pushed through? Especially in the case of someone like me where the idc had the same biological characteristics as the dcis.

I guess I will never know. In the end I poisoned and slashed myself anyway. Took a years worth of herceptin and lost my healthy breast as well. But I have often wondered on this very same subject.

[penelope]

the solution is easier for our daughters! Mine is 6. I would like to think that in 15 years they might be able to cure dcis.

I have recently heard of a study at UCSF where they are using a blood test to find dcis/bc at its earliest stages.

One can hope.