her2 positive ER & PR negative

I was just diagnosed with Her2 positive ER & PR negative breast cancer. I had a particial mastectomy and I am node negative. My tumor was small with a 3mm invasition in mass breast tissue. My oncologist said I have to make the decision on what treatment to have since only 1% of breast have this type of senerio of cancer. He said Herceptin will not help this senerio of cancer even though the fisch lab report suggested the use of Herceptin. If I opt for Chemo and ask for Herceptin to be would this be a benefit for less of a re-occurance rate? Or do you think I am safe with just Chemo and radiation?
I am seeking a second opinion but it will take weeks for another dr. appointment.
Please help, I need answers.
Thank you, Teresa j

Oh my goodness, PLEASE get a second opinion as this is EXACTLY what Herceptin is for. I'm er/pr-, her2neu 2+, stage 1, grade 3, no nodes. My doctor doesn't want to give me herceptin as I am on the weak side and is concerned about the long term affects of the heart not to mention MY FISH said to NOT use my FISH test as a main source of treatment so he is treating me with TEC (taxotere, epirubicin and cytoxin) but, I'm still taking my 1 tbs of olive oil every day and when I am done will be continuing with my Diane Dyer Breast Cancer Diet. If your FISH is recommending Herceptin, push for it.

Teresa

It sounds slightly odd advice if the path lab went so far as to suggest Herceptin. I suppose it depends upon the degree to which you are HER2/Neu positive. This is usually expressed as a series of '+' signs (+, ++ or +++). As I understand it, the greater the HER2 positivity, the more likely you are to benefit from Herceptin. Although even within the HER2+++ category, a significant proportion experience no or only partial benefit.

Having said that, the evidence seems to suggest that the earlier (by that I mean early in terms of stages of cancer invasion) you get Herceptin, the greater the relative benefit. Hence the adjuvant trials where the ability of Herceptin (particualry when combined with Taxol or Taxotere) to prevent recurrence in early stage patients looks a lot more significant than its ability (although still good) to completely reverse the progression of solid tumours of a more advanced stage.

My wife is Her2+++ and pr/er negative. She has been on Herceptin for 11 months.

It could be that given your tumour type, size, grade, location and confidence in surgical clearance etc, your onc considers you to be in such a low risk category for recurrence that he/she believes that further treatment is unecessary. Although having recommended chemo and radiation, I assume they recognise some risk.

If you are relatively healthy, Herceptin seems to have few side effects apart from a low risk of heart problems which are usually monitored with enthusiasm. On that basis you've got more to possibly gain than lose. A second opinion is well worth seeking.

As they say. An ounce of prevention is worth a pound of cure.

John

Only 1%? I'm her2+++ and was told 25% of us are her2, so I don't quite understand your physician's percentage. That doesn't seem correct. Why does he think the herceptin won't work with your scenario? Because, of no node involvement? If you're being given the option of chemo, I would vote for including the herceptin.

20-25% are her2positive, depending on the test utilized.Supposedly 10% of those are er and pr positive. Are you sure you have the path report right?

Did you have an area of DCIS? Does the 3mm refer to the size of the tumor or the size of the area of involved margin resected at the time of partial mastectomy?

If 3mm is the only size of the tumor, and no other area of DCIS, he/she may mean that you caught it so early that you represent 1% of all breast cancers by size.

Chemo plus herceptin works specifically for her2positive( by FISH) er and pr negative tumors.

Noone yet knows what works best for the 2% of all breast tumors that are her2positive and also er/pr positive, although we hope some info at the ASCO meeting might give us an idea.

Normally chemotherapy works best in er/pr negative tumors.

You can get a second opinion, usually for less than $250 on your pathology, as not all hospitals do the tests for her2 equally well.

Where do you live?

Hope this helps!

Teresa
I was Her2 +++, ER-, PR-, 7mm tumor, neg nodes 3 yrs ago, when Herceptin was not offered to stage 1! A year and a half later I had a recurrance and I am now Stage IV and on herceptin....wish I could have gotten it earlier. Push for it, it can only improve your odds at beating this.

hugs

Sheila

[penelope]

Al...
What type of markers would you suggest be done on someone who is fiagnosed early. I see lots of info on Pten and such but have no idea what I should ask for.

Rina and I are very similar and turns out are getting the same treatment plan so there is some comfort in that, but I wonder is there more we can do? Are there other markers that we should have done?

[astrid]

Check your pathology report. My tumor was 2+ with an IHC or immunohistochemistry. My FISH test was 3.4. I am ER+, PR+. Most Her2+ BC are ER-. So triple + (ER+, PR+ and HER2+) is only 15% of all BCs. If your FISH and IHC are only 2+ this is borderline and Herceptin may not have any benefits.

[RobinP]

The treatment of her2+ small invasive bc is controversial but here is what Dr. Slamon and others say about it:

http://www.breastcancerupdate.com/NS...ussion.htm#Top