treatment of small her2+ tumors discussed in review article

[Lani]

free access

Ann Oncol. 2010 Jun 20. [Epub ahead of print]
Small HER2-positive, node-negative breast cancer: who should receive systemic adjuvant treatment?
Joerger M, Thürlimann B, Huober J.

Breast Center, Cantonal Hospital, St. Gallen, Switzerland.
Abstract
Adjuvant treatment of early-stage breast cancer with combined trastuzumab and chemotherapy has become standard in patients with HER2-positive tumors and a diameter of >1 cm or positive lymph nodes. Currently, there are no data directly supporting the use of adjuvant treatment, including trastuzumab, in patients with HER2-positive tumors, a diameter of </=1 cm and no nodal involvement (pT1a,bpN0M0). However, 6%-10% of these small tumors are HER2 positive, and there is good evidence for an inferior clinical outcome in these patients, with recurrence rates of up to 30% after 5-10 years. Assumed that the relative risk reduction is similar to larger tumors, the absolute benefit should be large enough to consider adjuvant treatment. This review addresses current data regarding the prognosis of small HER2-positive tumors and discusses potential factors to individualize adjuvant treatment in patients with small HER2-positive tumors.

PMID: 20566473

google entrez pubmed, go to it, fill in PMID # you see in the line above

[AlaskaAngel]

The one aspect that is left out in considering risk vs benefit with these studies:

http://www.oncolink.org/resources/ar...h=01&year=2002

"We're talking about subtle differences; we're not talking about impaired or disabled women. And we do not want to say that adjuvant agents are not worthwhile; they are life-saving and appropriate in many cases," Dr. Ganz told Reuters Health.
However, she added, for women with very small tumors (no more than 1 cm) who may not be at risk for recurrence, adjuvant therapy "may contribute to some subtle decline in functioning."
The issue she is most likely to counsel these patients about is poorer sexual functioning. "The patient at least needs be forewarned that this might happen."
J Natl Cancer Inst 2002;94:39-49.

[Carol.hope]

Also, some percentage (at least 15%, maybe more) will have long-term chemo brain injury, which is NOT a subtle change. It can change everything about your life. (ask me, I'm one of them!)

Let's hope for more and more "personalized" treatment - information on who will and who will not benefit from the heavy-hitters, and who will likely have the long-term side-effects.

Remember, if there is a "10% benefit," that means that 90% of people taking the drug do not benefit from it, but are still at risk of the side effects.

- Carol
Lyons, CO