Advice Needed from Propeller Heads

[Tom]

Dear Friends at HER2Support,

I have been asked by my earlier mentioned friend to make a very important decision for her, and I must admit I am feeling a little weak in the knees about it.

As I may not have mentioned in the original post, she is contemplating enrolling in a clinical trial using a vaccine that has already shown promise in sensitizing the immune system to attack HER2+ BC cells. She needs to make this decision before she has her surgery. Now here comes the rub. It turns out that she had a prior lumpectomy four years ago for DCIS that was HER2+(+3)ER-/PR-, and the usual course of radiation therapy. Now she has a new case of DCIS that is also HER2+(+3) ER-/PR- in the same breast.

Conventional wisdom would automatically suggest a mastectomy for that breast. However, it has been suggested that she might consider having a second lumpectomy on the same breast that was involved four years ago.

The vaccine was in fact designed to stop HER2+ DCIS in it's early stages and prevent it from recurring. The vaccine will be given for six weeks prior to surgery, whether she chooses lumpectomy or mastectomy. Additionally, SNB will be performed at the time of either surgery. No repeat radiotherapy will be given.

I guess you can all see my concern at not following the standard protocol for a recurrent DCIS. I just don't know what to advise her. It would be great if she didn't need to undergo the mastectomy, and had another lumpectomy instead. If she does choose the lumpectomy after the vaccine, she would need to have a mastectomy later if there is a recurrence. She has no particular fear of either surgery (she is a tough cookie) but doesn't want to have to go through another surgery later if she doesn't have to do so, as it would be "inconvenient" as she says with her own brand of cold calm reasoning.

So, what do I advise she do? Does she roll the dice and have a lumpectomy, or take no prisoners and have the whole breat removed? Again, the vaccine has shown great promise in preventing HER2+ DCIS recurrences. I suppose I could advise her to go ahead and get the vaccine course, and see what imaging shows right before the surgery. If there is a clear response, it would add just a little information to her decision. I hate to ask you guys to help me make the call for her, but I need to know relatively soon. Thanks again for your help.

Sweating like the pig that I am,
Tom