Are we being aggressive enough?

[BonnieR]

I received 3 opinions before deciding on my treatment. One of the oncologist recommended TCH "without the C"! He thought it was the more difficult of the trio and, as you say, would not be adding much. So that is not unheard of in this situation. I ended up taking all 3 and was okay with it. But I totally identify with her anxiety and dread. Big scary decisions are being made. But trust the process and keep the faith.

[Debbie L.]

First, there are not good answers right now to the questions about stage I HER2+ cancers, especially ERPR positive ones. But there are some answers.

Second, while I am fascinated by Adjuvant!, it doesn't address HER2+ cancer. It does not include this important factor in prognosis (although there's a reference page that says it may be about 1.5 relative risk increase). More importantly perhaps, it doesn't include Herceptin in treatment options. So without those two critical pieces of predictive and prognostic information, it's essentially worthless for HER2+ use (imho). I do not blame Peter Ravdin for this - he's waiting for enough information to become available to include HER2. Right now, even his Genomic version of Adjuvant! is unavailable (undergoing revision) so we can't use it and include your wife's oncotypeDX score, either.

So about carboplatin - if you google carboplatin her2 breast cancer, you'll get quite a few hits. Most are studies of advanced bc but the basic principle (carboplatin seems to add some benefit) is still applicable. There are some adjuvant studies (same google, add word "adjuvant") but all the ones that I found were pay-per-view. Here's a few of the advanced bc ones:

http://theoncologist.alphamedpress.o...stract/9/5/518

http://www.medscape.com/viewarticle/446899

You'd probably like to know exactly how much absolute benefit carboplatin might add. I think that's the question to ask the provider who recommended TCH and also the one who does not use carboplatin. You are entitled to know more than just "we like this one better". We'll hope that their information is similar and your wife can make her choice based on the best information that is available.

Good luck, keep us posted.

Debbie Laxague