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01-08-2010, 11:01 AM
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#1
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Senior Member
Join Date: Mar 2006
Posts: 4,778
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recommended reading for all newly (and formerly) diagnosed with T1a or b NO MO her2+
bc--has info in it I had not seen before in SABCS papers, etc
unfortunately not open access
Clin Adv Hematol Oncol. 2009 Sep;7(9):591-8.
HER2-neu positivity in patients with small and node-negative breast cancer (pT1a,b,N0,M0): a high risk group?
Chavez-MacGregor M, Gonzalez-Angulo AM.
Division of Cancer Medicine, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas, USA.
Human epidermal growth factor receptor 2 (HER2-neu) is an important prognostic factor associated with worsened disease-free survival and overall survival in breast cancer patients; however, the prognosis of T1a,b,N0,M0 HER2-neu positive breast cancer has not been clearly determined. Trastuzumab has become a critical component of the treatment of patients with HER2-neu positive tumors, but the effect of treatment in patients with small tumors and node-negative disease has not been evaluated in clinical trials. Current guidelines have category 3 recommendations to consider the use of adjuvant trastuzumab in women with node-negative tumors that are 0.6-1.0 cm, and state that physicians should balance the risks associated with the known trastuzumab toxicities and the uncertain benefits that may exist with such therapy in this group of patients. The available data regarding the prognosis of patients with T1a,b,N0,M0 HER2-neu positive breast cancer is very limited. The purpose of this manuscript is to review the available literature in order to evaluate whether this group of patients represents a high risk group. Retrospective studies suggest that HER2-neu status is a powerful independent prognostic factor in T1a,b node-negative breast cancer. We believe that prospective studies and randomized clinical trials are strongly needed to clearly assess the impact of HER2-neu positivity in node-negative and subcentimeter tumors, and to determine if this group of patients can benefit from adjuvant trastuzumab treatment.
PMID: 20020671
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01-08-2010, 04:49 PM
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#2
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Senior Member
Join Date: May 2008
Location: Hershey, PA. Live The Sweet Life!
Posts: 2,005
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Re: recommended reading for all newly (and formerly) diagnosed with T1a or b NO MO he
Well, duh.....I mean why not see if what you are recommending is effective? Bad for business if it isn't....and for us.
__________________
Smile On!
Laurel
Dx'd w/multifocal DCIS/IDS 3/08
7mm invasive component
Partial mast. 5/08
Stage 1b, ER 80%, PR 90%, HER-2 6.9 on FISH
0/5 nodes
4 AC, 4 TH finished 9/08
Herceptin every 3 weeks. Finished 7/09
Tamoxifen 10/08. Switched to Femara 8/09
Bilat SPM w/reconstruction 10/08
Clinical Trial w/Clondronate 12/08
Stopped Clondronate--too hard on my gizzard!
Switched back to Tamoxifen due to tendon pain from Femara
15 Years NED
I think I just might hang around awhile....
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01-09-2010, 01:09 AM
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#3
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Senior Member
Join Date: Apr 2006
Posts: 148
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Re: recommended reading for all newly (and formerly) diagnosed with T1a or b NO MO he
I fulfilled this criteria, receiving neither chemo nor herceptin - just surgery, rads and tamoxifen.
Additionally, I take daily flaxseed, and like to think this contributes to my NED status, four years down the line.
Mcgle (UK)
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01-10-2010, 01:05 AM
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#4
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Senior Member
Join Date: Apr 2006
Posts: 148
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Re: recommended reading for all newly (and formerly) diagnosed with T1a or b NO MO he
Am I the only one? Definitely FISH positive.
Mcgle (UK)
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01-10-2010, 12:03 PM
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#5
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Senior Member
Join Date: Mar 2009
Posts: 126
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Re: recommended reading for all newly (and formerly) diagnosed with T1a or b NO MO he
I was a t1c (1.3)but I thought that MDA did a study on smaller her2+ tumors ??
__________________
Diag. 12/24/08-
IDC 1.3 er-/pr- HER2+
Grade 3 0/2 lymph nodes
no angiolympathic invasion
Bi-Lat. Mast. 1/8/09
Exchange scheduled for 6/17/09
Lost implants due to unknown reason :(
Hip Flap 1/26/2010 in NOLA :) LOVE EM'
TCH x6 (6 done and I am hoping to never do it again )
Well so much for never...
Local recurrence May 25,2014 is left over breast tissue.
April 2 , 2014 lumpectomy
April 28, 2014- June 9, 2014 start AC x 4
Taxol x12
Perjeta x 6
Herceptin x 18
And 33 rads just for fun. NOT!!!
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01-10-2010, 05:02 PM
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#6
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Senior Member
Join Date: May 2008
Location: Hershey, PA. Live The Sweet Life!
Posts: 2,005
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Re: recommended reading for all newly (and formerly) diagnosed with T1a or b NO MO he
Mcgle (UK),
You are definitely not alone (plz see my signature). I would love to see new stats on the validity of chemo and Herceptin for Stage 1 folks like us. Is it worth the agony vs benefit? I will be awaiting the answer.
__________________
Smile On!
Laurel
Dx'd w/multifocal DCIS/IDS 3/08
7mm invasive component
Partial mast. 5/08
Stage 1b, ER 80%, PR 90%, HER-2 6.9 on FISH
0/5 nodes
4 AC, 4 TH finished 9/08
Herceptin every 3 weeks. Finished 7/09
Tamoxifen 10/08. Switched to Femara 8/09
Bilat SPM w/reconstruction 10/08
Clinical Trial w/Clondronate 12/08
Stopped Clondronate--too hard on my gizzard!
Switched back to Tamoxifen due to tendon pain from Femara
15 Years NED
I think I just might hang around awhile....
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01-10-2010, 11:35 PM
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#7
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Senior Member
Join Date: Apr 2006
Posts: 148
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Re: recommended reading for all newly (and formerly) diagnosed with T1a or b NO MO he
Laurel
Four years ago, I had extreme reservations about my treatment plan; now - I think it was right.
No one wants to go through chemo / herceptin unnecessarily.
Thanks for your response.
Mcgle (UK)
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01-11-2010, 12:34 AM
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#8
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Senior Member
Join Date: May 2006
Location: Haarlem, the Netherlands
Posts: 835
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Re: recommended reading for all newly (and formerly) diagnosed with T1a or b NO MO he
Me too! I did 5 yrs of Zoladex/Arimidex and am currently NED. Down to once a year checkups. Hope Ned stays with me for as long as I live!
My doc said that he sees quite serious side effects and would still hesitate to prescribe H. for me.
Jacqueline
__________________
Diagnosed age 44, January 2004, 0.7 cm IDC & DCIS. Stage 1, grade 3, ER/PR pos. HER2 pos. clear margins, no nodes. SNB. 35 rads. On Zoladex and Armidex since Dec. 2004. Stopped Zoladex/Arimidex sept 2009 Still taking mistletoe shots (CAM therapy) Doing fine.
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01-11-2010, 06:10 AM
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#9
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Senior Member
Join Date: May 2008
Location: Hershey, PA. Live The Sweet Life!
Posts: 2,005
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Re: recommended reading for all newly (and formerly) diagnosed with T1a or b NO MO he
As you can see from my signature, I chose to go the most aggressive route out there which is the ACTH. Nasty stuff all of it! I think studies are absolutely necessary for women to make a truly informed decision. When I had to decide I looked at the stats and chose to toe up to the line and be poisoned 8 times. If I were to discover that it provided very little or no benefit in terms of overall survival, I doubt that I would chose that course a second time. However, you must live with what you knew at the moment you are confronted with the decision. I have no intention of beating up myself or the medical community that promoted the treatment. I do, however, firmly believe studies with stage 1 Her2s need to be compiled quickly to resolve the nagging question of treatment efficacy. Should we find a substantial benefit than so be it, continue the treatment recommendation. I have noted several stage 1 gals on this site who did not receive Herceptin and advanced to stage iv. It may be purely anecdotal, but still it gives me pause. This risk to progress is definitely present, just how much chemo & Herceptin mitigate the risk is unproven as yet.
__________________
Smile On!
Laurel
Dx'd w/multifocal DCIS/IDS 3/08
7mm invasive component
Partial mast. 5/08
Stage 1b, ER 80%, PR 90%, HER-2 6.9 on FISH
0/5 nodes
4 AC, 4 TH finished 9/08
Herceptin every 3 weeks. Finished 7/09
Tamoxifen 10/08. Switched to Femara 8/09
Bilat SPM w/reconstruction 10/08
Clinical Trial w/Clondronate 12/08
Stopped Clondronate--too hard on my gizzard!
Switched back to Tamoxifen due to tendon pain from Femara
15 Years NED
I think I just might hang around awhile....
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01-11-2010, 12:58 PM
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#10
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Senior Member
Join Date: Apr 2006
Location: Wilmington, Del.
Posts: 1,126
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Re: recommended reading for all newly (and formerly) diagnosed with T1a or b NO MO he
I was T1b and was aggressive. My oncotype score was high.
__________________
MJO
IDC, Stage I, Grade 2
Oncotype DX Score 32
Her2++ E+P+, Node Neg.
Lumpectomy 11/04/05 Clear Margins
3 Dose dense AC (Couldn't tolerate 4)
4 Dose dense Taxol & Herc. (Tolerated well)
36 weeks Herceptin (Could not complete one year due to decrease in MUGA score)
2 years of Arimidex, then three years of Femara
Finished Femara May 2011
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