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Old 06-24-2015, 01:17 PM   #1
Lani
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Thumbs up THE ABSOLUTE LATEST stats 4 her2+ tumors<2cm ER+,ER-, node+ node- with/without vitamH

"vitamin H" short for herceptin

this metaanalysis combined randomized adjuvant Herceptin trials to get these stats

not sure I agree with the last sentence--depends what thet call less agressive treatment ER+ her2+ tumors and < or= 1 node may need additional targetted treatment rather than less "agressive" treatment altogether

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J Clin Oncol. 2015 Jun 22. pii: JCO.2015.60.8620. [Epub ahead of print]
Efficacy of Adjuvant Trastuzumab for Patients With Human Epidermal Growth Factor Receptor 2-Positive Early Breast Cancer and Tumors ≤ 2 cm: A Meta-Analysis of the Randomized Trastuzumab Trials.
O'Sullivan CC1, Bradbury I2, Campbell C2, Spielmann M2, Perez EA2, Joensuu H2, Costantino JP2, Delaloge S2, Rastogi P2, Zardavas D2, Ballman KV2, Holmes E2, de Azambuja E2, Piccart-Gebhart M2, Zujewski JA2, Gelber RD2.

Abstract

PURPOSE:
We compared efficacy of trastuzumab versus no trastuzumab in patients with small (≤ 2 cm) human epidermal growth factor receptor 2 (HER2) -positive breast cancer treated in randomized trials.

METHODS:
A meta-analysis was conducted using data from five of the six adjuvant trastuzumab trials. Efficacy end points were disease-free survival (DFS) and overall survival (OS). Separate analyses were prospectively planned for hormone receptor (HR) -positive and HR-negative cohorts. Random effect models and Yusuf-Peto fixed effects models assessed the impact of heterogeneity on baseline hazards and treatment effects across studies. Peto-Pike cumulative incidence estimates were stratified by study and nodal status.
RESULTS:
Median follow-up time was 8 years. For 2,263 patients with HR-positive disease, 8-year cumulative incidence rates comparing trastuzumab versus no trastuzumab were 17.3% versus 24.3% (P < .001) for DFS and 7.8% versus 11.6% (P = .005) for OS, respectively; for 1,092 HR-positive patients with zero or one positive lymph nodes, results were 12.7% versus 19.4% (P = .005) for DFS and 5.3% versus 7.4% (P = .12) for OS, respectively. For 1,957 patients with HR-negative disease, 8-year cumulative incidence rates were 24.0% versus 33.4% (P < .001) for DFS and 12.4% versus 21.2% (P < .001) for OS, respectively; for 1,040 HR-negative patients with zero or one positive lymph nodes, results were 20.4% versus 26.3% (P = .05) for DFS and 8.2% versus 12.2% (P = .084) for OS, respectively.
CONCLUSION:
Women with HER2-positive tumors ≤ 2 cm in the randomized trastuzumab trials derived substantial DFS and OS benefit from adjuvant trastuzumab. Trastuzumab-treated patients with HR-positive disease and ≤ one positive lymph node may be candidates for trials assessing less aggressive treatment approaches.
2015 by American Society of Clinical Oncology.
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Old 06-24-2015, 02:44 PM   #2
LeahM
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Re: THE ABSOLUTE LATEST stats 4 her2+ tumors<2cm ER+,ER-, node+ node- with/without vi

Does this mean my 8mm tumor 1 pos node would NOT need H or am I reading this wrong?
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39 year old wife, mother of one and nurse.
April 20, 2012: Dx Invasive Ductal Carcinoma
April 25, 2012: ER+(5%), PR-, HER2+++
May 10, 2012: BRCA 1,2 Negative
May 23, 2012: MUGA Scan EF 70%
May 31, 2012: B/L Mastectomy. 2/2 nodes removed and CLEAR!! Power Port placed. 2 Drains. 2 Expanders placed
June 5, 2012: Drains OUT! Ahhhh..
June 12, 2012: Final Pathology Report, .8x.3cm tumor. Micromets to 1 node .35mm under cytokeratin staining. Stage 2A. Onc says "you are lucky to have found this early"
July 10, 2012: Started 6 rounds of TCH with weekly H
Sept 5, 2012: MUGA 65%
Sept 20, 2012: CAT scan of brain clear!
Oct 23, 2012: LAST TC! AMEN! Continue Herceptin every three weeks until July 2013.
Nov 19, 2012: Port out!
Dec 5, 2012: Started radiation
Dec. 10, 2012: MUGA 65%
Dec. 13, 2012: Turned 40. BEST BIRTHDAY EVER!
Jan 23, 2013: Last radiation. Told I am NED. Continue Herceptin every three weeks till July 2013.
Jan 29, 2013: Begin 5 years of Tamoxifen.
Feb 28, 2013: CT Scan with Contrast of lungs. 5mm and 4mm nodules of unknown origin. Rescan in 3 months.
Mar 6, 2013: EF 60%
May 8, 2013: Exanders out, implants implanted...abd. lipo and fat moved up. Girls are looking good!
June 3, 2013: CT Scan with Contrast of lungs. Previous nodules gone. New nodules (2mm and 3mm) found. Rescan in 3 months. So sorry I opened this can of worms...
June 11, 2013: EF 60%
June 25, 2013: Last Herceptin. wow...
Aug 20, 2013: Tumor markers within normal limits. Xray to sore left ribs shows no disease or fractures.
Sept 9, 2013: CT of lungs shows no disease. Closing this can of worms and moving on.
Nov 20, 2013: Tumor markers within normal limits. Severe Vit D deficiency, started on prescription Vit. D. Blaming chemo for this.
Feb 2014: Tumor markers within normal limits.
May 2014: Tumor markers within normal limits. Graduated to twice yearly onc appts.
Oct 2014: Tumor markers within normal limits.
May 2015: Tumor markers WNL. Bone density scan fine. Bone scan and xray of ribs shows "something" 4th right rib. Could be healed fracture but if it is healed why does it hurt?
Nov 2015: Tumor markers WNL. Follow up bone scan clear.
Feb 2016: Syncope! WTF? Dizzy too. Brain scan clear, ECHO EF 60%, Halter Monitor shows heart is fine. Viral? I will never know.
June 2016: Tumor markers WNL.
Oct 2016: Stabbing pain right eye. Long story short, trigeminal neuralgia.
Nov 2016 Brain MRI clear.
Jan 2017: Tumor markers WNL, still getting weird pain right rib area, and sometimes right upper chest. Xray x2, Bone Scan, Breast MRI all clear. Scar tissue? Rads. I may never know.
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Old 06-24-2015, 04:44 PM   #3
hestko76
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Re: THE ABSOLUTE LATEST stats 4 her2+ tumors<2cm ER+,ER-, node+ node- with/without vi

The way I read the conclusion makes you right...... ">" with a "-" under means less than or equal to. Since my tumor was less than 1 cm, no positive nodes, and I was ER- , I would receive Herceptin. Interesting outcome.....
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dx 10-31-11
Stage 1 Grade 3 (7mm tumor)
Lumpectomy 11-18-11
Er- Pr- Her2+++
0/5 nodes - no positive lymph nodes
Port installed 1-6-12
6 Rounds TCH
Rad. 33 tx
Last herceptin 12-10-12
Port removed 1-3-13
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Old 06-25-2015, 02:28 PM   #4
Lien
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Re: THE ABSOLUTE LATEST stats 4 her2+ tumors<2cm ER+,ER-, node+ node- with/without vi

I'm 11 years and 6 months out from diagnosis, never had Herceptin, because it was not yet available in my country for people with such small tumors. I had hormonal tx though. So far no recurrences.

So for those who didn't get Vit H and worry about it: there's a small benefit, but there's still a good chance that you will do fine without it.

Having said that, I think people should have a choice. My doc said that I was lucky that I didn't qualify, because I might have developed heart problems unnecessarily. But if it had been available, I probably would have opted to try it.

Jacqueline
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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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