Friend newly DX Er/pr+,Her2+ less than 1 cm.

[Soccermom]

Nodal status unknown..yet. Excisional biopsy in April.
Was told she'll be doing chemo and Herceptin along w / Tamox/AI

Anyone else have different experience as a stage 1 ? I've fit no idea what current standard of treatment is for Stage 1 and would like to be able to be more knowledgeable when we speak later today.

Thanks Her2sister!
Marcia

[suzan w]

You can see by my stats that your friend is on the right path!

[chekmark]

Ditto, same for me. I think it is the standard of care. Good luck to your friend.

[Laurel]

It's still the triple whammy for us until they feel safe dropping the chemo.

[Soccermom]

So TCH it is.. Does anyone ever substitute Taxotere for Taxol and I'm assuming the C is either Cytoxan or is it Carboplatin?
Forgot to ask if she's had Oncotype..

I hate this for her!

Thanks again!
Marcia

[lasarles]

I hate this for her also! You can see in my signature similar dx as your friend and my treatment. TCH for me was Docetaxel, Carboplatin and Herceptin.

[Jackie07]

Not sure if this will help:

National Cancer Institute
Breast Cancer PDQ (Last Modified: 02/08/2013)
Stage I, II, IIIA, and Operable IIIC Breast Cancer

HER2-directed therapies

In HER2-overexpressed disease, pilot studies have demonstrated remarkable clinical and pathologic responses when trastuzumab is given preoperatively in combination with chemotherapy.[218] A randomized study in patients with HER2-positive locally advanced or inflammatory breast cancers confirmed that the addition of neoadjuvant and adjuvant trastuzumab to neoadjuvant chemotherapy with sequential doxorubicin plus paclitaxel followed by CMF resulted not only in improved clinical responses (87% vs. 74%) and pathologic responses (38% vs. 19%) but also in the primary outcome: event-free survival (EFS).[219] This was defined as the time from random assignment to disease recurrence or progression—whether local, regional, distant, or contralateral—or death from any cause.

At 3 years, of all of the patients, 71% (95% CI, 61–78) showed improvement in EFS with trastuzumab versus 56% without trastuzumab (95% CI, 46–65), HR, 0.59 (95% CI, 0.38–0.90, P = .013), thereby favoring the addition of trastuzumab. The 3-year OS was 87% versus 79% at the time of the report (P = .114, not significant). Symptomatic cardiac failure developed in two patients receiving concurrent doxorubicin and trastuzumab for two cycles. Close cardiac monitoring of left ventricular ejection fraction (LVEF) and the total dose of doxorubicin not exceeding 180 mg/m2 accounted for the relatively low number of declines in LVEF and only two cardiac events. (See the Cardiac toxic effects with adjuvant trastuzumab section in this summary.)[219][Level of evidence: 1iiD]

The role of lapatinib in the neoadjuvant setting was examined in the GeparQuinto [NCT00567554] trial.[220] This phase III trial randomly assigned women with HER2-positive early stage breast cancer to receive chemotherapy with trastuzumab versus chemotherapy with lapatinib with pathologic complete response (pCR) as the primary endpoint.[220][Level of Evidence: 1iiDiv] pCR in the chemotherapy and lapatinib arm was significantly lower than it was with chemotherapy and trastuzumab (22.7% vs. 30.3%; P = .04). Other endpoints of DFS, relapse-free survival (RFS), and OS have not been reported. The results do not support the use of single-agent lapatinib with chemotherapy in the neoadjuvant setting.

Neoadjuvant therapy with dual HER2 inhibition was studied in the NeoALTTO [NCT00553358] trial.[221][Level of evidence: 1iiDiv] This phase III trial randomly assigned 455 women with HER2-positive early stage breast cancer (tumor size >2 cm) to receive neoadjuvant lapatinib compared with neoadjuvant trastuzumab compared with neoadjuvant lapatinib plus trastuzumab. This anti-HER2 therapy was given alone for 6 weeks and then weekly paclitaxel was added to the regimen for an additional 12 weeks for all enrolled patients. The primary endpoint of this study was pCR. pCR was significantly higher in the lapatinib plus trastuzumab combination arm (51.3%; 95% CI, 43.1–59.5) than in the trastuzumab alone arm (29.5%; 95% CI, 22.4–37.5). No significant difference in pCR was seen between the lapatinib (24.7%, 95% CI, 18.1–32.3) and trastuzumab groups (difference -4.8%, -17.6–8.2; P = -.34).

It is important to note that DFS, RFS, and OS have not been reported in this trial. pCR rates, while hypothesis-generating, do not substitute for these other efficacy endpoints. Nevertheless, the results suggest that dual inhibition of HER2 by a monoclonal antibody and a tyrosine kinase should be further explored for patients with early stage HER2-positive breast cancer. Confirmatory results from the similarly designed, ongoing, CALGB-40601 (NCT00770809) trial are pending. More definitive efficacy data will be provided by the phase III ALLTO trial that is randomly assigning women to trastuzumab or trastuzumab plus lapatinib in the adjuvant setting.

http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/page6#Section_519

[Soccermom]

Thanks everyone! My friend is handling this news incredibly well at this point.She amazes me
Her Mom was just re diagnosed the same week with a second primary bc 1 year after her initial diagnosis ..and her brother is battling stage 4 melanoma..no pity parties in that family they're all making snarky jokes about their "messed up genes"!

Thx again

[Debbie L.]

Marcia, I think it's probably the same treatment choices regardless (of stage) for most HER2+ cancer, unless she would like to explore clinical trials.

But . . . if she doesn't know nodal status, she doesn't (yet) know what stage the cancer is.

The NCCN guidelines aren't a bad place to begin looking at standard-of-care choices:

http://www.nccn.org/professionals/ph...lines.asp#site

(to go farther than the link above, choosing "breast cancer", requires me to log in, so I stopped at that link. I don't think the internet police will come after you if you say you're a medical professional to get in -- or you could choose "patient guidelines" and see if that's enough information)

Debbie Laxague

[Soccermom]

Thanks Debbie! Will check it out.
Marcia