tamoxifen and herceptin

[panicked911]

Hi:

I am 43 and just had a lumpectomy for multifocal BC on the right side. Both tumors were very small 1.2 no nodes, clean margins and no vascular invasion - thus early stage I. I am both estrogen (80 %) and progesterone (70%) as well as Hers 2 3 plus. I am being treated at a major cancer center in New York.
AS i am still recovering from surgery (2 1/2 weeks post op) - went to the sugeon last week and she gave me tomaxifen to start and then i see the oncologist on Nov. 14 at which time I will most likely be put on herceptin. I am wondering if anyone has gone down the Tamoxefen/ herceptain route. I realize not may people had acess to herceptain at my stage but any adice anyone can give would be greatly appreciated as I am still very new to this and have a huge amoutn to learn.

thanks,
Susanne

[BonnieT]

HI
I am 41 and started at stage 1 back in 2002 had a bilateral mastectomy since my mom died from BC, then chest wall recurrance , and chemo. and radiation 2004. I am now on tomaxifen and herceptin.
I started Tomaxifen after chemo. I couldn't get on herceptin until last summer.
I started herceptin every 3 weeks, but my MUGA ( heart scan) dropped. If you haven't had a MUGA you should before you start herceptin, and then get checked again to make sure you don't have any cardiac effects from the herceptin.I get checked every 2 months and I am now taking a smaller dose every week. I also see a cardiologist who put me on heart meds for now. BUT there are alot more people on herceptin that don't have any heart problems. But you should be monitered for that.
I hope this makes sense , I feel like I am rambling on !!!!!!
Tomaxifen is because you are estrogen/progesterone positive
Herceptin is for the her2 positive
God Bless
BonnieT

Susanne:

Are you premenopausal? If so, this is why you are on Tamoxifen. Your ovaries are still producing estrogen so the aromatase inhibitors wouldn't work for you. This may be appropriate regardless as you are not at high risk with small tumors and no nodal involvement. There is some question if the addition of Herceptin restores sensitivity to Tamoxifen in Her2 cancers. Just curious, are you at sloan-Kettering in New York?

Scott

[panicked911]

Hi Scott:

yes I am being treated at Sloan Kettering - why? I was originally diagnosised at a local "regional cancer center" in Westchester County and the "top notch" surgeon completely missed the second tumor and the pathology was "wrong" - luckily I was able to get into MSK very quickly and the surgeon was everything that I could have hoped for and more - its the follow up with the oncologist that has bee somewhat disappointing. hence these questions - Surgeon put me on tamoxefen (20mg) and will see oncologist on 11/14 that will be more than 6 weeks after surgery.
I am in the process of "oncologist shopping" and my a make a trip to dana Farber in Boston for a consult. Found a protocol on the web by harold burstein that calls for tamoxifen, ovary surpression ( chemically ) b/c I am pre menapausal - I am also awaiting the results of my onco type test. I can' do chemo safely and I am not covinced that I need it. Hence .......
Any advice you can give would be greatly appreicated.
Susanne

Hi Susanne:

I was just curious if you went to Sloan-Kettering because we went there for a consultation with Dr. Hudis who is their hot shot breast oncologist. He is pretty good and tells it like it is. You may want to give him a try before going to Dana Farber where we currently go. He was in favor of doing A.I.'s over the Tamoxifen though, but our situation was also a little more serious as we had nodal involvement. There are some other factors like osteoporosis vs. chance of recurrence you need to consider when chosing Tamoxifen over an A.I. I'd be curious as to what he says in your situation about combining Herceptin and Tamoxifen. Also, I had a follow-up question and put a call into him. He returned my call within ten minutes and was very thorough with me on the phone, which is more than I can say about some of the other oncologists I have spoken with.

Scott

[panicked911]

I have an appt with maura dickler who is supposedly an "expert" with early stage and run the trials hence herceptain - How has your experiencebeen with dana farber ? the only reason i am thinking of consulting up there is b/c there approach is slightly less ultra conservative than MSK - They are not automatically chemo if over 1 cent. I am now in the process of "oncologist shopping" i livein westchester county NY and ultimately the tewtmt will be done here - what I am searching for is the proper "plan" as i am clearly in the very early stages and are determined not to lt it progress from here- the trick is to do that w/out further "damaging" my neuro and immune system ---what was your situation adn how many oncologuists did you se before lading a dana farber?

Susanne:

We saw about 5 oncologists between Rhode Island and Dana Farber. Unlike the surgery which is pretty straight forward, oncology is more art than science. There were some differences in opinions, but it furthered our knowledge and helped make the right decision for us. So I say the more oncologists you see the better. It is probably a good idea to have your surgery pathology reviewed by another center like Dana Farber anyway for confirmation because it is critical in determining the optimum treatment.
If you're going to D.F., Larry Shulman or Eric Weiner are the guys to see.

Good luck,

Scott

I had a lumpectomy on Oct. 12. The margins were clear and nodes were clear. My cancer was diagnosed as HER2, Estrogen sensitive.
My oncologist has suggested that I should begin with 8 weeks of chemo, every 2 weeks; then 6 weeks of radiation therapy and 1 year of Herceptin; followed by 5 years of Arimidax.
She said that Arimidax is preferable to Tamoxifen because I am post menopausal.
I find all of this overwhelming. Is this standard procedure or are there feasible alternatives?
My oncologist said there is no data for the effectiveness of Herceptin without chemo.
Has anyone taken Herceptin without the chemo?

I haven't begun treatment yet and am tring to work out what I should do.

Makini

[Susan]

Hi:

I am also Stage I, grade 3, er +, her2+, and had a lumpectomy. I had 4 rounds of AC chemo. I had the oncotype test and it came back in the high risk. I finished chemo on Sept 7, and I have 2 more weeks of radiation left. I was premeno before all this started (I"m 47). I'm going to start herceptin on nov. 30, every 3 weeks. They are going to put me on faslodex for the hormone therapy. My oncologist said this works better with the her2+ status. I guess it'll be given once a month by injection. Good Luck to you

[panicked911]

There is no easy answer to your question - most of the research shows that for node negative, stage 1 - with strong er + and/or pr+ can either do chemo w/ herceptain or treat it hormonally by ablating the ovaries and then using either arimidex or one of the other anti estrogen drugs. The studies eve with Her2 factored in comes out close to equal.

After speaking with numerous oncs ay major cancer institutions, I have decided to do the ovary ablation, arimidex and adjuvent herceptain w/out chemo. There are currently studies underway to determine in node negative women whether chemo is right. they are not sure if the "chemo" works b/c it shuts down the ovaries anyway or b/c of its own.

It is a really tough call. For me b/c I am strongly er and pr+ I have made my choice. Its is scary no matter how you look at it. As my oncologist said no matter what we do there is no guarantee this willnot come back, you could do nothing and it could not come back, or we could hit it with everythign and it could come back.

I statred tamoxifen on oct. 19 and have already noticed a huge chnage in by breasts. Docs were really surprised how fast it worked - but still not enough for my comfort level.

Hope this helps

[suzan w]

My oncologist (in Seattle) strongly recommended chemo before herceptin. I was dx'd 5/05...invasive lobular...bilateral mast. in June...small tumor (7mm) in left breast...node neg, ER/PR+, Her2+ all scans neg. Then did oncotype dx test-high intermediate risk for recurrence. That is why onc. recommended chemo. I did 4 rounds of A/C and am now on herceptin/3 week intervals and arimidex (post menopausal) for 5 years. Am worried about the bone loss...and am going to see a Naturopath next week. Good luck with your decision!

[Michelle]

Susanne,
We have a very similar dx, except my tumor was 1.9 cm. I did chemo first. I also opted to add taxol after Ac, herceptin, and then rads. I was diagnosed in March and will be starting tamoxifen in two weeks. My onc. does not want to do an ooph, because I'am 35. I don't really understand that reasoning as many women this age have it done. He wants to stick with tamoxifen , because he says the aromatose inhibitors cause bone loss. There is evidence that the aromatose inhibitors may work better with herceptin, and you can do lupron shots to take those if you are pre menopausal. I have tried to research the facts, but need more info myself-Best wishes to you-
Michelle