HER2+ and no chemo for early stage?
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SpecialK,
Strictly as single-anecdotal observation, in considering the question of whether the Adriamycin is the issue or whether it is the trastuzumab that is the issue, or whether it is both that is the issue in terms of cardiac results, in my own individual experience I was supported by my PCP and insurance in obtaining an echocardiogram as a patient at 10 years out (diagnosed at age 51) who was treated with CAFx6 in 2002 -- but having had no trastuzumab, and no other chronic disease. My echo result was 70. The substitution of a regimen that either does not include an anthracycline OR does not include trastuzumab is considered "safer".
Edited to add: Also, my echo following treatment when measured 4 years later in 2006 was just under 50.
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Just spent the last hour searching and really can't find any significant trial results for FEC-TH except that it was used instead of AC-TH to reduce any heart risk. Most of the results I found for node negative suggested TCH was better. If anyone can find a trial saying FEC has better results please do.
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i was just diagnosed with HER2 ER/PR yesterday - my oncologist said if i didnt have that i would not have to do the chemo was so hoping for that- i had my right breast removed on April 28th - i have to do Chemo once every 3 weeks for 3 mths then Taxol 3 months weekly and then Herceptin weekly. My question to anyone who has already gone thru this how sick did you get- i want to go back to work and i want to know if you think i will be able to work-
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I didn't work, but some others did - I was lucky as I have income protection insurance. I remember not feeling too good for 2 weeks out of the 3. Once on Herceptin alone it was fine and I was back at work part time during that.
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Deciding what is the "best" choice out of choices where none are a certainty is where it gets emotionally, financially, and physically extremiely difficult. What is a no-brainer for some is not the same circumstances for others.
Herceptin works just about 50% of the time, and when it does, resistance often develops in a year or two. (I think that probably refers to those diagnosed among all stages.) Chemo works somewhere between 1/3 and 1/4 of the time. Going through all of the discomfort involved and any resulting SE's, and selling a house to do it could mean ending up without the house AND dealing with recurrence. Doing it with those odds would drive anyone up the wall.
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If your health is generally good and you can take good care of yourself ricanbabe, it won't be fun but it is possible. I was self-employed and had no choice, and I only had a workday or so off once or twice. I didn't have to deal with any infection.0 -
AA - why are you always so negative. It's not fair to yensmiles to try and confuse her again. One of my chemo buddies here was Stage IV back in Nov 2009 and remains NED due to Herceptin - she has ongoing treatment with it. I'm nearly 5 years out with a similar diagnosis to yensmiles and YES I would do it all again even if it entailed selling my house. I know no one can know for sure if the chemo/Herceptin had anything effect but it probably did - same as your chemo probably is the reason you are 12 years out.
Also look at women who have chemo before surgery - oh wow their tumours shrink some even so they are no longer detectable - that's proof enough for me.
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Susieq60, recurrence after treatment is less likely, but possible. It is hard to know what the options would be in that case for a person in a different country with a different health care system.What some people consider pessimism, others consider to be just keeping the facts in mind. Recurrence is possible for any of us, at any time.
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SpecialK, thanks, yeah, that's my concern too.. my heart.. LOL! though for someone who had a lump, i'm considered "young" at 39.. I've read Slamon's papers.. and indeed the TCH looks better in terms of side effects.
AlaskaAngel, what is a better reading at echo? 50 or 70? i've yet to get to those details..first echo will be on Wednesday, June 4th!
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susie...AA prefers to take the road of smoke and mirrors. At this week's most recent annual ASCO meeting, the news regarding HER2 positive disease keeps sounding better and better. It appears that after 10 years of treating early stage HER2 positive disease, survival rates are approaching the survival rates of HER2 negative sisters. And for those who are late stage HER2 positive, they are surviving longer than before the discovery. And the other terrific news is that for those with recurrences, there are now newer targeted therapies. Those are facts and reason for optimism!
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AA..We are all aware of the recurrence
nobody knows what the future will bring to any one of us
Yen.....I'm sending you love and hugs.....
Even though we are all here to support you.....This is your decision and your decision only
Sheila♥
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again, i think i'm having "pre-chemo" brain!!! Realised i just skipped an entire page of messages..
Ricanbabe, i can't share my experience, yet there is ONE lady (only one) seen by one of the oncologist i consulted who worked during chemo. There would be a few days after each cycle where she can't, but overall, besides the few days, she worked all through chemo. I was given her number to chat to her because of my anxiety. Another lady (a teacher) I met in another hospital took a whole year off, and when I asked her whether it was necessary, she just replied, she still gets paid, so she just took that rest. Very few people though worked consistently from what i hear.. and for those who do, it's because they have no choice. The lady i spoke to is a single mom supporting a teenage son, and she was determined to just live life as normal through chemo and then later during radiation, she even drove to the sessions herself and straight to work after that. I hope that helps. I am a trainer/facilitator by profession and will most likely be off work for the next year, so hesitant at the thought of public contact, though i do have one session of work on the 21st of June which the oncologist said I should be okay to go as my chemo is scheduled on the 5th.
SuzieQ, you're a gem, thank you for wanting to make this less confusing for me. I'm really okay.. and i'd confuse myself by reading to much and asking too much anyway, and cry over it, and be okay after crying.. so i really am okay and appreciative of AlaskaAngel's inputs.
Kayb, thanks heaps for the information of the trial you were part of.. i've been told (quite a few times) that epirubicin is really much less toxic than adriamycin though both are still anthracyclines, and also read the recommendations from St. Antionio Breast Cancer Symposium, that the panel agrees that adjuvant should include at least a taxane and for most of the panel, also an anthracycline. So am still considering FEC-TH..
as much as i'm anxious about it all, i think i'm going to be okay once wednesday/thursday arrives and I"M DOING CHEMO.. cos then it's no more thinking, no more questioning, no more crying, JUST BELIEVE and FOCUS ON THE BEST OUTCOME!
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2013 Top Stories in Oncology: This Was the Year for HER2-Positive Breast Cancer
- Written by
Kimberly L Blackwell MD
PracticeUpdate: In your view, which development that occurred in 2013 in breast cancer research could have the most significant impact on clinical practice?
Dr. Blackwell: This year was the year for more options in the treatment of HER2-driven breast cancer. In chronologic order, we saw the approval of T-DM1 in the United States in April 2013. We saw its approval throughout Europe in the fall of 2013 for the treatment of taxane/trastuzumab-refractory metastatic breast cancer. We saw a first-ever approval on the basis of neoadjuvant activities for pertuzumab in combination with a taxane in neoadjuvant setting in the fall of 2013. In the summer, at this year’s ASCO meeting, we had a study looking at an older drug, vinorelbine, in combination with trastuzumab and showing that the mTOR inhibitor everolimus improves progression-free survival.1 And, then, we also have the approval of lapatinib and trastuzumab in trastuzumab-refractory metastatic breast cancer throughout Europe. So we had three either drugs or combinations approved. We obtained new data from phase III studies of the use of everolimus in the HER2 setting. All these things combined really made it a breakthrough year for the treatment of HER2-positive breast cancer.
PracticeUpdate: What specific changes have you observed or do you foresee as a result of these developments?
Dr. Blackwell: I personally think that we are going to see a lot less recurrent HER2-driven breast cancer, and that’s because we are now able to use highly effective antibodies, like trastuzumab and pertuzumab, in the curable or earlier-stage setting. We know that pertuzumab improves survival in the metastatic setting, and now that we are able to use it in our earlier settings, based on the neoadjuvant approval, I would hope that we’ll take a generalized cure rate of somewhere about 90% for all women facing HER2-positive breast cancer to an even higher level. These are pretty exciting times! At San Antonio this year, we saw a 97% long-term disease-free survival for small lymph node–negative HER2-driven breast cancers with the combination of paclitaxel and trastuzumab.2 That is among the best cure rates we’ve ever seen in early-stage breast cancer. So, I think that all of these highly effective drugs that have limited toxicity will hopefully cure more women facing HER2-positive breast cancer.
I really feel that no one needs to be afraid of breast cancer anymore, at least not HER2-positive breast cancer.
PracticeUpdate: Would you put this development into historical perspective for the practicing physician?
Dr. Blackwell: In 2005, we saw the first data that trastuzumab improves overall survival for patients in the first-line metastatic setting.3 Very quickly after that, in 2008, we saw that trastuzumab offers women a higher cure rate in early-stage breast cancer, and the pace has really picked up. From 2005 to 2011, we had two drugs—trastuzumab and lapatinib—available for the treatment of this very important driver of growth, this HER2, and then, in a period of 12 months, we’ve seen two new drugs approved, one new combination approved, and one possible new combination for heavily pretreated patients.
PracticeUpdate: Would you summarize why you picked HER2 as the 2013 top story in breast cancer?
Dr. Blackwell: This success serves as a really important model that we should now be applying to forms of breast cancer that aren’t as hard to treat, including triple-negative. If we can do this in HER2-positive breast cancer, then nothing should slow us down in trying to figure out the same paradigm for a triple-negative breast cancer.
References
- O'Regan R, Ozguroglu M, Andre F, et al. Phase III, randomized, double-blind, placebo-controlled multicenter trial of daily everolimus plus weekly trastuzumab and vinorelbine in trastuzumab-resistant, advanced breast cancer (BOLERO-3).Paper presented at: ASCO Annual Meeting; May 31–June 4, 2013; Chicago, IL. Abstract 505. J Clin Oncol 31, 2013 (suppl; abstr 505).
- Tolaney SM, Barry WT, Dang CT, et al. A phase II study of adjuvant paclitaxel (T) and trastuzumab (H) (APT trial) for node-negative, HER2-positiven breast cancer (BC). Paper presented at: San Antonio Breast Cancer Symposium; December 10–14, 2013; San Antonio, TX. Abstract S1-04.
- Marty M, Cognetti F, Maraninchi D, et al. Randomized phase II trial of the efficacy and safety of trastuzumab combined with docetaxel in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer administered as first-line treatment: the M77001 study group. J Clin Oncol. 2005;23(19):4265-4274.
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Here's all the latest from this week's 50th Annual ASCO meeting regarding HER2 positive breast cancer:
http://abstracts.asco.org/144/AbstView_144_131379.html
A multicenter randomized study comparing 6 versus 12 months of trastuzumab in combination with dose-dense docetaxel following FEC as adjuvant treatment of women with axillary node–positive or high-risk, node-negative breast cancer overexpressing HER2.
Sub-category:
HER2+Category:
Breast Cancer - HER2/ERMeeting:
2014 ASCO Annual MeetingAbstract No:
623Citation:
J Clin Oncol 32:5s, 2014 (suppl; abstr 623)Attend this session at the
2014 ASCO Annual Meeting!Session: Breast Cancer - HER2/ER
Type: General Poster Session
Time: Monday June 2, 8:00 AM to 11:45 AM
Location: S Hall A2
Personalize your Meeting experience with a suggested or customized itinerary! Author(s): Dimitrios Mavroudis, Nikolaos A. Malamos, Stylianos Kakolyris, Ioannis Boukovinas, Pavlos Papakotoulas, Nikolaos Ziras, Vassilis Georgoulias; Hellenic Oncology Research Group (HORG), Athens, Greece
Abstract:
Background: Adjuvant trastuzumab in combination with chemotherapy improves outcome of women with HER2 positive early breast cancer. However, the optimal duration of treatment remains unknown. In this study we compared 6 versus 12 months of adjuvant trastuzumab. Methods: Axillary node positive or high risk node negative women with HER2 overexpressing or amplified early breast cancer were randomized following surgery to receive either 6 (arm A) or 12 (arm
months of adjuvant trastuzumab in combination with dose dense G-CSF-supported Docetaxel (75mg/m2 every 14 days for 4 cycles) following FEC (5FU 700mg/m2, epirubicin 75mg/m2, cyclophosphamide 700mg/m2 every 14 days for 4 cycles). The primary endpoint of the study was the 3-year disease-free survival (DFS). Results: Four hundred eighty one patients were randomized; 240 on arm A and 241 on arm B. Of them 83 (34%) and 100 (41%) were premenopausal, 200 (83%) and 180 (75%) were node positive, 165 (69%) and 156 (65%) were hormone receptor positive in arm A and B, respectively. Chemotherapy was completed in 98% and 99% of patients while trastuzumab therapy in 96% and 100% of patients in arm A and B, respectively. After a median follow up of 43.5 and 42 months there were 26 (10.8%) and 15 (6.2%) (p=0.07) disease relapses and the median DFS has not yet been reached (p=0.08) while the 3-year DFS rate was 92.4% and 95.1% for arm A and B, respectively. Conclusions: Preliminary results of this study in terms of disease relapse and DFS are in favor of 12 months of adjuvant trastuzumab administration. Clinical trial information: NCT00615602. Meeting: 2014 ASCO Annual Meeting Abstract No: LBA4 First Author: Martine J. Piccart-Gebhart
Category: Breast Cancer - HER2/ER - HER2+Meeting: 2014 ASCO Annual Meeting Abstract No: 502 First Author: Peter Andrew Kaufman
Category: Breast Cancer - HER2/ER - HER2+Meeting: 2014 ASCO Annual Meeting Abstract No: 506 First Author: Lisa A. Carey
Category: Breast Cancer - HER2/ER - HER2+0 -
Thank you Voracious! and sigh, I was hoping that before my 1 year of herceptin finishes, there'd be a trial to say it's okay to stop at 6 months.. guess not..
and i've no doubts when it comes to herceptin, it's studies on herceptin that keeps me going and saying yes (rather reluctantly) to chemo! 0 -
yensmiles, by echo, 50 is the low end (generally considered the point at which consideration should be given to holding off on trastuzumab until a repeat echo shows improvement), while 70 is considered pretty darn good.You have the energy of relatively young age to get you through treatment (whereas the vast majority of bc patients are over age 50 at diagnosis),. Your relatively young age puts you at higher risk as you realize (and helps in understanding your decision). Makes sense to me.... Your situation and questions and comments have provided a pretty healthy discussion here for others.
A.A.
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VR, for all their "compassion" and "genius", just how many more decades are they going to continue to avoid offering any officially authorized opportunities to provide trials for those like me, who are willing, seeking, and actively currently doing trastuzumab used without chemotherapy, to allow us to learn who benefits and who does not from the subtraction of chemotherapy, INSTEAD of all these spendy new additional drugs?
How easily the actual statements are used to point at not using trastuzumab at all, instead of at using it without chemotherapy:
" The researchers noted, however, that patients with T1a tumors may not require trastuzumab-based chemotherapy."
and
"We believe paclitaxel and trastuzumab can be considered a reasonable and appealing approach for the majority of patients with stage I HER-2–positive breast cancer,” Tolaney said. “That said, not all patients require adjuvant trastuzumab-based chemotherapy, particularly those patients with T1a tumors.”
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AA...Offering ANY type of chemo and/or targeted therapy to 1a tumors less than 5 mm is a very real debate among researchers and clinicians. The problem of quelling the debate boils down to ethics. Do you like going around in circles with me? I'm getting tired of running these laps with you.....Want to know how I would resolve the debate? N of one. And that is NOT going to happen any time soon! Move on AA! You have a right to be angry because you believe you weren't well informed when you chose your active treatment plan. You are STILL angry at how clinical trials are conducted. I get it and I'm sorry. AA, I often wonder when you post over and over again why you don't take your concerns to those people who will listen to you and help come up with constructive ways to help heal you. I know you are here trying to help others avoid the mistakes you made and I get that too. But as you can see, the sisters who have come after you are being well informed, or at least are being better informed than you were. Isn't it time for you to move on? I have to wonder how you behave with your loved ones. Really! I do wonder. Does anyone ever tell you to let go of things that pain you? I think you have so much physical and emotional pain from your experience, that the only thing that comforts you is trashing researchers and trying to inform weary travelers on this maze to educate themselves better than you had. But after awhile, sisters like me begin to lose our patience with you. I don't mean to sound hurtful AA,but your load of baggage through the years seems to grow heavier and heavier with each thread that you post on. It ALWAYS circles back to you trashing researchers. How sad.
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VR, I do understand that you believe there is discussion happening among professionals about such questions as mine. Where we differ is that I feel they do bear a high degree of responsibility for not actively initiating the organized authorized trials to evaluate the actions of a drug that is already available and being used by breast cancer patients who chose not to add chemotherapy. As someone who has actively gone through what I consider to be extensive and expensive and difficult treatment that is understood to be ineffective for between 3 out of 4 and 4 out of 4 patients for over a decade thus far, I wonder why. I understand that you do not feel personally inclined to pursue that question. Like you, most researchers never face having to do that treatment personally, and can continue to avoid doing that basic research on the question. I still question the ethical basis for that, given that the drug is available, has some established history, and has been and is being used by breast cancer patients who chose not to add chemotherapy.0 -
AA....I do understand your frustration and I appreciate it. But every discussion we have devolves into you BASHING researchers. Make your thoughts known to the establishment and please stop repeating yourself here! Okay? Take your bashing to the NIH bioethics department! AA...you know what I do? I've become the patient advocate at Sloan Kettering for rare breast cancers. I put my bad experience, that is, not having enough info to make an informed treatment decision because there is so little research money placed into studying rare "favorable" breast cancers into advocating for more research.
Stop bashing the researchers and begin working with them! Then maybe you might begin your healing process.
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Your advocacy for rare breast cancers is commendable, and your suggestion for personal advocacy is a fine one. By posting my position and questions, I do raise awareness. As someone who has been a participant in several clinical trials, I provide essential support for research that requires considerable expense on my part, but researchers and research are not as accessible to me as elsewhere. If my questioning of the ethics involved is not meaningful to you, I accept your personal disinterest in it.
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AA...there is awareness and then there is awareness. You question the ethics over and over again HERE. It is time to question the ethics elsewhere. Th NIH to begin with or even better...why not direct your questions directly to those researchers? I am not asking a question nor am I uninterested. Annice gave you an explanation and so did others on this discussion board and on NUMEROUS threads. What you do is neither "awareness" nor "advocacy." And if any newbie is persuaded by your "facts", then once they become enlightened and are no longer newbies, they will understand too what it is you are really doing.
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oh..AA...and there is a huge difference e between the words uninterested and disinterested. Maybe you should take up your interest with a disinterested group and they can teach you about the meaning of ethics and how it relates to HER 2 POSITIVE clinical trials.
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VR, Annice is a valuable resource as an early stage patient. As I understand it, she also has not personally done chemotherapy, and hopefully she will not need to.This is a forum for HER2 patients, regardless of their stage or treatment, including patients who have actually completed treatment.
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My opinion as a patient who actually completed chemotherapy is only one single person's opinion. It is a sad day when it becomes so unacceptable for a person who has gone through treatment to question the ethics of standard practice promoted by those who overwhelmingly have never had treatment personally.0 -
kayb,As a HER2-positive patient, I too am appreciative of Dr. Slamon's work. However, it puzzles me that anyone so directly connected with the development of the drug would not have had the capability and/or interest in the patients to share that information with patients long ago -- perhaps through the movie or the book about the development of the drug, where the targeted HER2 positive audience would easily have had access to it.
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yensmiles - I'm doing the same "back and forth" you're doing about chemo. I find out Tues what my onco recommends. I've done enough research to say yes to it if he does. I'm 49 and still have a lot of living to do - despite my hatred for dumping draino in my veins - I'll do it if it means I've given myself an additional edge in the game. I wish you luck in your decision - I'll let you know what I find out on Tuesday!
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AA - they are doing a trial for Herceptin alone but it is restricted to much older women - it is too risky to try in younger women. How could they offer a 40 year old Herceptin alone and then find out it failed - can't go back on that can you. I still say your permanent infliction you say came from chemo probably would have happened to you during natural menopause, so can you really blame the chemo.
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I do understand that principle. But now that there are patients actively choosing on their own to do trastuzumab alone who include younger women, that excuse for failing to offer those women that kind of trial is rather like pretending they don't exist.
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AA....it is not pretending like they don't exist. The clinicians and researchers know they exist. However,ethical guidelines prohibit the researchers from creating a trial.
And furthermore, it makes you sad that people who haven't experienced chemo are expressing their opinion? Perhaps you will next recommend that unless oncologists give themselves chemo they shouldn't be prescribing it! You should be thrilled that I and so many others support the efforts of bioethics committees. They are created to protect all of us!
Give it up, AA. No one is being ignored. Those researchers who you are bashing know EXACTLY what they are doing every day. They understand the meaning, "First do no harm." I get it. You believe you were harmed by chemo. Its been a decade since you were treated. I get it that you wish to attempt to be the voice for those who feel they were harmed by chemo. But the facts speak for themselves. Yes, chemo does not guarantee that it will kill the cancer before the cancer kills you. Chemo does come with the potential of long term side effects. Patients nowadays sign informed consent forms stating those facts. And you are disappointed in how clinical trials are conducted? Tell it to the NIH! Again, that is another lap!
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