Considering TH regimen for HER2+ microinvasive (very early stage) BC

Anyone have feedback who has done Taxol plus Herceptin? I just met with a medical oncologist to discuss possible chemo as I was thought to have DCIS but in fact, at mastectomy, was found to have about 8 foci of microinvasion (defined as < 1mm each).
I was wondering what your experience has been with the TH regimen. The other option we discussed was Kadcyla. Thanks!
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Hi, saf1234, did you make a decision about your treatment?
I'm in a similar boat and there aren't many of us!
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@saf1234 hello! I also would love what your decision was? I was found to have a single focus of invasive 1.3mm along w high grade dcis. It was Her 2+ so I decided BMX but no to radiation (it was on left side and I didn't want to risk my heart).
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@lemonwedge Hi there! Hopefully we get some response! What is your situation, if you mind sharing?
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@snm Hi! Glad to hear from you. My situation was +++ microinvasive (by definition less than 1 mm each) multifocal (2) IDC with DCIS, and it was staged as T1mic, negative nodes. Had a BMX. Radiation was not on the table, but I can take tamoxifen, which will reduce my recurrence risk by not a whole lot. I was not offered any additional treatment. I don't really know how to feel OK with just being monitored yet. I'm thinking about taking the Signatera test just to stay on top of the possibility of recurrence.
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@lemonwedge yeah I hear you.. does feel odd to be monitored only.. your tamoxifen decision is a big one given the side effects and tiny cancer. I was not offered the signatura test maybe bc my tumor was hormone negative? Anyway good luck with the decision making!
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@snm I think doctors don't know what to do with Signatera yet. It can tell you if there is I don't know what you call it—"tumor debris" in your blood, but it doesn't say where it is, so that can cause a lot of panic and confusion. I still think it might be good for me to have that information even if I don't know what it means or how to pursue it. I don't think hormone status has anything to do with the test—they take the tumor and analyze it, making a test that is specific to you.
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@saf1234 I'm in the same boat and struggling with a treatment decision. I am triple positive (ER+, PR+, HER2+) with DCIS and 2mm of invasive cancer. Bi-lateral mastectomy with implants. I've been given the choice of Taxol for 12 weeks + Herceptin for a year in addition to Tamoxifen. I'll definitely take the Tamoxifen, but struggling with the HER2 treatment decision, especially the Taxol part. I'm tempted to do go forward for peace of mind. I hope you have been able to reach a decision and if you'd like to share / keep in touch that would be great. Best wishes to you!
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@cltushman hi there, that's a tough decision. 2mm is very small but I totally get it. What did you MO say was your recurrence risk? Was your MO advocating for chemo?
I've heard that some MO use 5mm as cut off to offer chemo.
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@snm my recurrence risk is around 95% on the Tamoxifen (I'm ER+ and PR+), and if I add the HER2+ treatment I can get a potential benefit of another 2-3%. Both MOs I met with did not advocate for chemo specifically, but I personally want to address the HER2+ of the cancer in some way. HER2+ is quicker to recur and aggressive compared to ER/PR+. I was offered to do the Herceptin/Traztuzamab without the chemo but there's no clinical trials or research on it in early stage breast cancer, which makes that option tempting but confusing. It's so hard when these decisions are gray and left up to the patient. I've been so anxious about this but probably going to do the chemo plus Herceptin for peace of mind b/c that's what the clinical trails were based on. Hope you are doing okay and navigating okay over there. This is tough stuff.
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@cltushman yes tough choice. The herceptin only choice sounds like a good option..sort of like a middle of the road option- I just wish there was some evidence to support it! I wish you luck on whatever you decide!
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@cltushman It is such a tough choice. I hope you get some clarity. I don't know if this kind of information helps you with your decisions, but here is an article link below with many retrospective studies comparing treatments.
What is interesting to me about it is that in several of the studies (but not all) the untreated T1mic and T1A groups have better overall survival and breast cancer-specific survival.
Treatment of small (T1mic, T1a, and T1b) node-negative HER2+ breast cancer: a review of current evidence for and against the use of anti-HER2 treatment regimenshttps://pmc.ncbi.nlm.nih.gov/articles/PMC9156575/
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@lemonwedge Thank you, this is a great article! Do you mind my asking where you landed with your treatment? I wasn't able to find it in the thread. Thanks again.
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@cltushman Glad the article is helpful and I really understand the anguish and anxiety caused by this.
My +++ cancer was less than 1mm, making it microinvasive.
I had a DMX and my risk of recurrence is supposedly 1-3%. My surgeon's NP says they are basically treating it like DCIS.
No chemo or HER2 treatment was recommended, and, at this point, I'm not going to pursue tamoxifen.
I'm making lifestyle changes to hopefully help with my health, like eating the recommended foods/avoiding the ones not recommended, maintaining my weight, exercising, and (ideally) lowering stress. Sleep is still a challenge for me.
I hope you can find peace in what you choose.
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@lemonwedge Thanks for sharing. Sounds like you are on a great path, best wishes to you!
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@lemonwedge very helpful article - thank u so much! My MO reassured me that I had an excellent prognosis and most likely this will just be a blip in my life..never to return but if it does there is treatment. She told me this as I was worried..and I felt much better after that. I believe her words and feel settled it letting things play out.
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