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Topic: Tumor 20% Her2 positive and some weak ER+ cells -- How to treat?

Forum: Mixed Type Breast Cancer — Meet others who have mixed type breast cancer.

Posted on: Dec 1, 2019 08:58AM

dono7392 wrote:

My 2 cm tumor has a focal area of Her 2+ (20% of tumor) and some ER weakly positive (15%) and negative cells. Local oncologists want to treat it like Triple Negative and Her2 positive (with AC-TH) but out-of-town oncologists would treat like Her2+ (Carboplatin+Herceptin). Supposed to start chemo next week but not sure what to do! Please let me know if you have any experience with this or input--thank you

Dx 9/3/2019, DCIS/IDC, Left, 2cm, Stage IB, Grade 3, 0/8 nodes
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Dec 1, 2019 09:13AM windingshores wrote:

This is a tough one. I had a positive HER2 test, an equivocal and a negative. Then I had someone test again using 60 cells instead of 20 and got a negative, tough at the high end of normal. I have mixed ductal and lobular and the ductal areas were higher in HER2 expression. Someone told me that DCIS is even higher so that can affect results-?

I am 5 years out but still wonder if I was undertreated, but I don't think about it much.

Can you have the 20% of your tumor retested? How do you know it is 20%?

I would keep seeking opinions until you feel good about your decision. I had other contradictions and ended up seeing 4 oncologists. The last one really did everything possible to make me feel safe going forward.

I also talked with oncologists about risks of Herceptin versus benefit. Hard call.

Sympathies!


Dx 2/2015, DCIS/ILC/IDC, Right, 1cm, Stage IA, Grade 3, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery Lymph node removal; Mastectomy: Right Surgery Mastectomy: Left; Prophylactic mastectomy: Left Hormonal Therapy
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Dec 4, 2019 06:02PM dono7392 wrote:

windingshores. Such a difficult position to be in. I am just over the cusp of positive for Her2+ so fear I am being over treated and possibly not focusing on triple negative portion of tumor. I feel like I’m making a life or death decision! I take it you determined the risks outweighed any benefits? My drs are not very good about explaining that aspect to me.

Dx 9/3/2019, DCIS/IDC, Left, 2cm, Stage IB, Grade 3, 0/8 nodes
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Dec 4, 2019 06:27PM MinusTwo wrote:

dono - Triple Negative means ER negative, PR negative and HER2 negative - so you aren't that. You are fortunate to be HER2+ because there are good treatments available now. Treating for HER2 + (even if it's mild) will likely take precedence because it's more virulent. There are lots of different treatments for ER/PR negative. They aren't usually as critical and can be complementary to the HER2 positive treatment and most given at the same time - like I had.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Dec 5, 2019 07:04AM dono7392 wrote:

MinusTwo: The Her2 positive portion is a small "focal"' area of the tumor with the rest being Her 2 meg. Wouldn’tthe 80% that is ER/PR/HER2 negative be triple negative and treated as such?

Dx 9/3/2019, DCIS/IDC, Left, 2cm, Stage IB, Grade 3, 0/8 nodes
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Dec 5, 2019 07:06AM dono7392 wrote:

MinusTwo: The Her2 positive portion is a small "focal"' area of the tumor with the rest being Her 2 neg.Wouldn't the 80% that is ER/PR/HER2 negative be triple negative and treated as such?

Dx 9/3/2019, DCIS/IDC, Left, 2cm, Stage IB, Grade 3, 0/8 nodes
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Dec 5, 2019 08:34AM MinusTwo wrote:

dono - I don't remember & can't tell by your signature line - aren't you getting all this information from biopsies? Since only small samples are taken, you don't know how much will be HER2+. I'm not a doctor, but never the less starting HER2+ treatment along with chemo is the standard option.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Dec 5, 2019 10:20AM dono7392 wrote:

I put the information in my profile, so not sure why it isn't showing up but.....I had surgery and they examined the entire tumor "block"

Dx 9/3/2019, DCIS/IDC, Left, 2cm, Stage IB, Grade 3, 0/8 nodes
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Dec 5, 2019 11:37AM santabarbarian wrote:

Just another data point, I was TNBC and treated with Carboplatin and Taxotere, both often given with HP to Her 2 + people.

Carboplatin is fine to treat TNBC even w no Her 2 positivity. High grade, basal or basal-like TNBC cancers respond well to Carboplatin.

pCR after neoadjuvant chemo w/ integrative practices Dx 7/13/2018, IDC, Left, 3cm, Stage IIB, Grade 3, ER-/PR-, HER2- (FISH) Chemotherapy 8/13/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 12/27/2018 Lumpectomy: Left Radiation Therapy 2/11/2019 Whole-breast: Breast, Lymph nodes
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Dec 5, 2019 04:45PM MinusTwo wrote:

dono - you have to select to make your information 'public' and not private.

As SB said - TC is a good choice. I was ER/PR negative and HER2+. I had taxotere & carboplatin in conjunction with the herceptin & perjeta for HER 2+. Long days but all infusions given in one day every 3 weeks for 6 sessions.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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21 hours ago windingshores wrote:

Just to clarify, the final 60 cell count on the ductal areas of my IDC, ILC, DCIS tumor (where the HER2 was stronger), ended up being negative. With a positive, a negative, and equivocal and finally a negative with 60 cell count, I went with no Herceptin and no chemo. My Oncotype was low and I was highly positive for ER/PR so I went with anti-hormone treatment only.

Dx 2/2015, DCIS/ILC/IDC, Right, 1cm, Stage IA, Grade 3, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery Lymph node removal; Mastectomy: Right Surgery Mastectomy: Left; Prophylactic mastectomy: Left Hormonal Therapy
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21 hours ago dono7392 wrote:

Thanks for clarifying. That’s wonderful that you didn’t need chemo!

Dx 9/3/2019, DCIS/IDC, Left, 2cm, Stage IB, Grade 3, 0/8 nodes

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