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Topic: TRIPLE POSITIVE GROUP

Forum: HER2+ (Positive) Breast Cancer —

Testing, treatment, side effects, and more.

Posted on: Jan 31, 2011 07:30AM - edited Dec 10, 2012 08:55AM by TonLee

TonLee wrote:

This is primarily for people who find themselves with THREE +'s by their diagnosis. 

If you are new to breast cancer, please click on the link below and read.  It is "What I Wish I Knew At the Beginning of Treatment."

http://community.breastcancer.org/forum/6/topic/797454



IDC, 2cm, Stage IIIa, Grade 2, 4/4 nodes, ER+/PR+/HER2+, Skin Sparing uni-MX with TE, TCH, Rads Dx 9/14/2010, IDC, 2cm, Stage IIIA, Grade 2, 4/4 nodes, ER+/PR+, HER2+
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Jan 9, 2019 12:37PM nanette7fl wrote:

Triple sending ((hugs)) and tons of prayers your way. Sorry to hear about your lungs and praying it's not more cancer but something simple like infusion stuff.

~Nanette

Dx 10/23/2018, IDC, Left, 2cm, Stage IA, Grade 2, ER+/PR+, HER2+ (FISH) Dx 11/13/2018, IDC/Paget's, Left, 1cm, Stage IA, Grade 2, ER+/PR+, HER2+ (FISH) Dx 11/13/2018, IDC, Left, 1cm, Stage IA, Grade 2, ER+/PR+, HER2+ (FISH) Chemotherapy 12/4/2018 Taxol (paclitaxel) Targeted Therapy 12/4/2018 Herceptin (trastuzumab)
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Jan 9, 2019 01:14PM Moderators wrote:

Thinking of you TriplePHtown!! Medicating Please keep us posted.

rljes, there is a lot of discussion in the community about neratinib (nerlynx), which you can identify by using the Search button to the left. You may want also want to look at these pages as well: Nerlynx, Preventive Medicine Helps Ease Diarrhea Side Effects With Neratinib.

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Jan 9, 2019 02:12PM smokeywins01 wrote:

Afternoon ladies!

I was dx triple positive back in 2016 at 37 YO and was immediately put on Zoladex, and I'm still on the monthly shots.

Six rounds TCHP, finishing the year with Herceptin. Last treatment was September 2017. Double mastectomy in Feb 2017, with recon in Nov 2017.

Onc had put me on Tamoxifen, but then switched me over to Aromasin.

The reason for my writing is I'm freaking out a little bit. Having been on Zoladex for over 2 years, and aromasin for approximately a year now, possibly a little longer than that, and just yesterday I had a very small amount of bright red blood, noticed when in the shower. I just started exercising again, 1-min plank every morning, in addition to improving my diet to try to get rid of the 30lbs I gained since finishing treatment. The amount was only noticeable yesterday when cleaning inside with a washcloth, and there was no more for the rest of the night. No flow on a pantyliner like a normal period. Again this morning when I got up, there was another small amount, and no more for hours, until right before writing this post. Every time the amounts are very small, at most maybe a teaspoon. No spotting like a normal period, just seems to collect inside and comes out only when I urinate or clean.

I have no cramping pains like a normal period. GYN check was in the fall 2018, and all came back normal. I did overexert myself prior to this, helped hubby carry a mattress and boxspring out of the house. I have my monthly appt with my oncologist this month for my next shot, I know I need to mention it to her, but I'm scared cause I don't want more tests. I've already been through so much, including a 2 month experiment with Nerlynx in Feb 2018.

Has anyone else experienced this? I'm 39 now, and have been considering an ovariectomy, while at the same time I don't want yet another surgery. Then there are the fear of being on the Zoladex and Aromasin for another 10 years or so, since my mom is the only one who went through the change at the age of 50. I'm hoping someone can shed some light on this. I did also have adrenal fatigue prior to my diagnosis, and I've been using natural supplements to heal my adreanals as well. I'm trying to so hard to just get on with life and move past cancer, this is the last thing I need.


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Jan 9, 2019 02:25PM MACTAZ wrote:

TriplePHtown, all my prayers and thoughts are with you and wishing good results tommorrow.

Dx 8/14/2018, IDC, Right, 1cm, Stage IA, Grade 2, ER+/PR+, HER2+ Dx 8/14/2018, IDC, Right, 2cm, Stage IB, Grade 3, ER+/PR+, HER2+ Targeted Therapy 8/29/2018 Herceptin (trastuzumab) Chemotherapy 8/31/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 8/31/2018 Perjeta (pertuzumab) Dx 9/19/2018, DCIS, Right, <1cm, Stage 0, Grade 3 Targeted Therapy 1/3/2019 Perjeta (pertuzumab) Targeted Therapy 1/3/2019 Herceptin (trastuzumab) Hormonal Therapy Surgery 1/28/2019 Lymph node removal: Sentinel; Mastectomy: Right; Reconstruction (right): Tissue expander placement
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Jan 9, 2019 03:36PM SpecialK wrote:

triple - hoping for a benign explanation - I understand your fear - have had four recurrence scares, including a bi-laterally abnormal PET and sudden hearing loss. I was very fortunate that none of these events turned out to be more cancer, all had other reasons - hoping for the same for you, and wanted you to know that I totally understand your headspace right now - it's scary. Please keep us posted - we are waiting with you.

BMX w/ TE 11/1/10, ALND 12/6/10. 15 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present. Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ (IHC) Dx 9/27/2010, DCIS, Stage 0, Grade 3
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Jan 9, 2019 03:51PM Moderators wrote:

smokeywins01, sounds like it may be best to just check in with your gyn or treatment team to discuss the issue, and perhaps consider get your hormone levels checked, among whatever else they would suggest. We see that there is an older thread here: community.breastcancer.org/for... where they are discussing switching from Tamoxifen to Aromasin and experiencing similar symptoms, in case you would like to read it.

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Jan 9, 2019 04:04PM smokeywins01 wrote:

Thanks! I will be bringing it up with my onco on the 24th. The questions about how do I know if I am truly in menopause have come up multiple times between my husband and I, and I don't belive my onco has actually checked hormone levels. Thanks you for the info.

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Jan 9, 2019 05:49PM TriplePHtown wrote:

Thanks for all the thoughts and prayers for tomorrow

Dx 12/2017, IDC, Right, 2cm, Stage IIB, Grade 3, ER+/PR+, HER2+ Hormonal Therapy Radiation Therapy Targeted Therapy Perjeta (pertuzumab) Targeted Therapy Herceptin (trastuzumab) Chemotherapy Carboplatin (Paraplatin), Taxotere (docetaxel)
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Jan 10, 2019 12:03AM SisterStrong wrote:

TriplePHtown- I am so sorry you have to go through this worry

My thoughts, prayers and heart will be with you

Dx 7/16/2018, IDC, Right, <1cm, Stage IB, Grade 3, 0/2 nodes, ER+/PR+, HER2+ (FISH) Surgery 9/29/2018 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Targeted Therapy 10/12/2018 Herceptin (trastuzumab) Chemotherapy 10/12/2018 Taxol (paclitaxel) Hormonal Therapy
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Jan 10, 2019 03:19AM CAT21 wrote:

Hi

I am triple positive and have just been told after 14 months on Tamoxifen (one finished herceptin a year ago) that its in my bones and liver spots. Looking for any positive stories please. Seeing Consultant this afternoon to get my plan! I had a complete response to chemo and herceptin last time so not sure what has happened. Feeling alone and sad!!x

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Jan 10, 2019 07:58AM Moderators wrote:

CAT, we're sos sorry you have to be here for this reason, but really glad you've found us!

Besides this forum, we thought you may be interested in also posting in the Stage IV forum. We're sure you'll find positive stories and comfort here in this wonderful Community. Members have tons of advice and experience and will help you along the way. And please, let us know if there's something we can do for you. We're all here for you!

Best wishes,

The Mods


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Jan 10, 2019 08:45AM ElaineTherese wrote:

CAT21,

I'm sorry to hear about your mets. How disappointing, after a presumably successful treatment the first time around. I second what the Moderators said. If you'll be doing Herceptin and/or Perjeta as part of your new treatment plan, there is a Stage IV thread for that. There are also Stage IV threads for bone mets and liver mets. There are lots of women on those threads who have lived for years and years with their mets. They have all sorts of insights on treatments, side-effects, and coping mechanisms. ((Hugs))

DX IDC June 28, 2014, 5 cm., 1 node tested positive (fine needle biopsy); 0/20 after neoadjuvant chemo + ALND; Grade 3; ER+ PR+ HER2+ Neoadjuvant chemotherapy starting 7/23/14 ACX 4, Taxol X 12, Perjeta X 4; Herceptin: one year Chemotherapy 7/22/2014 AC Targeted Therapy 9/16/2014 Perjeta (pertuzumab) Targeted Therapy 9/16/2014 Herceptin (trastuzumab) Chemotherapy 9/16/2014 Taxol (paclitaxel) Surgery 1/11/2015 Lumpectomy: Right; Lymph node removal: Right, Underarm/Axillary Hormonal Therapy 2/24/2015 Aromasin (exemestane), Zoladex (goserelin) Radiation Therapy 3/8/2015 Breast, Lymph nodes
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Jan 10, 2019 01:56PM TriplePHtown wrote:

Everything is okay!!! Thank you so much for the thoughts and prayers😘😘😘. Waiting on Doctor but his PA just told me CT was good. Xray had seen a nodule that was unchanged on CTand nothing they are worried about.

Dx 12/2017, IDC, Right, 2cm, Stage IIB, Grade 3, ER+/PR+, HER2+ Hormonal Therapy Radiation Therapy Targeted Therapy Perjeta (pertuzumab) Targeted Therapy Herceptin (trastuzumab) Chemotherapy Carboplatin (Paraplatin), Taxotere (docetaxel)
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Jan 10, 2019 02:00PM LaughingGull wrote:

CONGRATS TriplePH!!!!!!

Very happy for you!!!!!

AC, THP, then HP to complete one year. Oophorectomy + AI. Right side MX+ALND, Left side MX Dx 10/26/2017, IDC, Right, 3cm, Stage IIB, Grade 3, 2/6 nodes, ER+/PR+, HER2+ (IHC)
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Jan 10, 2019 02:16PM Gudrun wrote:

So happy for the good news, dear TriplePH.

Daughter dx at 28: Dx 8/2015, IDC, Left, 3cm, Stage IIA, Grade 2, 0/4 nodes, ER+/PR+, HER2+ (IHC) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone), Zoladex (goserelin) Targeted Therapy Herceptin (trastuzumab) Targeted Therapy Perjeta (pertuzumab) Chemotherapy Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery Mastectomy: Left; Reconstruction (left): TUG flap
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Jan 10, 2019 02:36PM LaughingGull wrote:

Hi triple positive sisters,

Hope everyone enjoyed the holidays. I wish a happy new year to all.

I have been reading the posts now and then, but not contributing much in the last few months. I was very happy to hear the good news about TriplePH scan so I finally decided to get out of the dark side and say hi.

@ Kattis, I think being traumatized sounds just normal. I am a bit traumatized too. I recently joined a weekly meditation group. Seek help. Talking to a psychiatrist has definitely helped me. Being dry down there has its remedies and doesn't mean you cannot have intimacy.

@ CAT, sorry about your news, and here is hoping that your disease can be controlled, and you that you have ahead of you many years of a good life with tolerable treatments. What a disappointment, as ElaineTherese says. May I ask you what symptoms if any you had that led to the discovery of those mets?

On my side, I am having my penultimate Herceptin+Perjeta treatment right now, and the last one will be in three weeks. Before anyone congratulates me, let me just say that I am consumed with worry about finishing systemic treatment, given the significant amount of residual disease I had in my breast and lymph nodes, plus all the other ominous signs in my post-surgical report: lymphatic invasion, vascular invasion, lymph nodes extranodal extension, only 6 nodes found in full node dissection -indicative that the nodes were matted because of disease. Maybe there were some more ominous things I cant remember right now. I talked to my oncologist about further treatment with Nerlynx or Kadcyla. He was against recommending Nerlynx for me, because there is no data comparing Nerlynx agains Herceptin + Perjeta, since the trial that led to Nerlynx' approval by the FDA compared Nerlynx against Herceptin alone. He also was against recommending Kadcyla for me, because, although the data demonstrates the benefit of Kadcyla instead of Herceptin + Perjeta, it doesnt demonstrate the benefit of Kadcyla after Herceptin + Perjeta.

So, since my oncologist doesn't recommend any further treatment, and also he doesn't believe in scans or checking cancer markers unless there are symptoms of progression, I feel like they are abandoning me to sit here waiting for the other shoe to drop, knowing that I am at "high risk of recurrence and death", which is the way the literature describes my situation, and that I have tolerated all treatment very well until now. He did recommend that I seek a second opinion on Kadcyla, and I am going to get it tomorrow. If anyone (in my situation or not) can recommend specific questions for my second opinion appointment, I would appreciate it. I will send an update tomorrow.

Best to all,

LaughingGull

AC, THP, then HP to complete one year. Oophorectomy + AI. Right side MX+ALND, Left side MX Dx 10/26/2017, IDC, Right, 3cm, Stage IIB, Grade 3, 2/6 nodes, ER+/PR+, HER2+ (IHC)
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Jan 10, 2019 02:46PM Cascadians wrote:

Laughing Gull, my MedOnc said if there's any indication whatsoever after surgery that there's any residual disease, he's going to zap it with Kadcyla. 50% greater survival rate. He did say pending FDA release and insurance willing to pay for it. Studies are clear showing the benefit.

Dx 9/17/2018, IDC, Left, 1cm, Stage IA, Grade 3, ER+/PR+, HER2+ Targeted Therapy 10/2/2018 Herceptin (trastuzumab) Chemotherapy 10/2/2018 Taxol (paclitaxel) Surgery 1/23/2019 Mastectomy: Left, Right
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Jan 10, 2019 04:16PM LaughingGull wrote:

Cascadians: the 50% benefit is clear when giving Kadcyla instead of, not after Herceptin+Perjet

AC, THP, then HP to complete one year. Oophorectomy + AI. Right side MX+ALND, Left side MX Dx 10/26/2017, IDC, Right, 3cm, Stage IIB, Grade 3, 2/6 nodes, ER+/PR+, HER2+ (IHC)
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Jan 10, 2019 04:23PM Jstarling wrote:

TripleP, we love good news! My thoughts are with you all

Dx 1/2018, DCIS/ILC, Left, 1cm, Stage IB, Grade 2, 0/4 nodes, ER+/PR+, HER2+ Surgery 2/11/2018 Lumpectomy: Left; Lymph node removal Surgery 3/1/2018 Lumpectomy Chemotherapy 3/27/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 3/28/2018 Herceptin (trastuzumab) Radiation Therapy Whole-breast: Breast, Lymph nodes
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Jan 10, 2019 05:12PM TriplePHtown wrote:

Dear Laughing Gull, I totally understand your concerns as I had residual disease in my breast and and the one node they had previously identified. My oncologist said it was my choice about Nerlynx though side effects are high and the stats showed about a 3% improvement. We have some travel planned and I have lost quite a bit of weight so I've decided to wait a bit before I make a decision on that. I asked about Kadcyla too and I believe he said it is only approved for metastatic patients and, as currently studied, will probably be used instead of Herceptin in the first year when approved - so we are caught in the middle. Let us know what your second opinion says about Kadcyla. Someone a while back on here mentioned a study with a vaccine for Her2 but I don't know if that study is still taking participants. My targeted therapy ended a few weeks ago and can relate to the mixed emotions. I'm glad you joined a meditation group and hope that you stay healthy. PM me if you ever want to communicate privately.😘


Dx 12/2017, IDC, Right, 2cm, Stage IIB, Grade 3, ER+/PR+, HER2+ Hormonal Therapy Radiation Therapy Targeted Therapy Perjeta (pertuzumab) Targeted Therapy Herceptin (trastuzumab) Chemotherapy Carboplatin (Paraplatin), Taxotere (docetaxel)
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Jan 10, 2019 06:53PM LaughingGull wrote:

Hi TriplePH,

I remember your case well since we are in the same boat! Your scare sent me into PANIC mode. I am soooo glad you got a benign result, dear Smile

I will send an update tomorrow.

LaughingGull

AC, THP, then HP to complete one year. Oophorectomy + AI. Right side MX+ALND, Left side MX Dx 10/26/2017, IDC, Right, 3cm, Stage IIB, Grade 3, 2/6 nodes, ER+/PR+, HER2+ (IHC)
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Jan 11, 2019 02:03AM - edited Jan 11, 2019 09:13PM by Princess_Meg

This Post was deleted by Princess_Meg.
Dx at 38 Dx 9/19/2017, DCIS/IDC, Right, 3cm, Stage IIA, Grade 2, 1/10 nodes, ER+/PR+, HER2+ (FISH) Chemotherapy 11/19/2017 AC + T (Taxol) Surgery 3/20/2018 Lymph node removal: Underarm/Axillary; Mastectomy: Right; Reconstruction (right): Tissue expander placement Radiation Therapy 4/30/2018 Targeted Therapy 5/2/2018 Herceptin (trastuzumab) Hormonal Therapy 8/1/2018 Femara (letrozole) Surgery 11/20/2018 Reconstruction (left): Silicone implant; Reconstruction (right): Latissimus dorsi flap, Silicone implant Targeted Therapy 11/28/2018 Perjeta (pertuzumab)
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Jan 11, 2019 02:17AM Gudrun wrote:

I just wonder if this residual disease only refers to remaining HER2 pos cells? What if there is "only" ER+/PR+ tissue left? Do after treatment options, like Nerlnyx or Kadycla make any sense in this case?

Daughter dx at 28: Dx 8/2015, IDC, Left, 3cm, Stage IIA, Grade 2, 0/4 nodes, ER+/PR+, HER2+ (IHC) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone), Zoladex (goserelin) Targeted Therapy Herceptin (trastuzumab) Targeted Therapy Perjeta (pertuzumab) Chemotherapy Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery Mastectomy: Left; Reconstruction (left): TUG flap
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Jan 11, 2019 02:23AM - edited Jan 11, 2019 02:43AM by Princess_Meg

Hi CAT21 I am so sorry to hear about your met. Sending e hugs to you. Let me share a quick positive story with you.

Yesterday I went for infusion (H& P) and met a lady who came to flush her port. She was diagnosed almost 6 years ago with stage 4B ovarian cancer. The cancer was everywhere, ovaries, liver, spleen you name it.As a matter of fact, the first MO she met told her he wouldn't touch her that she should go home and put her “business in order" then she came to my hospital and the MO she met asked her if she was ready to fight as the battle against cancer starts in the head. Long story short, she's still here 6 years in June after DXed at stage 4B. You will be fine just don't get tired and weary just yet❤️

Dx at 38 Dx 9/19/2017, DCIS/IDC, Right, 3cm, Stage IIA, Grade 2, 1/10 nodes, ER+/PR+, HER2+ (FISH) Chemotherapy 11/19/2017 AC + T (Taxol) Surgery 3/20/2018 Lymph node removal: Underarm/Axillary; Mastectomy: Right; Reconstruction (right): Tissue expander placement Radiation Therapy 4/30/2018 Targeted Therapy 5/2/2018 Herceptin (trastuzumab) Hormonal Therapy 8/1/2018 Femara (letrozole) Surgery 11/20/2018 Reconstruction (left): Silicone implant; Reconstruction (right): Latissimus dorsi flap, Silicone implant Targeted Therapy 11/28/2018 Perjeta (pertuzumab)
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Jan 11, 2019 02:30AM - edited Jan 11, 2019 02:31AM by Princess_Meg

Hi Gudrun, not sure I understand your question but if you mean to know if kadcyla only works for HER2 positive residual disease then yes. Atleast for now

Dx at 38 Dx 9/19/2017, DCIS/IDC, Right, 3cm, Stage IIA, Grade 2, 1/10 nodes, ER+/PR+, HER2+ (FISH) Chemotherapy 11/19/2017 AC + T (Taxol) Surgery 3/20/2018 Lymph node removal: Underarm/Axillary; Mastectomy: Right; Reconstruction (right): Tissue expander placement Radiation Therapy 4/30/2018 Targeted Therapy 5/2/2018 Herceptin (trastuzumab) Hormonal Therapy 8/1/2018 Femara (letrozole) Surgery 11/20/2018 Reconstruction (left): Silicone implant; Reconstruction (right): Latissimus dorsi flap, Silicone implant Targeted Therapy 11/28/2018 Perjeta (pertuzumab)
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Jan 11, 2019 09:24AM Gudrun wrote:

Thank you princess Meg. This exactly was my question. I'm afraid my English is a bit stiff. My daughter had residual tissues after tx but this time with Her2 negative.

Daughter dx at 28: Dx 8/2015, IDC, Left, 3cm, Stage IIA, Grade 2, 0/4 nodes, ER+/PR+, HER2+ (IHC) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone), Zoladex (goserelin) Targeted Therapy Herceptin (trastuzumab) Targeted Therapy Perjeta (pertuzumab) Chemotherapy Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery Mastectomy: Left; Reconstruction (left): TUG flap
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Jan 11, 2019 10:40AM LaughingGull wrote:

Gudrun, that sounds like your daughter will benefit from hormonal treatment but not from Kadcyl

AC, THP, then HP to complete one year. Oophorectomy + AI. Right side MX+ALND, Left side MX Dx 10/26/2017, IDC, Right, 3cm, Stage IIB, Grade 3, 2/6 nodes, ER+/PR+, HER2+ (IHC)
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Jan 11, 2019 05:11PM rljes wrote:

Hi Everyone,

It sounds like a lot of us are at that point of being offered Neratinib or Kadcyla.  I have joined the FB closed group Nerlynx (Neratinib), to get an idea what I'm in for.  Same as for the Cancer treatments- SE's are different for everyone. I have 2 more Herceptin treatments to go, so I have a few months to decide. 

Good Luck to All of us! Rj

Finished Chemo Mar 13, 2018 *Started Chemo 11/28/17 / No recontruction - going flat /Neulasta Injection Pod Dx 6/26/2017, IDC, Left, 3cm, Stage IIB, Grade 2, ER+/PR+ Dx 8/22/2017, 1/7 nodes, HER2+ Surgery 8/22/2017 Mastectomy: Left, Right Targeted Therapy Herceptin (trastuzumab) Chemotherapy Carboplatin (Paraplatin), Taxotere (docetaxel)
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Jan 11, 2019 05:15PM van2018 wrote:

FYI, was triple positive but after neoadjuvant chemo and BMX, the repeat biomarker test showed ER+ PR- HER2- for the residual disease but my MO still wants to treat me per the original biomarkers...ie. Herceptin or Kadcyla, if insurance will cover it.

Dx 4/21/2018, IDC, Right, 2cm, Stage IIA, Grade 2, ER+/PR+, HER2+ (IHC) Chemotherapy 5/22/2018 AC + T (Taxol) Targeted Therapy 7/17/2018 Herceptin (trastuzumab) Targeted Therapy Perjeta (pertuzumab)
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Jan 11, 2019 05:44PM LaughingGull wrote:

Quick update:

My second opinion doctor does not recommend Kadcyla after having had Herceptin + Perjeta for an entire year and says the data is not there and my insurance won't approve it. Bawling

Bummed but it is what it is. Second opinion doctor will present my case to their board in case they recommend something else and I also asked about clinical trials.

boogirl: regarding Tamo v AI when in the cusp of menopause, both my regular MO and my second opinion MO (whom I saw today) said that the strategy of ovaries removal + AI is the best for us triple positives with strongly estrogen-driven cancer and residual disease. Optimal, best, those are the words I heard both times.

AC, THP, then HP to complete one year. Oophorectomy + AI. Right side MX+ALND, Left side MX Dx 10/26/2017, IDC, Right, 3cm, Stage IIB, Grade 3, 2/6 nodes, ER+/PR+, HER2+ (IHC)

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