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Oct 2, 2019 09:51PM
1207262- like you, I initially read every HER2+ related research report I could find and went into a bit of a tailspin because of what I found. I fixated all the negative aspects like HER2/ HR crosstalk etc (although in my case I think I was looking for valid reasons to NOT do chemo). I met with a breast surgeon who basically insisted in no uncertain terms that I do neoadjuvant chemo, and when I confronted her with the negative research I'd done, she said that in her many many years operating on HER2+ patients who underwent neoadjuvant chemo, almost ALL of them had significant shrinkage of their tumors, and many achieved pCR. I was looking at stats that said only 26% of HER2+ plus HR+ saw pCR after neoadjuvant TCHP (whereas 63% of HER2+ but HR- saw pCR), but I think it's important to remember that ultimately chemo is just one step of the process; the goal of neoadjuvant chemo is to shrink things down enough to get nice clean margins in an aggressive cancer (& to "test" how responsive the cancer is to a particular chemo regimine), not to "cure" the cancer- surgery will still happen no matter what (not to mention the options of radiation and endocrine therapies). And as mentioned, if the Herceptin ISN'T effective on your mom's low HER positivity, there's still the other chemo given alongside it.
I am in the 90s on both HER2 and ER (so not exactly the same as your mother), but after only 2 rounds of TCHP my I had significant, palpable shrinking and softening in my large main tumors and affected lymph nodes, so I know for me it was "worth it" to that end even if don't achieve pCR. I'm still weighing the cost/benefit ratio of hormone therapy, obsessing about HER2 positivity affecting the efficacy of tamoxifen. But if your mother is wanting to do every single thing she can regardless, then she'll do that therapy as well, because for now these are the best options they can offer us, even if they aren't always as effective as we'd like. I believe I read that the long term HER2 crosstalk is MORE likely with tamoxifen vs AIs plus surgical or chemical ovarian suppression (someone correct me if I'm wrong), so that might be worth exploring?
Diagnosed at age 43. Triple + luminal B regional spread to lymph nodes, pathological TNM stage llB after 6 sessions neoadjuvant TCHP (dropped perjeta after 4 doses), initial clinical stage lllA
5/24/2019, IDC, Left, 5cm, Stage IIIA, Grade 2, ER+/PR+, HER2+ (IHC)
8/1/2019 Perjeta (pertuzumab)
8/1/2019 Herceptin (trastuzumab)
8/1/2019 Carboplatin (Paraplatin), Taxotere (docetaxel)
12/27/2019, DCIS/IDC, Left, 4cm, Stage IIB, Grade 2, 2/8 nodes, ER+/PR+, HER2+ (IHC)
12/27/2019 Lymph node removal: Underarm/Axillary; Mastectomy: Left
3/4/2020 Whole-breast: Lymph nodes, Chest wall