Topic: How large does Tumor gets chemo and herceptin

Forum: HER2+ (Positive) Breast Cancer — Testing, treatment, side effects, and more.

Posted on: Jan 21, 2012 05:05PM

Posted on: Jan 21, 2012 05:05PM

ccjj wrote:

Curious... my step mom had BMX due to high grade DCIS in left and suspicious area of concern in right.  After surgery, pathology came back with invasive ILC Her2+ in right breast. Very small, less than 1/2 cm. Sentinel nodes were clear.  Surgeon thought no chemo would be needed.  I thought all Her2+ invasive tumors were treated with chemo and herceptin.  What size warrants chemo and herceptin?

Dx 7/7/2011, ILC, 2cm, Stage IIA, Grade 2, 1/9 nodes, ER+/PR+, HER2+
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Jan 26, 2012 03:15PM - edited Jan 26, 2012 03:16PM by suzieq60

I know that the study didn't have many patients, but we all loved that flat line when we saw it.

2nd diagnosis October 2010 - IDC 5.8mm node negative - missed on mammogram in October 2009 Dx 10/13/2009, ILC, 1cm, Stage I, Grade 3, 0/5 nodes, ER+/PR+, HER2+
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Jan 26, 2012 03:57PM AlaskaAngel wrote:

Well, it would also be more honest if they put a footnote indicating that they don't have information as to what effect or how much effect is due to the addition of chemotherapy, also.

A.A.

Dx 12/3/2001, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2+, Surgery 1/3/2002 Lumpectomy: Left; Lymph node removal: Left, Sentinel Chemotherapy 3/12/2002 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Fluorouracil (5-fluorouracil, 5-FU, Adrucil) Radiation Therapy 9/10/2002 Breast Hormonal Therapy 11/15/2002 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jan 26, 2012 08:18PM orange1 wrote:

AA -

From large studies we know that:

For Her2+ breast cancer, chemo without herceptin cuts recurrence risk approximately in half.  Add Herceptin, and recurrence is cut approximately in half again.

So perhaps they should put a footnote in saying half the effect was from chemo?

Dx 8/2007, IDC, 1cm, Stage I, Grade 3, 0/3 nodes, ER+/PR-, HER2+
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Jan 26, 2012 09:04PM beesie.is.out-of-office wrote:

orange1, good point!  But shouldn't it say that 67% of the risk reduction was from chemo?

If someone starts out with a 28% risk, chemo cuts that risk in half to 14% and Herceptin cuts it in half again to 7%, the total reduction in risk is 21 percentage points (75% risk reduction!), of which chemo provided 14 of those percentage points - 67%.

Not making a statement here, just following up on the math!  Wink

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Jan 26, 2012 09:11PM AlaskaAngel wrote:

Orange1,

I can see how easy it would be to take that point of view with numbers.

But since we don't yet know whether trastuzumab alone used on a system that has not had the effect of severe depression of the immune system through chemo may actually be enough for very early stage HER2 positive aggressive cancer all by itself (since we only have other studies of use of H used alone with higher-risk patients), or whether it would be 100% adequate for early stage HER2 positive HR+ bc in combination with hormonal therapy, we can't just arbitrarily assume we know whether any chemo or how much other therapy would be needed.

A.A.

Dx 12/3/2001, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2+, Surgery 1/3/2002 Lumpectomy: Left; Lymph node removal: Left, Sentinel Chemotherapy 3/12/2002 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Fluorouracil (5-fluorouracil, 5-FU, Adrucil) Radiation Therapy 9/10/2002 Breast Hormonal Therapy 11/15/2002 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jan 26, 2012 09:29PM - edited Jan 26, 2012 09:29PM by bluedasher

AA and orange,

first off, they only have two years of follow-up on half the Herception group in that study. That makes the chart pretty meaningless. They carried the line out to 5 years, but they only had two women who had more than 3 years of follow-up in the Herceptin group. In BCIRG 006, the lines for both Herceptin arms in the node negative graph stay pretty horizontal for the first 2 years while the non Herceptin arm starts dropping at 12 months. So it isn't surprising to me that in this group of women with smaller node negative tumors there were no recurrences at 2 years follow-up when Herceptin is given. There aren't enough women who got Herceptin and had follow up past 2 years in this study to tell whether the zero recurrences is because Herceptin delayed or prevented recurrence. I hope that it prevented it but there isn't information here to confirm that.

secondly, in that study, some of the non-Herceptin group did have chemo. They mention that one of the 5 recurrences in the non-Herceptin group had had chemo. They don't mention what proportion of that group had chemo. 

thirdly, it isn't clear that the effect of chemo or Herceptin or the combination of them scales the same independent of how far along the cancer was. For example, in BCIRG 006, adding Herceptin to AC-T cut recurrence by about half in the node negative group but by about 1/3 in the node positive group. And even with such a large sample (~3000 in the study with about 300 node negative and 750 node posititive in each arm), the confidence intervals on the hazard ratios are still pretty broad. For example, when node negative DFS was improved by about half, the 95% confidence interval was 0.28 to 0.77 - anywhere between cutting recurrence by 1/4 to 3/4. Effect of chemo and Herceptin has been studied so little on node negative tumors >1cm that IMO there is no support for saying how much Herceptin improves odds compared chemo alone.

Also, even if one knows that chemo plus Herceptin cut recurrence by x and chemo alone cut it by y, there is no way to use x and y to figure out that Herceptin alone would kill z. There can be cancer cells that Herceptin kills without help and cancer cells that chemo kills without help, an unknown overlap between those two sets and some cancers that only the synergistic effect of chemo plus Herceptin kills.

The whole world is a narrow bridge and the main thing is to not fear. Dx 9/2008, IDC, <1cm, Stage IB, Grade 2, 0/5 nodes, ER-/PR-, HER2+ Targeted Therapy Herceptin (trastuzumab) Surgery Lumpectomy: Left Radiation Therapy Chemotherapy Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Jan 26, 2012 09:44PM AlaskaAngel wrote:

I don't disagree with that. At all.

A.A.

Dx 12/3/2001, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2+, Surgery 1/3/2002 Lumpectomy: Left; Lymph node removal: Left, Sentinel Chemotherapy 3/12/2002 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Fluorouracil (5-fluorouracil, 5-FU, Adrucil) Radiation Therapy 9/10/2002 Breast Hormonal Therapy 11/15/2002 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jan 26, 2012 09:54PM orange1 wrote:

Thanks Beesie!  I never remember to check my math. 

Dx 8/2007, IDC, 1cm, Stage I, Grade 3, 0/3 nodes, ER+/PR-, HER2+
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Jan 31, 2012 11:25AM PatMom wrote:

There is no rubber stamp, one size fits all treatment for any type of breast cancer. 

Age of the patient is a huge factor in what combination of treatments is recommended.

Comorbidities are another huge factor in treatment decisions.

Heart disease is the leading cause of death in women over 40, so the cardiac risks associated with Herceptin may become a much larger factor as a woman ages.

No matter how well you think you know another person, there may be factors in their health history or their family history that you may not be aware of that may significantly influence treatment choices.

There is no treatment that will guarantee a successful outcome.  When one becomes available, the word "cure" will be used, until then, we do the best we can to make the best choices for our particular circumstances.

To the original poster - the standard approach is for a medical oncologist to prescribe the AI that seems to be the anticipated treatment for your step mother, but they may be waiting until all surgery is completed before adding that component.  This journey can be overwhelming, and sometimes time is needed to deal with one issue before moving on to the next.  Wishing you all the best as you search for the best possible outcome.

Until the time when someone comes up with a definitive "cure", we each have to cobble together what we believe will be the most effective treatment that we can live with, not merely survive.
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Jan 31, 2012 07:31PM gsg wrote:

My aunt was just diagnosed IDC Triple Positive, Grade 2, 8 mm.  Her breast surgeon said she would not get chemo nor Herceptin, just lumpectomy, radiation, Arimidex because tumor is so small.  I asked her to make an appointment with an oncologist for another opinion. She saw her today.  Guess what.  Lumpectomy, TCH and then radiation and Arimidex.  Would definitely advise people to see an oncologist on their own and not take the word of the breast surgeon.  They're not oncologists.

I also just sent my aunt a link to this thread, so you may have a new sister joining you!  Bonus:  She's hysterical.

Best wishes to you all.

Pardon me if I repeat myself. Can't remember jack. Dx 3/2006, IDC, 3cm, Stage IIA, Grade 2, 0/2 nodes, ER+/PR+, HER2-

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