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 06:05PM

Posted on: Jan 21, 2012 06:05PM

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 31, 2012 09:49PM lago wrote:

gsg Do send your aunt over to these threads:

 taxotere,carboplatin and herceptin  and TRIPLE POSITIVE GROUP 

Let her know she won't possibly be able to read the entire thread but it's worth a skim. Introduce herself and start asking questions. The gals on those threads are awesome.

DONE!! goo.gl/IoaN6U • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010 Dx 7/13/2010, IDC, 5cm, Stage IIB, Grade 3, 0/14 nodes, ER+/PR+, HER2-
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Feb 1, 2012 11:02AM dancetrancer wrote:

Beesie wrote:   "HER2 T1a tumors: 3 recurrences among 36 patients who did not receive Herceptin & chemo, therefore an 8.3% recurrence risk."

Beesie, I just looked at this study.  The follow-up is at 41 months (3.4 years).  How do you evaluate how bad this 8.3% recurrence risk over 3.4 years is?   I mean, how do you know if this risk is high enough to warrant the risk of chemo/TZM?  I don't know how to weigh it.  Does this risk get higher as time goes on, or does it get less?  (BTW, it is duly noted that the small sample size indicates these numbers may not be statistically significant or accurate.) 

Cold caps work! coldcapphotos.shutterfly.com/p... TCH: 4/10 - 6/13/12; 33 rads; BMX w/fat grafting; DX: 7/29/11 @ age 43: Stage 1A on L (3 mm IDC w/ 6 cm DCIS, Gr 2 ER/PR+, HER2+) 0/3 nodes; Stage 0 on R (2 mm DCIS); see bio.
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Feb 1, 2012 12:28PM bluedasher wrote:

Dancetracer, the risk will go up as time goes on as the numbers are tracked cumulatively. Once 8.3% have had recurrences, their recurrences can't unhappen so the number can only go up. HER2+ tumors tend to be aggressive and grow relatively quickly so recurrences tend to happen (really to be found - something has to get big enough to be found) sooner rather than later.

In the MD Anderson retrospective study, it looks like most of the HER2+ recurrences happened in the first 3 and a half years. The line for DFS has dropped below 80% at that point, It gets down to 77% by 5 years so a few more percent happen later. What I can't tell is whether the T1a's are the late occurences - it seems logical for the tumors that start smaller to take longer for a recurrence. 

I think that the best one can say at this point is that your risk of recurrence is probably somewhere between that 8.3% and the 23% in the MD Anderson study. The studies are so small.  

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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Feb 2, 2012 12:13AM AlaskaAngel wrote:

What I would want to know is, what percentage of those who recurred were within 5 years older or younger than my age, and what percentage had the same HR status as I did (within 5 years older or younger than my age). If a huge percentage of them were much younger than me (farther from natural menopause), or had hormonal status that was less favorable than mine, it might help in deciding about treatment.

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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Feb 2, 2012 01:08AM beesie.is.out-of-office wrote:

dancetrancer, 

You asked:  "How do you evaluate how bad this 8.3% recurrence risk over 3.4 years is? I mean, how do you know if this risk is high enough to warrant the risk of chemo/TZM? "

My understanding, as bluedasher points out, is that most recurrences of HER2+ BC occur within the first few years.  If I'm interpreting correctly, bluedasher is saying that the MD Anderson study suggested that 80% of recurrences were within the first 3 1/2 years.  If that's correct, that would mean that a 8.3% recurrence rate over 3.4 years probably equates to a 10% - 11% recurrence rate overall. 

Is that enough to warrant the risk of chemo/TZM?  What's "enough" is different for everyone, based on how we see risk.  For me, the question would be "what percent of those recurrences were distant recurrences?"  There are other ways to deal with the risk of a local recurrence, and frankly, after a MX the risk of local recurrence is likely to be very low.  But a distant recurrence is what you really want to avoid and that's the reason why women take chemo/TMZ.  Personally I'd be okay with a reasonably high risk of local recurrence before I'd subject myself to the risks of a treatment (depending of course on what those risks are) but I'd be willing to expose myself to quite a bit of risk from a treatment if it meant even a relatively small reduction in my distant recurrence risk.  

To the data that is being discussed, I want to point out again that the MD Anderson study that showed the 22.9% 5-year recurrence risk included both local and distant recurrence and both T1a and T1b tumors.  So it's not a clean comparison to the study that shows the 8.4% recurrence rate for T1a tumors only over 3.4 years.  Unfortunately I haven't been able to locate the numbers for distant recurrence risk only for this second study (the study is so small that I suspect the numbers wouldn't be meaningful anyway) but for the MD Anderson study, the 5-year distant recurrence rate for the T1a and T1b tumors was 13.6% - quite a bit lower that the "23%" or "25%" (rounded up) numbers for total recurrence that continue to be quoted here. Truthfully, for me, a 13.6% distant recurrence risk would be plenty to warrant chemo/TMZ; similarly, if I had a T1b tumor, for me the decision would be an easy one.  With a T1a tumor I'd be in the same quandary that you are in because the question that doesn't seem to have an answer is "what is the distant recurrence rate for HER2+ T1a tumors?" 

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Feb 2, 2012 01:33AM bluedasher wrote:

Bessie, you misunderstood what I said. The MD Anderson study poster has a chart of disease free survival versus time (as such studies often do). The HER2+ line on that chart is a bit below 80% at 3 and a half years. (It doesn't have grid lines so a bit below 80% is the best I can do.) The table says disease free survival is at 77% at 5 years. So at 3.5 years, around 11% had had recurrences and by 5 years about 2% more had recurrences.

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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Feb 2, 2012 10:00AM dancetrancer wrote:

Thank you so much everyone for the responses and education.  Beesie, you nailed it - that is my exact question - what is the distant recurrence rate for t1A's?  (I agree, I'm MUCH more concerned about a distant recurrence, b/c that is MUCH more scary.)   I just emailed one of the authors of the study to see if he will answer my question on this.  We'll see if I get a response...I've been pretty lucky getting responses from authors when I email them!  (2 for 2 so far!) 

 Has anyone seen this study? (sorry if it's been discussed before)

Age and Survival Estimates in Patients Who Have Node-Negative T1ab Breast Cancer by Breast Cancer Subtype

 Dr. Gonzalez said they use the charts in this study when discussing risk with their T1a and T1b patients, to help decide on whether to go ahead with treatment or not.  I was able to get my hands on the entire article yesterday and am still analyzing it.  They did some type of multivariable model using hazard ratios.  I will only report distant recurrence info as that is what is most concerning to me: 

HER2+ compared to HR+:  4.70, p value < .001

TN compared to HR+:   2.08, p value .039

<= 35 y/o compared  > 50 y/o:  2.60, p value .04

35-50 y/o compared to > 50 y/o:  2.01, p value .008

Grade 3 compared to Grade 1 or 2: 1.00, p value .99

T1b compared to T1a:  1.45, p value .16

Hormonal therapy compared to no hormonal therapy: 1.19, p value .51

I highlighted the areas pertinent to my particular case.  This table required quite a bit of head scratching on my part to figure out, but I think the take home message for me is, that I can say that my age makes a significance difference (not as much as < 35 y/o, but still reaches significance < .05) in increasing my risk and should be an additional factor to consider alongside the HER2+ factor, which we all know of course increases the risk.  The other factors - grade (I'm grade 2) and stage/tumor size (ta1) did not reach significance level and no conclusions about their importance can be drawn from this study, at least. 

Here's an excerpt from the conclusion:

"There is a paucity of data guiding clinicians on how to proceed with patients with small, node-negative breast cancers.  However, as more information regarding these aggressive biological subtypes emerge, planning systemic treatment based on stage alone appears to lead to worse outcomes.  Taking into account aggressive biological subtypes such as TNBC and HER2-positive breast cancers, as well as age at diagnosis, may better aid the patient and clinician in forming an individualized treatment plan.

Several limitations should be considered when interpreting its results.  This is a retrospective single-institution cohort, which lends inherent bias.  Because clinicians may have been biased to treat t1b tumors with aggressive biology, patients who received systemic chemotherapy or TZM therapy were excluded from this cohort.  This may account for the more frequent t1a tumors in this analysis.  However, this may provide further support for the need to consider the higher recurrence risks for these small tumors."   

Feedback from the research gurus here?  I love that you guys love to pick this stuff apart.  Hope someone else is able to get a copy of the full article.  BTW, my hospital has a patient library.  I can call/email the librarian, and she will get me full articles if they are available and email them to me at no charge.  I try to only request really important ones, so I don't do it all the time and lose my privileges.  But just an FYI for anyone else who may be affiliated with a large university hospital - it's a great resource!   

Cold caps work! coldcapphotos.shutterfly.com/p... TCH: 4/10 - 6/13/12; 33 rads; BMX w/fat grafting; DX: 7/29/11 @ age 43: Stage 1A on L (3 mm IDC w/ 6 cm DCIS, Gr 2 ER/PR+, HER2+) 0/3 nodes; Stage 0 on R (2 mm DCIS); see bio.
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Feb 3, 2012 08:07PM Minnshark wrote:

Sorry Bluedasher, my post wasn't clear. I understand the purpose of chemo/radiation and that the type of surgery doesn't impact the chemo decision. The sentiment I was trying to convey is I did a BMX and haven't looked back. Lumpectomy would have required rads and I was not that attached to my breast to keep either one of them. Actually with the discomfort of reconstruction had I have known I wouldn't have done that either.

Diagnosis: 11/29/2011, IDC, .4cm, Stage 1a, Grade 3, 0/2 nodes, ER-/PR-, HER2+
BMX: 12/14/2011
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Feb 22, 2015 11:24AM - edited Feb 22, 2015 11:26AM by Kheng

Blue dasher

May I know your age and did you opt for chemotherapy

 What is your chemo drugs?

Is your tumour 7 mm?

I am 60 and may not opt for chemotherapy as William Woods from Sloans Kettering Cancer Centre said that he will not recommend adjuvant therapy for hormones negative, her2 positive, node free , 1 cm tumour , grade 3 survivors

From his study, 98.7% mastectomy survivor has 10 years DFS without adjuvant therapy

goh_sweekheng@Yahoo.com.sg

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