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Oct 4, 2017 10:30AM
Oct 4, 2017 10:30AM
Re: "As of my last reading (I haven't looked at the latest recommendations), chemo/Herceptin is not recommended for HER2+ tumors < 1 mm."
The above is not entirely accurate. For ductal, lobular, metaplastic or mixed invasive cancer, that is hormone receptor-negative (ER- PR-), HER2-positive, and node negative ("pN0"), the current version (as well as previous versions) of the NCCN guidelines for breast cancer (Version 2.2017) provide for consideration of chemotherapy plus trastuzumab for those with "Tumor ≤0.5 cm including microinvasive" (i..e., T1mi or T1a):
====> "Consider adjuvant chemotherapy [aa,gg] with trastuzumab [bb,cc] (category 2B)"
Thus, in such patients, treatment plans that either include or do not include chemotherapy plus trastuzumab would be formally within current treatment guidelines.
There are footnotes (aa, gg, bb, cc) that accompany this statement, which I would be inclined to discuss with a Medical Oncologist to ensure accurate understanding of the general guidance provided.
Medical advice entails a personalized risk/benefit analysis. Understanding of recurrence risk profile and the potential benefit of treatment is made more challenging by the more limited clinical data addressing either distant (metastatic) recurrence risk and/or the potential benefit of treatment applicable to those with T1mi, T1a or T1b size tumors, as compared with the data available for larger (T1c or above) and/or node-positive tumors.
The NCCN guidelines for breast cancer can be obtained at no charge with free registration here:
Please note that the charts up front are current as of April, 2017. However, the Discussion section is under revision and has not yet been updated to conform with recent revisions. Therefore, the Discussion section may not be current in some respects.
The main treatment guidelines for adjuvant (post-surgical) systemic therapy for those with early stage invasive HER2-positive disease are located in (1) Chart BINV-5 (hormone receptor-positive, HER2-positive) or (2) Chart BINV-7 (hormone receptor-negative, HER2-positive)
Guidelines address the typical case, and there may be appropriate exceptions in the individual case. The guidelines are not a substitute for case-specific advice from a medical oncologist, but instead should be used to better inform discussions with your treatment team.
AJCC Staging Summary - Tumor size information on page 1, top, center:
T1 = Tumor ≤ 20 mm in greatest dimension
T1mi = Tumor ≤ 1 mm in greatest dimension
T1a = Tumor > 1 mm but ≤ 5 mm in greatest dimension
T1b = Tumor > 5 mm but ≤ 10 mm in greatest dimension
T1c Tumor > 10 mm but ≤ 20 mm in greatest dimension
T2 Tumor > 20 mm but ≤ 50 mm in greatest dimension
T3 Tumor > 50 mm in greatest dimension
Stage IA IDC, 9/2013 BMX. Right: IDC (1.5 mm, grade 2) with DCIS (5+ cm), 0/4 nodes, pN0. Left: DCIS (5+ cm), 0/1 node, pN0(i+).