Topic: calling all t1A (> 1 mm but < 6 mm) sisters who are HER2+

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

Posted on: Jan 31, 2012 09:59AM - edited Apr 24, 2014 06:29AM by dancetrancer

Posted on: Jan 31, 2012 09:59AM - edited Apr 24, 2014 06:29AM by dancetrancer

dancetrancer wrote:

I decided to start this thread to help others who may end up in this "grey" area and are struggling to make a decision about chemo/Herceptin or not.  Current national guidelines do not recommend treatment for our stage.  Treatment is only considered for 6 mm and up HER2+ sisters.  HOWEVER, some docs do still treat t1A sisters, which makes for a very confusing and stressful decision making process for t1A gals.  I thought we could run an ongoing list of sisters, sharing our decision making process, recommendations, etc.  I will be keeping an informal poll and will update it as we go along.  So far, here is what I found:

  • 6 had no treatment (no Herceptin; some had chemo without Herceptin) and recurred with METS (one dx 2004, one 2007, one 2009, two 2010; one 2012)
  • 7 had no treatment with dx ranging from 2007 to 2012.  One has had a local recurrence 3 years after diagnosis. All others have had no recurrence yet. 
  • 29 have had treatment or are currently undergoing tx; 1 had a local recurrence after tx (ranging 2008 to 2012) 

This is completely unscientific, I know, as there likely is bias b/c women who are more aggressive about treatment may be more likely to frequent these boards, but, I still find the data helpful.  

Of the treated group:
12 had taxol plus Herceptin
12 had TCH
1 refused chemo but doc agreed to Herceptin only

1 had chemo only recommended, no Herceptin

2 had AC-TH

1 had  FECX4 with Herceptin 

 If you reply, please share the size of your IDC, year you were diagnosed, your age (if you are ok with that), Grade of IDC, ER/PR status, recommendations you received from MD's, decision you made, and treatment (if tx'd) you had.  Also note if you have had a recurrence or not. Oh and also if you don't mind sharing, tell us if you are in the USA or another country.  I am interested in seeing if there is a trend for treatment or no treatment based upon country.  

Thank you, I will update the numbers as we move along.   

P.S.  Edited to add an important point made by Beesie in this thread, so that newbies don't freak out when they see whatever numbers happen to be above:   "those who have problems tend to stay on the board longer or return to the board or search out the board when they do have problems. For example, judging by the women here, one would think that the recurrence rate and rate of mets (generally, not just HER2+) is much higher than it actually is. There are thousands of women who've popped in here for a short while, completed their treatment and then, because they don't have a recurrence, are never seen again. It's generally only the women who have a recurrence who return. It makes sense, but it means that the numbers will be skewed to those who have a recurrence vs. those who've happily moved on with their lives and have no further problems." 

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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Mar 13, 2012 09:42PM dancetrancer wrote:

Thanks whippetlover!  

I have a low risk tolerance.  However, that means I'm afraid of recurrence but also afraid of long term side effects of chemo.  LOL.  Just have to laugh at myself.  I would make a horrible president or general...I don't make decisions from my gut well at all, obviously!  

Truly, though, I've come to terms with all of the gray in this situation, as best I can.  I am ready to make a decision after this last consult.  

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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Mar 13, 2012 10:02PM suzieq60 wrote:

dancetrancer - great article!! Good luck with your decision, I know you'll make the right one.

Sue

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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Mar 13, 2012 10:07PM KCD wrote:

Coming back to say that I chose  to go with 12 weekly taxol / herceptins followed by every herceptin every three weeks for a year.    I just compeleted treatment 4 of 12 today.

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Mar 13, 2012 11:19PM dancetrancer wrote:

KCD - thank you for the update!  I hope your treatments are going smoothly! 

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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Mar 21, 2012 04:35PM dancetrancer wrote:

Hi all!  Well, I finally made a decision after meeting with an onc at MD Anderson (one of the authors of the 2008 study and subsequent articles).  She strongly recommended chemo/Herceptin, especially since I am "young"/premenopausal.  Please feel free to check out my thread where I detail all of what she said to me (I took notes after listening to my taped appt).  If you are trying to make a decision, you may find it very helpful.  I think I started posting the summary around page 8 or 9.   I grilled her like I always do all of my docs, and she wasn't phased in the least.  She knows all the small HER2+ research forwards, backwards, and sideways and had an answer for everything.   I totally trust her recommendation.  Will be starting TCHX6 sometime within the next two weeks. 

< 5 mm HER2+ IDC...why NOT chemo??? 

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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Mar 21, 2012 05:03PM dancetrancer wrote:

FYI, just happened upon this article discussing local recurrence rates for t1ab's.  

Estrogen/progesterone receptor negativity and HER2 positivity predict locoregional recurrence in patients with T1a,bN0 breast cancer. 

Abstract
PURPOSE:

Data have suggested that the molecular features of breast cancer are important determinants of outcome; however, few studies have correlated these features with locoregional recurrence (LRR). In the present study, we evaluated estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) as predictors of LRR in patients with lymph node-negative disease and tumors < or = 1cm, because these patients often do not receive adjuvant chemotherapy or trastuzumab.

METHODS AND MATERIALS:
The data from 911 patients with stage T1a,bN0 breast cancer who had received definitive treatment at our institution between 1997 and 2002 were retrospectively reviewed. We prospectively analyzed ER/PR/HER2 expression from the archival tissue blocks of 756 patients. These 756 patients represented the cohort for the present study.

RESULTS:
With a median follow-up of 6.0 years, the 5- and 8-year Kaplan-Meier LRR rate was 1.6% and 5.9%, respectively, with no difference noted in those who underwent breast conservation therapy vs. mastectomy (p=.347). The 8-year LRR rates were greater in the patients with ER-negative (10.6% vs. 4.2%, p=.016), PR-negative (9.0% vs. 4.2%, p=.009), or HER2-positive (17.5% vs. 3.9%, p=0.009) tumors. On multivariate analysis, ER-negative and PR-negative disease (hazard ratio, 2.37; p=.046) and HER2-positive disease (hazard ratio, 3.13, p=.016) independently predicted for LRR.

CONCLUSION:
Patients with ER/PR-negative or HER2-positive T1a,bN0 breast cancer had a greater risk of LRR. Therapeutic strategies, such as the use of chemotherapy and/or anti-HER2 therapies, should be considered for future clinical trials for these patients. 

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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Jun 4, 2012 02:16AM laprofessoressa wrote:

Thanks for this. I have a 6mm tumor (they thought it was larger but the rest ended up being DCIS....), HER 2 POS

Lumpectomy

now will begin (in 2 weeks) chemo TCH and Herceptein for the year & radiation

Dx 4/24/2012, <1cm, Stage I, ER-, HER2+ Surgery 5/10/2012 Lumpectomy: Left, Right; Lymph node removal: Right, Sentinel Surgery 5/24/2012 Lumpectomy: Right Targeted Therapy 6/19/2012 Herceptin (trastuzumab) Chemotherapy 6/19/2012 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy Breast
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Jun 4, 2012 09:27AM dancetrancer wrote:

You are so welcome laprofessoressa!  I'm glad you found it helpful.  I'm currently in the middle of TCH myself.   If you have any questions about that regimen, this thread is very helpful - lots of great ladies on it who have been through TCH still post over there:  taxotere,carboplatin and herceptin

And I don't know if you are hormone positive or not, but if you are, the triple positive thread is also a fantastic resource.  

Welcome to the boards!  

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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Jun 8, 2012 01:31PM hopeful123 wrote:

Thought this might interest this group it is an abstract at the most recent ASCO. I was excited about the last line and wanted to share- no relapse!

Author(s): Yazan Migdady, William M. Sikov, Bachir Joseph Sakr, Adam J. Olszewski; Memorial Hospital of Rhode Island, Pawtucket, RI; Warren Alpert Medical School of Brown University, Providence, RI; Program in Women's Oncology, Women and Infants Hospital of Rhode Island, Providence, RI


Abstract:

Background: T1ab triple-negative (TN) or Her-2-positive (H2+) breast cancers are reported to pose relatively high risk of relapse, but benefits of adjuvant chemotherapy are uncertain. We studied the impact of chemotherapy on recurrence-free survival in this group. Methods: Records of all consecutive cases diagnosed in Brown-affiliated centers in 2000 - 2010 were reviewed. Factors influencing chemotherapy decision were studied with logistic regression, and recurrence-free interval (RFI) with a Cox proportional hazard model and Kaplan-Meier estimator. Results: Among 1415 screened T1a/b N0 cases, 161 were eligible (57 TN; 104 HER2+), with a median age of 57 years; 66% tumors were T1b. 20% of patients underwent mastectomy, 76% received radiation and 30% hormonal therapy. Adjuvant chemotherapy was recommended in 53% of cases. Younger age (p<10-6), stage T1b (p<10-5), high grade (p=0.001), HER2+/ERPR- status (p=0.017) and diagnosis after 2006 (p=0.007) were significantly predictive of the medical oncology recommendation. There was a significant trend with decrease in anthracycline (p<0.001) and increase in taxane use (p<0.001). With a median follow up of 46 months, the 5-year rate of relapse was 6.1% (95%CI 2.7-13.9%), somewhat higher in T1b tumors (8.1%) and without detectable difference in TN/HER2+ subgroups. In a univariate analysis chemotherapy did not significantly impact the recurrence-free interval (HR=0.45; 95%CI 0.09-2.34; p=0.32), however there was a detectable benefit (p=0.02) for T1b tumors in a multivariable Cox model including age (p=0.02) and LVI (p=0.01). The histology, type of surgery and year of diagnosis were not significant. There were no relapses among ER/PR+ patients who received hormonal therapy or HER2+ patients who received trastuzumab. Conclusions: The risk of relapse in biologically aggressive T1ab breast cancers is very low with judicious use of adjuvant therapy. The benefit of chemotherapy is likely restricted to the highest-risk patients with T1b tumors, lymphovascular invasion and younger age.

Dx 1/2012, IDC, Stage IA, Grade 3, ER+/PR-, HER2+
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Jun 8, 2012 01:33PM - edited Jun 8, 2012 01:35PM by hopeful123

Background: T1ab triple-negative (TN) or Her-2-positive (H2+) breast cancers are reported to pose relatively high risk of relapse, but benefits of adjuvant chemotherapy are uncertain. We studied the impact of chemotherapy on recurrence-free survival in this group. Methods: Records of all consecutive cases diagnosed in Brown-affiliated centers in 2000 - 2010 were reviewed. Factors influencing chemotherapy decision were studied with logistic regression, and recurrence-free interval (RFI) with a Cox proportional hazard model and Kaplan-Meier estimator. Results: Among 1415 screened T1a/b N0 cases, 161 were eligible (57 TN; 104 HER2+), with a median age of 57 years; 66% tumors were T1b. 20% of patients underwent mastectomy, 76% received radiation and 30% hormonal therapy. Adjuvant chemotherapy was recommended in 53% of cases. Younger age, stage T1b, high grade, HER2+/ERPR- status and diagnosis after 2006 were significantly predictive of the medical oncology recommendation. There was a significant trend with decrease in anthracycline and increase in taxane use. With a median follow up of 46 months, the 5-year rate of relapse was 6.1%, somewhat higher in T1b tumors (8.1%) and without detectable difference in TN/HER2+ subgroups. The histology, type of surgery and year of diagnosis were not significant. There were no relapses among ER/PR+ patients who received hormonal therapy or HER2+ patients who received trastuzumab. Conclusions: The risk of relapse in biologically aggressive T1ab breast cancers is very low with judicious use of adjuvant therapy. The benefit of chemotherapy is likely restricted to the highest-risk patients with T1b tumors, lymphovascular invasion and younger age.

Sorry looks like the previous message got chopped.

Dx 1/2012, IDC, Stage IA, Grade 3, ER+/PR-, HER2+

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