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Jun 13, 2014 12:09PM
Jun 13, 2014 12:12PM
It has been a long time since I posted on here, mainly because chemo had me pretty sick, and I didn't want to be a bummer for those of you going through this new protocol because it looked like I wasn't following the same wonderful course.
Well, I made it through my six sessions of Taxotere, Carboplatin, Herceptin and Perjeta, and had a bilateral mastectomy with immediate reconstruction on May 30th. I just received the pathology report day before yesterday, and I was very surprised.
For those of you that remember me from my initial posts, my initial diagnosis was IDC, 2.5 cm extending to 6 cm with suspected involved DCIS. This got me the neoadjuvent treatment including Perjeta which had just been approved for neoadjuvent treatment only for early stage bc with tumor size 2cm or more. The tumor was 0% ER/PR staining, 100% staining 3+ Her2Neu over expression.
But then I had a pesky MRI and they found another separate lesion, prompting an MRI guided biopsy on a tiny 4mm finding. Turned out this one was ER/PR positive, Her2 negative and again invasive, but only grade 1. But it was so inconsequential compared with the other tumor, they decided to go forward with the neoadjuvent chemo regimen targeting only the Her2 positive tumor.
In early April I had another Pet scan, and the Her2 tumor seemed to be shrinking, but still there, but the hormone receptive one seemed to have grown tremendously. I thought what they were looking at was a hematoma from the biopsy because I had sustained a huge bruise on that breast that lasted months, so I wasn't too concerned.
Well, here's the interesting part. The pathology report is in, and that nasty Her2 positive tumor is literally gone! I had a complete pathological response cPR on that tumor, and all that was left was the clip. BUT, the little 4mm hormone receptive tumor grew from 4mm to 3.7 cm in that short time between starting chemo in January and surgery in May. It also changed from grade 1 to grade 2, SBR score 7. There was also expansive DCIS grade 3, central expansive "comedo" necrosis. Apparently that means there were dead cancer cells throughout my ducts, I assume from the suspected DCIS surrounding the first tumor.
I am literally a petri dish for effectiveness of this chemo regime for Her2 positive neoadjuvent targeted therapy because it shows how incredibly effective the Herceptin and Perjeta were in targeting the Her2 proteins, but yet the hormone receptive tumor was literally growing out of control because I had no hormone targeted therapy during this time. My surgical oncologist believes that it grew so rapidly due to my immunosuppression during chemo. It goes a long way to prove the protocol of neoadjuvent treatment for Her2 positive cancer, but for hormone receptive cancer, immediate surgery and adjuvent treatment later.
I am so happy with the outcome of the more dangerous Her2 positive tumor. And, I am so thankful for UCLA Dr. Dennis Slamon for his work on Herceptin, and now his involvement with Perjeta. Having the opportunity to see so clearly the effectiveness of this targeted therapy with my unique situation with the two tumors really sends home how fortunate we Her2 positive patients are to be treated now and not 15 years ago.
My next hurdle is getting through this rather painful mastectomy and reconstruction surgery. That's a story for another thread….
11/26/2013, IDC, 5cm, Grade 2, ER-/PR-, HER2+
1/10/2014, IDC, <1cm, Stage IA, Grade 1, ER+, HER2-
1/13/2014 Herceptin (trastuzumab)
1/13/2014 Perjeta (pertuzumab)
1/13/2014 Carboplatin (Paraplatin), Taxotere (docetaxel)
5/29/2014 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left); Reconstruction (right)
5/30/2014, DCIS, Stage 0, Grade 3, 0/6 nodes, ER+/PR+, HER2-
5/30/2014, IDC, <1cm, Stage 0, Grade 1, 0/6 nodes, ER+/PR+, HER2-
5/30/2014, IDC, 3cm, Stage IIA, Grade 2, 0/6 nodes, ER-/PR-, HER2+