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Topic: Herceptin only?

Forum: HER2+ (Positive) Breast Cancer —

Testing, treatment, side effects, and more.

Posted on: Jun 4, 2015 05:36PM

Cheesequake wrote:

I met with my surgeon today to discuss placing a port in advance of chemo. We talked about all the specifics, the procedure itself, risks, etc, and I was doing fine. Then he said, "so what's going on in your head right now?" and the floodgates just opened. I started bawling about how conflicted I am about chemo - the potentially permanent or long lasting side effects, the relatively low improvement numbers, the lack of ability to monitor effectiveness, the likely destruction of my sex life - and volunteering for this all when I feel absolutely, totally fine. I'm literally vacillating from one hour to the next between "it would be absolutely foolish not to try every conventional treatment in the arsenal" and "I am NOT signing up for that shit!!" I cried all the way home and then some more, my eyes are nearly swollen shut. I just got back from having a chest/abdomen/pelvis CT scan (even though I'm not supposed to have radiation unless absolutely necessary because I have Li-Fraumeni Syndrome, which increases my risk for new radiation induced cancers) so I've decided not to even make any irreversible decisions until I have the results and know whether I'm Stage IV.

All of that was just to get it off my chest, sorry for the rant. The point of this thread is to ask, since I am utterly terrified of chemo:

Is there any effectiveness to just doing Herceptin? Or must it be done in conjunction with chemo?

Thanks.

I'm age 42, married, no kids. I have Li-Fraumeni Syndrome, a genetic disorder that gives women a nearly 100% lifetime risk of several types of cancer and makes radiation-induced cancers more likely. Dx 3/4/2015, IDC, Left, 3cm, Stage IIA, Grade 2, ER+/PR+, HER2+ (FISH) Surgery 4/27/2015 Lumpectomy: Left; Lymph node removal: Sentinel Targeted Therapy 7/17/2015 Herceptin (trastuzumab) Chemotherapy 7/17/2015 Carboplatin (Paraplatin), Taxotere (docetaxel)
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Jun 4, 2015 09:05PM - edited Jun 6, 2015 10:03PM by sauvez-la


In December 2014 I found out I had Stage iv Breast cancer (Liver mets). From what I've read I still don't know if taking Hercepin when I first had breast cancer in 2010 would have reduced the chances of it coming back but because I never got chemo before, I am a perfect candidate for a Herceptin-Perjeta-Taxol combo that can add 5 years to my life. Check out this article in the New England Journal of Medecine:

http://www.nejm.org/doi/full/10.1056/NEJMoa1413513

However I'm wondering, since this treatment only works 30-50% of the time, if I'd rather not have it at all and enjoy the rest of my life without chemo brain, vaginal atrophy, blurred vision, neuropathy..?


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Jun 4, 2015 09:17PM gracie22 wrote:

That's a big, largely unanswered question. From what I have read, there is not much info since Herceptin is almost always given in conjunction with standard chemo for stage 1 to 3 in the US. Herceptin solo is sometimes used with stage VI and for early stage for older HER2 patients who can't tolerate or don't want chemo, more commonly in Europe.  I am HER2+, had a BMX in late January after a 4cm tumor found in one breast.  SNB was negative.  Chemo and Herceptin highly recommended, but I have done neither at this point. I had a PET which was negative (and yes, I know that it is no guarantee that there are not mets, just not ones visible at this point), and was considering solo Herceptin when a hospital acquired staph infection landed me back in the hospital for a week followed by another 2 weeks of IV antibiotics--I'd had one step reconstruction with implants and lost one of the implants to the infection. It is hard when you were feeling perfectly fine, and boom, the "treatment" makes you miserable. I am back at work and thankfully feel well now. I saw two oncologists prior to the infection and while both emphatically recommended the standard chemo treatment, both also offered solo Herceptin when I indicated that chemo was a non-starter for me.  I am in a different situation than you; I am older (56) and I am OK with possibly not doing anything further beyond monitoring; I accept the possible repercussions of that decision. Kid is raised, I have had satisfying work and relationships--I don't feel like putting myself and my loved ones through it. I have probably read a thousand blogs, articles, studies, patient comments etc. since getting diagnosed back in December. This site in particular has been very helpful in getting a window on what it is like to deal with breast cancer. The treatments are not for me; I loathe being a patient, medical environments and reliance on others, and in my particular situation, QOL is key.  The bottom line: chemo/Herceptin regimens improve your chances statistically. Most oncologists feel that there is a synergy with chemo/Herceptin and that the chemo increases the effectiveness of Herceptin. There is a price for whatever decision we make; the choice to undertake the treatment is a uniquely personal one. Herceptin is definitely more attractive than the standard chemo since it actually targets something and seems to do less overall damage than chemo, although there is a small heart risk. And even Herceptin does not work on everyone; from what I have read it will benefit 30 to 50% of patients--the stats vary.  One of the oncologists emailed me recently about considering Herceptin again.  At this point, so far past surgery, I am not sure of the benefit, but I am willing to listen.  Another writer on these boards, AlaskaAngel, is a proponent of  solo Herceptin for early stagers and may have more specific info for you, and SpecialK is so very knowledgeable. I get how confused you are and how heartsick some of the entries here can make you.  Some women have suffered terribly, and there is so little clarity on how or if we will benefit from these treatments. This is a chemo-positive website in general, and that makes sense since there is just not much else. I don't think we will ever graduate to drastically different treatment until there is a bit of a medical and patient revolution. The techniques being developed to analyze tumors are so much more sophisticated than the treatments.

Dx IDC, Right, 4cm, Stage IIA, Grade 3, 0/2 nodes, ER-/PR-, HER2+ (FISH) Surgery Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right): Silicone implant
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Jun 5, 2015 11:39AM Bernie440 wrote:

Hello. I was diagnosed with Stage 1 Grade 3 ER-PR- HER2+++ last August at age 51.  I started the TDM1 trial in October which is Kadcyla (aka Super Herceptin)  TDM1 is Herceptin (targeted therapy) combined with a targeted chemo which is supposed to  have less side effects than standard chemo.  Most people do not have any problems and even keep their hair.  I had a bad reaction to it and only took 4 or the 17 treatments (given every 3 weeks intravenously)  My onc pulled me from the trial and I am now doing Herceptin only.  I did have high intensity radiation (16 treatments) back in February - no side effects from that so far. 

Invasive medullary carcinoma. Dx aug 2014 Dx 8/12/2014, IDC, 1cm, Stage I, Grade 3, 0/1 nodes, ER-/PR-, HER2+ Surgery 8/20/2014 Lumpectomy: Left Radiation Therapy 1/22/2015 Breast Targeted Therapy 1/29/2015 Herceptin (trastuzumab)
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Jun 5, 2015 03:27PM - edited Jun 5, 2015 03:28PM by Cheesequake

Bernie, thank you for posting. So what was your reaction was to the Kadcyla? Do they plan to put you on different chemo?

I'm age 42, married, no kids. I have Li-Fraumeni Syndrome, a genetic disorder that gives women a nearly 100% lifetime risk of several types of cancer and makes radiation-induced cancers more likely. Dx 3/4/2015, IDC, Left, 3cm, Stage IIA, Grade 2, ER+/PR+, HER2+ (FISH) Surgery 4/27/2015 Lumpectomy: Left; Lymph node removal: Sentinel Targeted Therapy 7/17/2015 Herceptin (trastuzumab) Chemotherapy 7/17/2015 Carboplatin (Paraplatin), Taxotere (docetaxel)
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Jun 8, 2015 12:35PM Bernie440 wrote:

I reacted to the Kadcyla about 10 days after its infusion by having severe stomach pains that lasted 24/7 for 7 to 10 days straight each time I was infused with it.  I also completely lost my appetite.  I would try to eat, but couldn't even swallow food.   I also couldn't hardly drink anything.  I lost 25 lbs in three weeks time. 

No plans to put me on chemo.  Just Herceptin now thru October.  I did have rads in February.

Invasive medullary carcinoma. Dx aug 2014 Dx 8/12/2014, IDC, 1cm, Stage I, Grade 3, 0/1 nodes, ER-/PR-, HER2+ Surgery 8/20/2014 Lumpectomy: Left Radiation Therapy 1/22/2015 Breast Targeted Therapy 1/29/2015 Herceptin (trastuzumab)
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Nov 9, 2015 04:09AM barbiecorn wrote:

I definitely would have tried Herceptin if it were not for my family heart issues...entire family passed in their 60s, and 50s from heart related issues...I am pushing 70...was not sure if my heart could handle it...I have read of women who had to stop Herceptin due to heart issues.....it is a personal choice...good luck to everyone facing this issue.

Dx 12/26/2011, 2cm, Stage IIA, Grade 2, 0/0 nodes
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Nov 9, 2015 06:17AM ruthbru wrote:

A friend of mine was allowed to do Herceptin only. She was 63 years old, Stage IA, and highly ER & PR positive (so the 5 years of an anti-hormonal was a must as part of the 'get out of chemo' deal). She did fine with it all, and 9 years later is still fine. I do know though, that had she been younger they would have been very reluctant to 'only' do Herceptin.

"Invisible threads are the strongest ties." Friedrich Nietzsche Dx 2/2007, Stage IIA, Grade 3, 0/11 nodes, ER+/PR-, HER2-
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Nov 9, 2015 06:48AM ElaineTherese wrote:

Heart issues run in my family, too. But, I was OK with Herceptin because my oncologist has been monitoring my heart very carefully. I am relatively young, though (46 at diagnosis, now 48).

DX IDC June 28, 2014, 5 cm., 1 node tested positive (fine needle biopsy); 0/20 after neoadjuvant chemo + ALND; Grade 3; ER+ PR+ HER2+ Neoadjuvant chemotherapy starting 7/23/14 ACX 4, Taxol X 12, Perjeta X 4; Herceptin: one year Chemotherapy 7/23/2014 AC Targeted Therapy 9/17/2014 Perjeta (pertuzumab) Targeted Therapy 9/17/2014 Herceptin (trastuzumab) Chemotherapy 9/17/2014 Taxol (paclitaxel) Surgery 1/12/2015 Lumpectomy: Right; Lymph node removal: Right, Underarm/Axillary Hormonal Therapy 2/25/2015 Aromasin (exemestane), Zoladex (goserelin) Radiation Therapy 3/9/2015 Breast, Lymph nodes
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Nov 9, 2015 11:18AM Topaz15 wrote:

thank you all for the informative discussion, I'm facing the exact decision now... Spoke to different Oncologist and the view seem to vary regarding taxol/ hercipton vs only hercipton. I was told about the synergistic benifit but no one explained how much is that benifit likely to contribute to success. Also , I'm not clear why the need for such long treatment period if hercipton is such a targeted therapy.


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Nov 12, 2015 11:31AM ThePrincess wrote:

Anyone itchy across the shoulders?? I just found out this is a common SE and treated with claritin! I've been going nuts thinking it was something else! Hope this helps someone!

Dx 3/23/2015, IDC, Right, 1cm, Stage IIA, Grade 3, ER-/PR-, HER2+ (FISH)
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Nov 17, 2015 10:25AM MamaBexar wrote:

I am a good example of the choice between Herceptin and Herceptin/Chemo. My case was presented at two different cancer conferences for a total of 20 MO. There were eight different recommendations. Majority said Herceptin only due to my age (77) and my Ki67 score(3% indicates VERY slow cell growth). They did not even put in port at time of surgery. Then the Mamaprint came back at High Risk of reacurrance. At that point Taxol weekly was added. Now they are saying that a mamaprint should be done on every HER2+.

MamaBexar Dx 7/27/2015, IDC, Right, <1cm, Stage IA, Grade 2, 0/4 nodes, ER-/PR-, HER2+ (FISH) Surgery 9/8/2015 Lumpectomy: Right; Lymph node removal: Sentinel Targeted Therapy 10/8/2015 Herceptin (trastuzumab) Chemotherapy 10/8/2015 Taxol (paclitaxel)
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Nov 17, 2015 10:27AM MamaBexar wrote:

Topaz, I recommend the Herceptine site online. It has so much info that you will find helpful.

MamaBexar Dx 7/27/2015, IDC, Right, <1cm, Stage IA, Grade 2, 0/4 nodes, ER-/PR-, HER2+ (FISH) Surgery 9/8/2015 Lumpectomy: Right; Lymph node removal: Sentinel Targeted Therapy 10/8/2015 Herceptin (trastuzumab) Chemotherapy 10/8/2015 Taxol (paclitaxel)
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Nov 17, 2015 06:39PM AlaskaAngel wrote:

The question about trastuzumab alone vs chemo and trastuzumab really is a question about the way in which clinical trials can both advance information and inhibit it.

Initially there was leeway for those who were on the fence to obtain trastuzumab without chemo. But because the trials used both chemo and trastuzumab and had no "arm" of patients that did trastuzumab alone, official :"approval" of the use was based on the documented use of chemo + trastuzumab. In other words, it was a conclusion reached not on the basis of evidence, but instead on the lack of evidence that would prove whether trastuzumab if used alone would work for any given group of patients.

Some pro-chemo advocates point to the trials that used trastuzumab alone for those patients who had mets as being "evidence" that trastuzumab when used alone was not very effective. I hate to state the obvious, but there isn't much out there that turns mets around, period. IMHO, the reason trastuzumab wasn't effective for those with mets was because it couldn't deal with that much of a tumor burden. That is my own personal speculation.

My friend with early stage aggressive HER2+ bc chose not to do chemo in 2006, and was able to get trastuzumab alone through an independent oncologist (someone who doesn't have to trot along with the herd decision-making process). She remains without recurrence at this time.

Best of luck with your decisions,

AlaskaAngel

Dx 12/3/2001, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2+ (IHC) 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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Nov 18, 2015 04:01AM ca55 wrote:

AlaskaAngel - I have been following this thread, but have never posted. I guess the real reason is I never wanted to advocate for my choice to do herceptin only since it was not the standard of care. I will be finishing my year of treatments next month. It is not my intention to convince anyone to follow my treatment plan, but I have to admit that I was very encouraged by your friend who is NED since 2006. My reason for not doing chemo was because of a comorbidity. I was diagnosed with follicular lymphoma at the time I discovered my breast cancer, and am not being treated for it at this time. It was all so overwhelming, and all I could think of at the time was weakening my immune system with chemo, and unleashing the indolent lymphoma. I know that may not be rational, but that was my fear. Anyway, I convinced myself that herceptin alone was better than no adjuvant treatment, and my MO agreed. She has always made me feel like I made a good decision, even though it was not the recommendation of the tumor board (taxol plus herceptin, of course). It seemed to me that the herceptin could handle whatever stray cancer cells may be present after surgery. I don't know that; I just believe it.

Dx 10/29/2014, IDC, <1cm, Stage IB, Grade 3, 1/3 nodes, ER-/PR-, HER2+ Surgery 11/3/2014 Lymph node removal: Left, Sentinel Surgery 11/13/2014 Mastectomy: Left Targeted Therapy 12/28/2014 Herceptin (trastuzumab)
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Nov 18, 2015 06:14AM AlaskaAngel wrote:

ca55,

Yes. Because chemo (even with its poor, hit-and-miss track record in general) worked some of the time, it became the "standard of care", whether or not there are categories of patients who not only get no benefit from it but who then are faced with the down sides of doing chemo in terms of the immune system response. This is addressed by adding drugs such as trastuzumab, which raise the level of response to what they want to call "synergy", for lack of any other explanation as to why the use of chemo for HER2+ patients was so dismal prior to the addition of trastuzumab.

I also had aggressive stage 1 HER2+ bc, and did CAF chemo x 6 followed by radiation for a lumpectomy, followed by a year of tamoxifen at full dose and then less than a year at half dose. I've never done an AI. I have had no recurrence. At time of dx, the Herceptin (trastuzumab) trials were in progress, but I did not know about them. I told my onc I was interested in participating in clinical trials for HER2+ patients and apparently was eligible for one of them, but he did not tell me about them. They had been going since sometime around 1999. I had no comorbidity, but felt that because I had no poor health habits (no smoker, proper weight/diet/exercise, etc.) PLUS a huge family history of bc but only 1 death from it (a diagnosis in the 1950's when bc was diagnosed in the later stages), I felt chemo was not as likely to help and would be more detrimental. At the time, such online info as this board were just beginning to evolve and were not known to me. I did the recommended tx.

A.A.

Dx 12/3/2001, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2+ (IHC) 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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Nov 18, 2015 08:52AM AlaskaAngel wrote:

P.S.

What I do think is relevant to mention (and that explains the "synergy" of chemo added to trastuzumab) is the benefit that occurs with treatments that bring about ovarian suppression/menopause. Chemo does this for most (since the majority of bc patients are over the age of 40).

The issue there is, since ovarian suppression can be done through other, far less toxic and expensive methods that don't tinker with the immune system, it doesn't make sense to use chemo to do it.

Ovarian suppression/menopause affects the rate of metabolism, slowing it down. That is what brings about weight gain. Weight gain then gradually contributes to recurrences by increasing the amount of body fat, since body fat is a source of more estrogen. However, when the metabolism is slower, there is more time for abnormal cells as well as normal cells to proceed through the normal process of dying instead of the process of cancer cells multiplying rapidly.

The points here are:

1) that we probably aren't going to be able to avoid the sexual slowdown involved with either chemo or ovarian ablation, but of the two, OA may be preferable as a natural process that allows the immune system to continue to function -- especially if one chooses to use a form of ovarian suppression that one can choose to stop at a point in time, rather than choosing permanent removal of the ovaries.

2) that younger patients, who have a higher recurrence rate, likely should make sure they do add some form of OA to the trastuzumab, and not just dump the chemo and rely on trastuzumab.

3) and weight management through diet and exercise also are likely to make a real difference in terms of recurrence.

A.A.

Dx 12/3/2001, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2+ (IHC) 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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Nov 18, 2015 09:54AM - edited Nov 18, 2015 10:13AM by BarredOwl

Hi AlaskaAngel:

May I ask if you know whether your friend was ER-PR- (like some of the posters here) or was her disease hormone-responsive (ER+ and/or PR+)? In the latter case, do you know if your friend also received endocrine therapy?

Both synergistic effect and additive benefits of trastuzumab with chemotherapeutic agents have been observed in vitro for certain combinations, although in vitro observations may not translate in vivo. Regarding the basis for a possible synergistic or additive effect, if chemotherapy alone is used to treat triple negative cancers, it makes me wonder whether chemotherapy may have some benefit that is potentially distinct from its effect on ovarian suppression/menopause.

BarredOwl

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+).
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Nov 18, 2015 10:34AM MamaBexar wrote:

BarredOwl, I think you hit the nail on the head about the difference in treatment for triple positive and only Her2positive. The treatment options are completely different. Hormone therapy is a powerful tool for ER/PR positive but will do nothing for ER/PR negative. And the triple neg. have nothing to fall back on except chemo.

MamaBexar Dx 7/27/2015, IDC, Right, <1cm, Stage IA, Grade 2, 0/4 nodes, ER-/PR-, HER2+ (FISH) Surgery 9/8/2015 Lumpectomy: Right; Lymph node removal: Sentinel Targeted Therapy 10/8/2015 Herceptin (trastuzumab) Chemotherapy 10/8/2015 Taxol (paclitaxel)
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Nov 18, 2015 10:35AM AlaskaAngel wrote:

Good questions, Barred Owl.

My friend was in her 50's like me at time of diagnosis, and although she did not do ovarian suppression along with the trastuzumab, she had already gone thru the observable/measurable signs of menopause in her 40's, and she completed several years of an AI.

As for your other very logical question: (" Regarding the basis for a possible synergistic or additive effect, if chemotherapy alone is used to treat triple negative cancers, it makes me wonder whether chemotherapy may have some benefit that is potentially distinct from its effect on ovarian suppression/menopause") - Do you have any particular ideas or evidence to indicate what the cellular process or processes for that benefit for triple negatives might be? The results don't seem to be very successful even with the addition of chemo and in particular, younger/triple negatives tend to have trouble achieving complete OA even with chemo. The only guess I have about that is that, again, it may be the inability to effectively achieve slowing down the metabolism through use of chemo or other methods of OA (and thus the speed of cell proliferation, including that of cancer cells).

A.A.

Dx 12/3/2001, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2+ (IHC) 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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Nov 18, 2015 11:08AM - edited Nov 18, 2015 11:10AM by AlaskaAngel

MamaBexar,

I note you are HR-negative, and am sorry for the dilemma you face. My only comment is to question whether we should continue down the road of maintaining that every drug has to be compared to the significantly poor success of chemotherapy, and never get the chance to see if new drugs like trastuzumab IF used alone demonstrate at least comparable results for some bc patients, if not superior results (due to a more intact immune system when trastuzumab is used without chemo?)

Here is a recent discussion that I think makes more sense and provides more hope than simply relying on chemotherapy + trastuzumab as if it were superior to OA + trastuzumab:

www.pharmaceutical-technology....

Dx 12/3/2001, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2+ (IHC) 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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Nov 18, 2015 11:38AM - edited Nov 18, 2015 11:53AM by BarredOwl

Hi AA:

Thank you for the information.

I am not very knowledgeable about triple-negative disease, but triple-negative disease might have features or other associated changes that might make it less tractable, but not necessarily intractable.

Regarding chemotherapy in general, different agents have different mechanisms of action (e.g., platinum agents, alkylating agents, other inhibitors of DNA synthesis or repair, mitotic inhibitors/anti-microtubule agents), but most seem to result directly or indirectly in cell death of tumor cells (cytotoxicity). To my knowledge, the processes hit by such agents are common to breast cancer cells, regardless of receptor status (though different tumors may be more or less susceptible).

I agree with you about the challenges of clinical trial design. I don't like to even think about the existence of "CSCs".

BarredOwl

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+).
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Nov 18, 2015 01:03PM - edited Nov 18, 2015 03:32PM by BarredOwl

Hi MamaBexar:

Yes, my concern would be that any potential benefits of trastuzumab plus endocrine therapy (without chemotherapy) in hormone-responsive, HER2-positive disease may not be predictive of the potential benefit of trastuzumab alone (without chemotherapy or endocrine therapy) in ER- PR- HER2-positive disease.

I hope you are tolerating your treatment well.

BarredOwl



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+).
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Nov 18, 2015 05:20PM - edited Nov 18, 2015 05:20PM by WarriorCheryl

I am just 2 weeks out of surgery for my stage 1, HER2+ 3 tumor. I am 62, I am totally not wanting the general chemo one oncologist wants to administer for 18 weeks, followed by Herceptin. Can the herception be administerd alone, maybe with some radiation first?

Dx 9/30/2015, IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER-/PR-, HER2+ (IHC) Surgery 11/3/2015 Lumpectomy: Right; Lymph node removal: Sentinel Targeted Therapy 12/17/2015 Herceptin (trastuzumab)
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Nov 18, 2015 06:08PM - edited Nov 18, 2015 06:20PM by BarredOwl

Hi WarriorCheryl:

I am sorry about your recent diagnosis. I note that radiation is a loco-regional treatment only and cannot reach any cells that may have already traveled via the lymph or blood to distant sites. So unfortunately, radiation therapy cannnot substitute for chemotherapy and/or trastuzumab (Herceptin).

From another thread you said no nodes are affected so far. Does that mean you are node-negative as determined by sentinel node biopsy?

Do you have a copy of your pathology report and the following information (1) tumor size; (2) estrogen-receptor (ER) status; and (3) progesterone-receptor (PR) status?

Also, do you know what chemotherapy drug or regimen was recommended?

With this information, others with similar diagnoses can share their experiences or maybe direct you to other helpful threads.

BarredOwl


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+).
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Dec 17, 2018 10:50AM airstriptrip wrote:

I am stage 1 HER2Positve +3 1 cm with ( clear nodes and margins) Oncologist wants me to do chemo and herceptin for 3 months and then Herceptin for 12 months. can I choose to do just herceptin or Radiation and antiestogen therapy?

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Jan 14, 2019 08:52PM - edited Jan 14, 2019 08:53PM by Blownaway

airstrip trip - My dx was similar to yours and my oncologist team at MD Anderson insisted on the same treatment thatyours are recommending. I was to first have a lumpectomy and when I asked if I could skip the chemo if I chose to have both breast removed, they said no. I would still have the same treatment plan after surgery, either way.

BTW - be sure to join the Triple Positive thread

Dx 3/31/2014, DCIS/IDC, Left, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2+ (FISH) Surgery 5/13/2014 Lumpectomy: Left; Lymph node removal: Left, Sentinel Surgery 6/3/2014 Lumpectomy: Left Targeted Therapy 7/3/2014 Herceptin (trastuzumab) Chemotherapy 7/3/2014 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 10/7/2014 3DCRT: Breast Hormonal Therapy 1/10/2015 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy Breast
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Feb 9, 2019 07:47AM BatyaD wrote:

Triple Positive here. I've been struggling with the same question: Why not Herceptin only?

My oncologist explained to me yesterday, and I found some research the day before. Cancer is heterogeneous---it contains more than one mutation. So if you target only one of the mutations (which is what Herceptin does), the other mutations in the mix might get stronger. That's very oversimplified.

So I'm almost convinced about doing both. She also said there's only a 6-10% difference in outcome of doing both versus doing neither (for my particular situation), which leaves me still wondering about a decision.

Dx 12/5/2018, IDC, Right, <1cm, Stage IA, Grade 3, 0/2 nodes, ER+/PR+, HER2+ (FISH) Chemotherapy Taxol (paclitaxel) Targeted Therapy Herceptin (trastuzumab) Radiation Therapy
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Feb 10, 2019 07:51AM WC3 wrote:

BatyaD:

Cells have receptors on them. These are docking ports for certain molecules, called "ligands" that set off a chain of events in the cell, which can ultimately cause the cell to divide, and thus proliferate, or inhibit cells from doing so, depending.

In ER positive breast cancer, the cells contain estrogen receptors, which, when activated by the binding of estrogen to the receptor site, cause cell proliferation. The goal of Tamoxifen or AIs is to limit the amount of estrogen in the body that is available to bind to estrogen receptors, thus reducing cell proliferation.

Another receptor which causes cell proliferation when activated is HER2, which stands for "human epidermal (growth factor) receptor 2". Many normal cells have these receptors in small numbers...something like 20, but HER2 positive breast cancer cells have millions of them.

HER2 does not actually have a known ligand itself. It appears to be activated by the activation of other receptors, HER1, HER3, and HER4. When these receptors are activated, in addition to doing whatever they do, they sometimes attach to the HER2 receptor and activate it.

Herceptin works by attacking and damaging or destroying the HER2 receptors while Perjeta prevents other receptors from attaching to it and activating it.


Dx 2018, IDC, Left, 3cm, Grade 3, ER+/PR+, HER2+ (FISH) Chemotherapy 6/1/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 11/15/2018 Lymph node removal: Left, Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Targeted Therapy Perjeta (pertuzumab) Targeted Therapy Herceptin (trastuzumab)
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Feb 10, 2019 08:22AM BatyaD wrote:

WC3--thank you so much! That was a really great explanation.

Here's the question I had today and I bet you know the answer!!

Does the HER2 (and other numbers) occur in specific cells, or is it in all the DNA everywhere in the body? Because the lumpectomy got the cancer out (clear margin), negative lymph nodes, and nothing else showing. So if it's only in the cancer cells---where will the Herceptin go? And if it's everywhere, why isn't there cancer everywhere? I'm obviously missing an important step in the make-sense-of-this chain.

I thought the Taxol was to get the other cancer gop. Neither oncologist was pro-Perjeta for me.

Thanks!

Dx 12/5/2018, IDC, Right, <1cm, Stage IA, Grade 3, 0/2 nodes, ER+/PR+, HER2+ (FISH) Chemotherapy Taxol (paclitaxel) Targeted Therapy Herceptin (trastuzumab) Radiation Therapy
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Feb 11, 2019 01:57AM - edited Feb 11, 2019 02:00AM by WC3

BatyaD:

Cell receptors, including HER2, are like little switches on the surface of the cell. When the ligands attach to them, they get switched on and something happens.

Most or all cells in our body have receptors of various types, and many different cells have HER2 receptors. Having these receptors alone does not make the cell cancerous. HER2 positive cancer cells have mutations in the cell DNA that cause them to have too many HER2 receptors, and having too many HER2 receptors contributes to uncontrolled cell proliferation.

Dx 2018, IDC, Left, 3cm, Grade 3, ER+/PR+, HER2+ (FISH) Chemotherapy 6/1/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 11/15/2018 Lymph node removal: Left, Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Targeted Therapy Perjeta (pertuzumab) Targeted Therapy Herceptin (trastuzumab)

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