In the mushy middle - Different Dr. opinions

barb39

I had a .5 tumor which was staged at 3A and had 10/13 lymph nodes. Scary!  I got chemo,raDIATIONSA D HERCEPTIN FOR 52 WEEKS.  i ALSO TAUGHT 130 KIDS EVERY DAY IN 6TH,7TH AND 8TH GRADE MATH EVERY DAY EXCEPT TO GO TO CHEMO EVERY 3 WEEKS FOR 1 DAY. i DID FINE. i AM NOW FREE FOR 9 YEARS!!  kEEP HOPE AND BE POSTIVE!!  i'M HAPPY(VERY) AND INVOLVED IN SO MUCH AND i DON'T WORRY AND YET I WAS A

BASKET CASE ABOUT CANCER FOR YEARS.. i THINK THAT WE SHOULD NEVER LET IT MAKE US FEEL BAD B/C WE CAN BEAT IT IF WE ARE IN CHARGE....

Hattie

My stats were not the same, but one of my docs said something very helpful--if you are given two options, both are right, and you can choose.  That helped me.  As Yogi Berra said,   "If there is a fork in the road, take it."  Are you leaning one way or another?  You can safely go with your gut here: with 2 medical opinions you trust, you can make the call.  Maybe you need a little more information, but then you can make your decision and feel good about it.  none of us are textbook cases.

Take care,

--Hattie 

Anonymous

Wow, Barb, that is wild - a 1cm tumor with TEN nodes involved????  Holy HER2+++ tumors, Batman!!

Still, I'm glad you're doing well and it's good to know someone has survivied and thrived so long with this!!  Congratulations - it's wonderful that you're feeling great.  I can't wait until I can say the same thing.   Laura 

jill323

bumping for Tanya

mmm5

ladies

I have done so much research and work in Diagnostics for the last 16 years. I would get the Herceptin with any size tumor, it is very doable and the results are now turning out to be so awesome for HER2 gals. Once all the data is reviewed at 10 years Her2 may be deemed the more favorable prognosis. Look at the study called the Her2 joint analysis.

Now also a study I believe from MD Anderson states even tumors >1cm should have chemo if Her2 positive.

jill323

mmm5 - Page back a page.  I have actually posted the MD Anderson study.  Indeed, it does recommend herceptin for tumors of less than 1 cm.  

Jill

dreaming

Over 15 years I was 40, I wanted the most aggressive treatment I could get, I had a mastectomy, and chemo" 5 FU, Metrotrexate and Cytoxan[now they do not use this to much] I wanted slow drip.

I was Stage 1 , all 18 lymph nodes clean. Had 2 types of cancer, one found during the surgical biopsy and the larger invasive one during the mastectomy.

There is no protocol for breast cancer, that is why doctors have different opinions, some are more aggressive others not. I am glad of what I chose for me, ask for another opinion, or go to the NCI web page and read the information for doctors.

manue

Hi Ladies, Christi sent me to this link...I'm facing two choices for my chemo treatment after my Bilateral Mastectomy on July 7. My BC was 1.3cm, ER (90%), PR (1%), HER2+, BRCA1+

1) AC (Adriamycin/Cytoxan) then H (Herceptin) for a year every 3 weeks. Hormone therapy or AI (clinical Trial) for 5 years. ovaries out.
2) Clinical Trial with TH (Taxol/Herceptin) weekly for 12 weeks then H for a year every 3 weeks. Hormone therapy or AI (clinical trial) for 5 years. ovaries out.
After some comments from this site I asked her about AC-TH and TCH because those were not part of my options. She thinks AC (Adriamycin/Cytoxan) then TH (Taxol/Herceptin) is too strong, the same for TCH (Taxotere, Carboplatin, Herceptin).
The first option with A is scaring with the possibility of heart problem! I know I'm young (kind of 41!) but still... The trial is very appealing to me, Taxol and Herceptin seem to be a good combo. I know I need the Herceptin with HER2+ and Chemo with it! Dilemma, dilemma... I'm going to call my oncologist today and find out what is my % of BC recurrence... She was very positive with me and she reminded me of my good prognosis and a big hug at the end of my appointment! Thank you for listening, Manue

mmm5

Manue

The question you ask has been asked several times on these boards and is a good one. Your tumor and stats are close to mine, have you had the ONCOTYPE. Many Oncs don't do oncotype as it is usually high if Her2 is involved. My suggesion is to really think about staying away from AC I have now met 3 woman in their 40s who have had AC and Herceptin and have had some permanent heart damage. Also studies show that Herceptin works better in conjunction (duing the use of chemo) with chemo rather than following it. I had TCH and it was ok although it was rough on my WBC's. Many woman are doing the Taxol/Herceptin now and feel good about it and from what I read maybe the new course of treatment recommended as some feel stage 1 ladies have been overtreated.

I just don't know, I wanted enough treatment where I felt I was doing everything I could but was adamant not to do an Anthracycline as I was very aware and had seen those suffer heart damage.

Good Luck and feel free to PM me.

By th way I was 42.

orange1

Manue -

This is an editorial, but the data are worth considering.  I am not advocating AC TH.  But I think considering the evidence for concurrent therapy being more effective and the possible heart damage from AC, I would strongly consider TH or TCH.

From Current Oncology - Volume 15, Number 1 (published in 2008):

Which Approach is the Most Effective (referring to concurrent Herceptin or sequential Herceptin)?

The key trial that will answer the question of effectiveness is NCCTG N9831, which randomized patients to no trastuzumab (t), concurrent t, or sequential t with a chemotherapy backbone of AC followed by weekly paclitaxel.  The results to the unplanned interim analysis presented a the 2005 American Society of Clinical Oncology meeting demonstrated that the concurrent approach was superior to the sequential approach, and furthermore, that the sequential approach was no better than control.  However, given threat the interim analysis was unplanned, most clinicians will not make treatment decisions based on its results.

Another trial presented at the 2007 San Antonio Breast Cancer Symposium also indicated that the sequential approach may not be as effective.  The randomized PACS-04 study was initially designed to compare 6 cycles of FEC100 to 6 cycles of epirubicin given concurrently with docetaxel.  Then in a second randomization, Her2+ patients were randomized to receive or not receive t after completion of chemotherapy.  The authors presented their results with a median follow-up of 4 years.  No significant improvement was observed in DFS (hazard ratio 0.86 or overall survival (hazard ratio 1.27).  There did appear to be initial efficacy in the first 18 months, but the effect was lost over the next 2 years.  Numerically, fewer metastatic events were seen on the t arm.

And so PACS-04 is the first negative adjuvant t trail (meaning did not show an improvement with t).  Why given all the previous trials, was an additional benefit of t not seen in its patients?

The PACS-04 patients all received adequate anthracyclines, and about 50% had an adequate dose of a taxane.  The results seen are similar to those from the unplanned analysis of the sequential arm of NCCTG N9831 (hazard ratio 0.87).  Also, it is concerning that, with sequential therapy, a benefit initially seen is lost with longer follow-up.  The suggestion is that t may have a cytostatic effect when given sequentially as compared with a cytotoxic effect when given concurrently.

Why was no benefit seen with the the sequential approach in the PACS-04 trial, when a benefit was observed in HERA?  One explanation may be that the patients in HERA did not receive adequate chemotherapy, ant the in the presence of third-generation regimen, the benefit of t is seen only in a concurrent and not in a sequential regimen.  The evidence from concurrent regimens has previously showed a benefit in the range of about 50% reduction in the relative risk of disease recurrence and 40% reduction in the relative risk of mortality.  And notably, these results occurred despite a backbone of third-generation chemotherapy regimens....

 Good Luck with your decision.

manue

Good Morning Orange1, thank you so much for the information. I had a very bad week last week with an infection in my right breast (expanders)... feeling better now! After a lot of reading and soul searching I'm taking the clinical trial that my oncologist offered: TH (Taxol/Hercepting) weekly for 12 weeks then Herceptin for the year...I have more decisions to make down the road but for now I've got this one down. Manue.