Question re chemo for Stage 2, HER-2 (+) DX

cebo

Hello:  Forgive the cross-posting--I posted this question in the chemo and DCIS forums too to reach the widest possible audience 

A friend of my sister was recently diagnosed with DCIS (no solid tumor, but cells throughout her ducts), but then found to have microscopic cells in her sentinel node.  (I understand from a reply I received to my post in the DCIS forum that this means she does not have DCIS, and this makes sense.)  A further axillary dissection of 12 nodes showed no cancer cells in the other nodes.  Her cancer is ER(+), PR(-) and HER-2(+) and apparently has been classified as Stage 2. 

Have any of you had a similar diagnosis?  If so, do you know if there is a "gold standard" chemo for this DX?  Her oncologist has recommended TAC, followed by a year of IV Herceptin (total of 18 mos. of tx).  She also was given a second option of TCH--which I assume means she would get Herceptin with Taxotere and Cytoxan all at once, over a shorter time period? 

Any information you could provide would be greatly appreciated!

HensonChi

I did TCH and the herceptin lasted a year.  Just finished yesterday!  Anyway my onc did not want me to do the adriamyacin with the herceptin as that is a double whammy on the heart I guess.  So I did the TCH!

cebo

Thanks for the info--and congrats on finishing treatment--what a huge milestone!

orange1

A typical regimine for Stage 2 Her2+ BC is AC TH.  With this AC is given together, followed by TH.  The T and H are given together for all T infusions.  This is followed by completing 1 year total of Herceptin.  This is the protocol that was used in most of the large clinical studies for adjuvant treatment of Her2+ BC. 

TCH is often given for Stage I Her2+ BC.  Depending on how you interpret the numbers, it is virtually as effective as AC TH with a much reduced risk of heart damage, and generally easier to tolerate.  Because there might be a very slight advantage (in terms of recurrance) with AC TH, many oncs prefer to give AC TH to stage 2 patients who have a higher risk and therefore may benefit from that protocol despite the slight risk of heart damage and very slight risk of leukemia from the A. 

However TCH was tested in stage 2 patients (and approved for use in them) and may be a reasonable option, especially since your friend only had micromets.

Based on the HERA trial, where H is given after chemo (versus with some overlap as in AC TH or TCH) it appears that Chemo given with Herceptin is a little more effective then when Herceptin is given after chemo (no overlap).

For whatever its worth, I did TCH.  My onc refused to let me do AC TH - he considered it not worth the risk with Stage 1 disease. 

HensonChi - congrats on finishing!

cebo

orange1, thanks so much for all of this excellent information--I will be sure to pass it on to my friend so she can ask her onc the appropriate questions.  I truly appreciate it

orange1

You're welcome.  Good luck to your friend.

cebo

Best of luck to you too!