Her-2 and Hormone Therapy?

KarenW

I'm American, but live in Italy, and the docs here want me to go on Hormone therapy for 5 years.

44 years old.  Not in menapause.  I had 6mm tumor - caught early.  Then, in Feb 2009 partial mastectomy (1/4)- 3 lymph nodes taken - but turned out clear! Her-2 3+, Est positive 80% and prog. 10%.

In April I did 9 weeks of Vinorelbina (6 of those weeks took the oral dose which worked better for me) and started Heceptin every 21 days.  Now (July) just started radiation - 30 sittings.

But I have done a bunch of reading on line and everything I have found says that Her-2 seems to be "resistent" to Hormone Therapy.

Any of your doctors saying this, or NOT recommending this therapy?  Or have you found any other conflicting information that it might be beneificial...?

I'm not crazy about putting my body into instant menapause --- and sucking all the hormones out of my system with a drug...?  Not that I want kids, because can't do that after chemo --- (ok, could try in 2 years - but I'll be 47!  .... ahhhh --- not interested in doing them at that age!) so....  I'm more worried about the side effects and putting yet another "farmico" into my body every day....

 Any help would be really appreciated!  Karen

orange1

Hi Karen -

Unfortunately its impossible to know the best treatment for any individual.  I can only add a few more more things to think about....

Historically, since Her2+ tumors were aggressive, oncs generally hit them with every drug available to fight them.  Thus, all the studies were conducted with Her2+, hormone receptor + (HR+) women getting hormonal therapy - most often given tamoxifen since in the studies a majority were pre or perimenopausal and AIs are typically used only in post menopausal women.  So there is no information on the outcome of Her2+, HR+ treated with latest chemo + Herceptin that did not get hormonal therapy.

In the large HERA study Her2+ HR+ node negative had 3 year DFS of 95%.  Considering most of the risk of recurrence in Her2+ is in the first 3 years, this is a very good result and perhaps argues for tamoxifen.

In the general population of HR+ women (including both Her2- and Her2+), the higher the degree of HR+ (estrogen and progesterone), the more improvement in outcome you get from hormonal therapy.  At 80 and 10% respectively, you are very HR+, especially for Her2+ which tends to have a lower degree of HR than Her2-. 

Saying that Her2+ is "resistent" to hormone therapy is another way of say Her2+ are more likely to recurr.  This could be due to a combination of Her2+ having on average lower levels of HR positivity, thus proportionally less likely to benefit from tamoxifen and, the effect of PM and IM CYP2D6 metabolizer status on Her2+ women, which at least for the PMs leads to an exceptionally bad outcome. (I don't have information on the effect of IM status on Her2+, but based on slightly worse outcomes in the Her2- IM population, I would guess the result would be worse outcome). 

It seems the HR positivity of your tumor is weight in favor of tamoxifen.  And until you know your metabolizer status you don't know if you have a big negative in the tamoxifen column. (About 7% are PMs, about 30% are IMs and most of the rest are EMs)

Many on these boards tolerate the tamox very well, if your can put up with the hot flashes.  Since tamox does not diminish the level of estrogen in your body, many tolerate much better than AIs.  Some of the posts on hormonal therapy where women have a hard time tolerating tamox may be due to menopausal symptoms from chemo induced menopause, and not due to the tamox itself.  I think most of the younger women (therefore not in menopause) tolerate it very well.

Good luck with your decision