Triple Positive and Early Stage: Any other chemo choices?

Teal3Pink1

Triple Positive and Early Stage: Any other chemo choices?

Teal3Pink1

Hi everyone,

Since there isn't a lot of data on early stage and herceptin and even less on early stage triple +, I am interested in hearing what others with a similar situation have experienced.

Lumpectomy was performed on 1/10 and I have appointments next week with 3 oncologists at different medical institutions.Choosing chemo will be tricky b/c I have a prior history of recurrent ovarian cancer. I tested BRCA negative.

Thanks!

saralmom

Well, I was stage IIa, with 2 nodes positive - so I'm not sure if I'll be helpful.  I had AC x 4 at 2 weeks, and the Taxol x 12 weekly, and Herceptin every 3 weeks during Taxol and continuing til next June (1 year).  I think the other common chemo with Herceptin is TCH.  I'm not sure of the dosing for that though.  I went big guns due to the nodes.  Good luck with your chemo decisions.

Teal3Pink1

Thanks Saralmom! Any information is helpful. It's good to have different options to mull over! Looks like you have an anniversary coming up. Congrats on your survival!

lago

I was IIB considered early stage. I just finished 6tx of Tatotere/Herceptin/Caroboplatin with 11 more hercepins to go every 3 weeks. Will be taking generic arimidex (hormone suppression) for 5 years.

THC is not as hard on the heart and it gets you started on herceptin earlier. Both treatments (AC then Taxol/THC) are typical for HER2+ AC/Taxol seems to be given more often to women with positive nodes.

AlaskaAngel

Hi Teal3Pink1

Chemotherapy works sometimes for those who have fast-dividing cells but from your description you do not. Hormonal therapy works best for those who are fortunate enough to be early stage ER+ and/or PR+, so consider such things as ovarian ablation, or the aromatase inhibitors. I personally did not know enough at time of diagnosis and back then they only offered tamoxifen (which I would not recommend for HER2 positives), so I did chemo, rads and tamoxifen.

AlaskaAngel

sheila888

AlaskaAngel....I dont understand what you meant by saying

 (which I would not recommend for HER2 positives), so I did chemo, rads and tamoxifen.

AlaskaAngel

Hi seyla888,

I was combining several thoughts there in one sentence. Trastuzumab was not available to me at the time I was diagnosed and I never did receive it, and ended up doing CAF and then tamoxifen. However, tamoxifen can upregulate HER2, and it may not be the best idea for HER2s, particularly since trastuzumab therapy for early stage bc is at most given for only a year, whereas tamoxifen is given for much longer than that. Without continuing trastuzumab with the tamoxifen there is the question as to whether using the tamoxifen alone would then be free to upregulate HER2. There is also has been a question about the use of tamoxifen and one's AIB1 level. (google tamoxifen and AIB1).

AlaskaAngel

sheila888

When I was DX Herceptin was just approved for stage I BC so I got it.

Im also on Femara.

Thanks

Teal3Pink1

Thanks for all the information! Saw 1 med onc and have 2 more to go. The jury is still out on what the appropriate course of action is for me. Hope to have a plan by the end of the week!

pejkug3

I'm interested in what you find.

I'll be traveling down this road right behind you.

2ns_Jenn

Teal -
You indicate the size of your tumor was <1 cm.  Just curious what the exact size was.  I was in a similar situation where I was early stage, triple positive and tumor size was <1 cm.  Mine was measured at .4cm (or 4mm) which is considered a very gray area.  The NCCN guidelines do not recommend chemo/herceptin for anything less than .5cm.  I saw 4 oncs and got 4 different opinions so it was left up to me to figure out the best course of treatment.  I wanted to be as aggressive in treating it as possible but I finally came to the conclusion that the risks of chemo/herceptin were not worth the small percentage (2-3%) of benefit we would gain. 

Good luck to you!

saralmom

Tealpink - thanks for your well wishes on my one year mark.  It means alot to have others who understand the magnitude of that recognize it.

Teal3Pink1

3 doctors and 3 tumor boards later, it looks like we're going to go with herceptin and femara and radiation. (Exact type of radiation to be determined, I'm hoping for short-course pinpoint rads.) Please note that without my ovca history, some type of chemo would be included. I am absolutely thrilled to have a plan so things can get started.  

Jenn: the IDC is 7mm.

pejkug3:  Good luck!

Thank you all for your thoughts!

saralmom

Tealpink - I remember being at a kind of peace once I knew what my plan was.  I'm glad you have your plan now, and you can concentrate on beating this.

weety

My tumor was also 7mm, no nodes.  I was given TCH, radiation (because of small margins even after mastectomy because of small breast size) and now on femara (also had ovaries out).  My onc chose the full course of chemo because of my age (38) mostly.  She said that I had 38 more years to live and she would rather hit it hard now since I was young and strong and healthy enough to bounce back from chemo.  7mm was considered the "gray" area when I was diagnosed.  I'm not sure if it still is or not. 

Teal3Pink1

saralmom: Thanks! Yes, peace is exactly what I feel! The "not knowing what they're going to do with me" phase is like torture. It takes so long for all these little bits and pieces of the puzzle to come together. 

weety: I am amazed by just how much gray area there is to navigate! I LOVE that your med onc approached this aggressively taking your age and future (38 years--woohoo!) into consideration. The time to hit things hard is right up-front. 

I didn't want to cloud my question about using other chemos, but I had significant (although not life-threatening) reactions to 3 of the chemos I was on, the ones most commonly paired with herceptin. Plus, it was important to try to preserve my bone marrow b/c the chances of my having another ovca recurrences are much higher than for brca. My plan feels good. Just the right amount of aggression hitting both receptors and allowing me to keep my ovca options on the shelf.

I just watched "Living Proof" this morning. Amazing story! Thank you Dr. Slamon! Thank you Lilly Tartikoff and Revlon/EIF! Thank you Genentech! And thank you to all the women who participated in the trials and made it possible for me to have herceptin!