3 mm IDC HER2+, questions for onc next week?

dancetrancer

Hi all, just found out today that my 3 mm IDC is HER2+ (FISH test +, too).  So, I am scheduled to meet with the MO next week.  I have seen lots of threads with lots of acronyms for chemo...I know there are variations in what kind of chemo but they all come with Herceptin to really kick the Her2.  So, can someone explain to me the difference in the various chemos that might be suggested to me with this size of IDC?  i.e. what are the different protocols, why would one be chosen over another, etc.  I want to be prepared with knowledgable questions for the MO.

If there are any links that spell this out clearer, please feel free to share.  Thanks all!  

SpecialK

dancetrancer - here is the link to Herceptin's site that shows the info for AC-TH (Adriamycin, Cytoxan, then Taxol or Taxotere and Herceptin), and also for TCH (Taxotere, Carboplatin, Herceptin).  Many oncologists no longer like to prescribe the AC-TH combination because of the cardio-toxicity of Adriamycin and Herceptin combined, they are both potentially cardio-toxic.  I think the more prevalent is use of TCH, which seems to have less issues for the heart, but potentially more for neuropathy. There is also the possibility that you may receive a recommendation of Taxol and Herceptin, a little gentler combo, since your invasive area was so tiny.

http://www.herceptin.com/breast/

For your invasive component you may receive differing opinions about the need for chemo even though you are Her2neu+.  Unfortunately, you fall into a gray area for treatment, and it is hard to get a consensus.  I would recommend that you get more than one opinion, and then carefully consider what is said.  You might seek an opinion from a NCI designated center, as they might be more likely to be up on the current thinking about treating very small Her2+ cancer.  If you are in Alabama, the University of Alabama at Birmingham is NCI.

here is another link from last year specifically about size and treatment:

http://annonc.oxfordjournals.org/content/early/2010/06/19/annonc.mdg304.full

I had a much larger sized invasive tumor, and received 6 TCH, with the continuing year of Herceptin.  If you have any specific questions, don't hesitate to ask.  Good luck with your appt!

dancetrancer

SpecialK, thank you for spelling out (literally!) all of the possible chemo/herceptin combo options, and giving me such a great general overview of current practice patterns.  I do know I am in a controversial area, due to the small size of my IDC, and have read several threads on the board about this.  I am currently a UAB patient, plus I've been seen for another opinion at Emory (regarding radiation) - so fortunately I have two big NCI centers at my fingertips.  

I know when people say they get 6 TCH, etc. that means 6 treatments of that particular chemo.  However I see from your tag line that you were in treatment for almost 4 months (for the TCH).  So, I guess they space them out...can someone give me an idea of the timeline when they do treatments?  Every other week or what?  

And I take it it is standard to get a port?  Is the Herceptin an injection by port, too?  Or is that a pill?

Obviously, I am a complete newbie on this stuff, with lots of basic questions!

thank you so much for your help!  

SpecialK

dance - here is the TCH deal.  You get pre-meds of steroids and sometimes Benadryl and Tylenol, then an infusion of Taxotere, then Carboplatin, then Herceptin.  Herceptin is given by IV drip, as are the other chemo drugs.  They are all combined with normal saline in a mixture, except for Adriamycin which is injected into the IV.  I had a port implanted during my BMX because I already knew I would be receiving chemo due to Mammaprint testing of my biopsy sample.  Because Herceptin is given for an entire year most MO encourage having a port.  Repeated infusion are hard on the veins, and sometimes you have permanent damage from overuse.  If you were to receive Adriamycin a port is recommended because it can burn your skin if it leeches out from the IV.  My TCH infusions were given at 3 week intervals so that comprised the 4 months. Some who are receiving TCH get the Herceptin portion weekly, then switch to the every 3 weeks after done with the T & C portions.  Herceptin continues for a year, whether every three weeks or weekly.  The dosing is the same, it is just that the weekly is a smaller but more frequent amount. For smaller invasive areas, such as yours, some have received only 4 cycles of chemo, so that is good because many of the side effects are somewhat cumulative.  If you can stop at 4, you will most likely have a shorter recovery period. Also, some MO use a Taxotere and Cytoxan combination.  Some of the other combinations are given differently AC-TH does Adriamycin & Cytoxan first (usually 4 tx) then you make the switch to Taxol and Herceptin, sometimes for 8 or 12 weekly tx, then continuing on the Herceptin alone for the year.  With Taxol and Herceptin I believe some do 8 or 12 weekly, then the Herceptin continues. 

Keep asking questions - best to be informed!  I am glad you have good treatment facilities at your fingertips, that does give you a real advantage.

Mocity

I did a 12 week regimen of Taxol + Herceptin.  I took these weekly and then after 12 weeks had Herceptin every 3 weeks for a year.

 Some do it every 3 weeks all the way through.  I worked full time and my onc suggested weekly since they would be lower doses instead of one big one.  I didn't have too many issues.

Good luck to you!

Also - Herceptin is given through an IV via your port.   

dancetrancer

Hi CristiC - another t1A Her2+ gal found - wahoo!    Can't help myself, there are so few of us, it is great to connect!

So, you did the same regimen as maja and fluff queen...I see a trend developing.  

Did you have any problems with oncs saying you didn't need treatment b/c your tumor was too small?