Perjerta effective

hmfish

Hi all,

My mother who is 63 years old, was just diagnosed with breast cancer. Both left and right lumpectomies were performed last week to remove the tumor (no neoadjuvant treatment before surgery), and just received the biopsy report:

Right breast:

• low to intermediate grade of DCIS, 2 foci
• size of tumor: 1.4cm and 0.8 cm
• OR +ve
• PR -ve
• HER2 equivocal
• KI 67: up to 2%

Left breast:

• IDC, grade III
• tumor size: 2.2cm
• OR -ve
• PR -ve
• HER2 +ve
• KI 67: 60%
• no lymphovascular permeation
• isolated tumor cells in 1 out of 7 sentinel lymph nodes

My questions are:

• Anyone else have such a high KI67 index? Her doctor said my mom's is very high. Is this worrisome?
• Her doctor recommended all three treatment: radiation, chemotherapy, and targeted drug (TCH). I heard Perjeta is a new drug that have promising results, but her doctor didn't mention it. Anyone knows if TCH+P is much more effective than TCH? Should I insist on TCH+P?
• My mom has weak bones and is Calcium deficient. Would these drugs have a much worse effect on her? I heard now the side effects are much more manageable? I am thinking of hiring an in-house helper to take care of my mom since I am working full time...
• Any other advice/suggestions?

Thank you all first for reading and answering!! This sure is a tough time for my family, so I appreciate any input you may have!!

ElaineTherese

Hi!

Whether or not your Mom gets Perjeta may depend on where you live and her course of treatment. Perjeta is not routinely offered in Canada for early stage breast cancer, but in the United States, Perjeta is recommended for neoadjuvant (before surgery) chemo for HER2+ tumors that are 2 cm or larger. Your Mom could have qualified for Perjeta, based on the characteristics of the tumor in her left breast. However, she had her surgery first. If she wants adjuvant (post-surgery) targeted therapy like Perjeta, she may have to request it and have her oncologist work out something with the insurance company.

TCH is not a targeted drug; Taxotere and Carboplatin are chemo agents; Herceptin is a targeted therapy as is Perjeta. Taxotere and Carboplatin are best known for causing gastrointestinal distress like diarrhea or acid reflux. They are gentler on the heart than Adriamycin and Cytoxin. A very rare side effect of Taxotere is permanent hair loss; the vast majority of TC women regrow their hair, but there are a few women on BCO.org who have had permanent hair loss.

It is aromatase inhibitors (hormonal therapy) that weaken the bones by reducing the amount of estrogen in the body. Your Mom might not be prescribed an AI because of her bone situation. Also, while her DCIS seems to have tested positive for ER, her IDC in her left breast tested negative for it. So, hormonal therapy may not be as important in her case.

Yes, some doctors use KI67 rates as a way of measuring the aggressiveness of a tumor. But, even without your Mom's KI67%, her cancer would qualify as aggressive because it is Grade 3 and HER2+.

I did not have the TCH regimen, so I cannot speak to how your Mom will manage it. I expect she'd appreciate any help you can get for her, as she might not have much energy. So, I'm sure she'd appreciate help around the house with cleaning, cooking, and the like.

((Hugs)) and best wishes!

TizzyLish

I had surgery first. My tumor was 3 cm and my oncologist was able to get Perjeta approved by my insurance company for use in the adjuvant setting. I don't know if TCHP has MUCH more promising results than TCH alone (TCH is a great and effective protocol on its own)but it's certainly worth inquiring with your mom's oncologist and trying to get it approved by her insurer.