Anyone with a Her2+ tumor over 1 cm on Taxol+Herceptin?

Cherry-sw

Hi, I have posted it on other threads so I apologize if some people find it annoying but I am looking for those who had Her2+ tumor approx 1-2 cm and did just weekly Taxol. My tumor was 1,5 cm with high Ki67, I was offered weekly Taxol x 12, Herceptin every three weeks, and was told that it was standard of care, I live in Europe but I believe the same valid for US. I however raised my concern to my current oncologist whether I should receive more aggressive treatment. She discussed my case with her colleagues and even though they believe that they have already given me the optimal treatment,they can offer me to replace the remaining three infusions of Taxol with Epirubicin (anthracycline they use in Europe instead of AC) every three weeks. I get to choose. I have checked the long and short term SE with anthracyclines and they are really heavy. Besides it cannot be combined with Herceptin and I would have to resume it later.

My question is: I see some people with really small tumors less than 1 cm receiving weekly Taxol but is there anyone who had a tumor between 1-2 cm, no nodes involved, who was recommended this regimen and went through with it. How high was your Ki67?

Thank you in advance for all your response,

Cherry

KimCee

Hi Cherry,

Ok, I already had AT in 1999. Went an aggressive route back then because I was only 36. That tumor was pretty friendly but I did not want to say "what if". This one is her2+ and my ki67 was high at 28%. I will do Taxol and Herceptin. There is a lifetime limit on Adriamycin. Did you have lymphovascular invasion

Cherry-sw

Hi KimCee, I am not sure about LVI but I am sure I had, have to check with my oncologist, my Ki67 was 50%, Grade 3, usually Her2+ tumors of this size have LVI. Did you?

KimCee

Cherry,

My first "friendly" BC had LVI, this new ugly one did not...go figure...

First BC was treated by an onc from MSK. He did not go much by grade as he said it was subjective. Not sure how true that is but I had my slides sent for second opinion....I was definitely a crazy person first time around. First pathology said grade 1. Second opinion said grade 3....will never know what it truly was

stephincanada

2.1 cm

Ki67 83%

Focal of LVI

Chemo was FEC-D ("E" being Epirubicin

Cherry-sw

Stephincanada, thank you for reply. How did you experienced epirubicin?

Cherry-sw

Are there so few who only did Taxol+Herceptin but had a tumor between 1-2 cm?

molly1976

I did - my tumor was 1.6cm, no lymph involvement, and I had 12 doses of weekly taxol + a year of herceptin. I'm 32 months out now from diagnosis with no further problems. My oncologist has said the words to me "I don't think you're going to have a recurrence." (Whether I believe this on a daily basis is another story, of course, but he seems to believe it so I try to trust him.)

Cherry-sw

molly1976, thank you very much for your reply. Did you tumor have LVI? Mine had it and KI67 was 50%. My oncologist said that weekly paklitaxel and Herceptin was a standard treatment for me but given these two aspects she leans towards an anthracycline because if added taxan and Herceptin it lowers the risk of dying of bc with 34% according to her. I asked her whether she had seen any recurrence for early stage Her2 who received weekly Taxol + Herceptin and she said no but she also said that this regimen was relatively new and there is no statistics for a longer period of time. This is a tough decision to make.

molly1976

I didn’t have LVI, no. I asked about it specifically and my doc said it was negative for that but he wouldn’t use it to influence treatment decisions anyway. I didn’t have Ki-67 testing because we already knew I’d have chemo given the Her2+ status

Cherry-sw

My oncologist believes that the presence of LVI can influence the decision what chemo to use, the fact that you did not have it makes you a good candidate for skipping heavy regimen.

Kimm992

Diagnosed at 35. I had 4 tumors - the largest was 1.7 cm. No lymph node involvement. Some minor LVI.

I had FEC-D. Her2+ scared me and I wanted to throw the book at it. My MO made it clear it's what he thought I should do and I agreed.

Cherry-sw

Kimm992, this is what I want to do as well, to threw everything the modern medicine has to offer, I am considering to add epirubicin to the treatment.

Laxmom73

I had a 2.4 cm ER+, Her2+ mass removed in Oct and just started my first chemo treatment. The onc put me on 4 dense doses of AC, which will be followed by Taxol and Herceptin. I questioned whether it was aggressive treatment (based on what I've read), but was told it was standard protocol.

Cherry-sw

Hi Laxmom73, thank you for your reply, your oncologist is absolutely correct, for this size of tumor AC+T+H is standard protocol, for larger tumors they even add Perjeta, sometimes they replace AC+T with Taxotere+Carboplatin, but AC+T ha higher efficacy.

ExTexan

Hi Cherry & everyone,

When I had my lumpectomy in October they found the tumor was 1.3 cm, negative SLN. Since it's HER2 3+ and Grade 3 according to the first pathology report, I'll be on weekly paclitaxel for 12 weeks and during that time also receiving weekly Herceptin. After that, I'll be on Herceptin every 3 weeks for a total of a year of Herceptin. I'm seeing a medical oncologist who does a lot of research recommended to me by a family member involved in the drug side of cancer treatment and she seems to think it's a good plan. Before prescribing the treatment the oncologist had my slides reviewed by her pathology department since she's at a different institution than my surgeon.

Cherry-sw

ExTexan, thank you for your reply. Do you know whether your tumor had LVI and what its Ki67 was? Cherry

Jellybean12

hi all! Unfortunately I'm newly diagnosed as of 9/17,intralobular, tumor size 2 cm, no node involvement or LVI, stage IIa, triple positive, intermediate grade. Lumpectomy 10/17 with 0/9 lymph nodes. My MO Recommends weekly taxol/herceptin +|- pertuzamab (no AC). My questions are re effectiveness of taxol vs taxotere- in articles, seems mechanism of action is similar, just taxol not used as long in this setting to treat BC so unable to evaluate response to treatment beyond 5yrs of treatment. In short I want to make sure to have best treatment for my situation to treat circulating cells and prevent recurrence but also do not want to use most aggressive drugs with worsening side effect possibilities unless it truly is more effective. Any information would be greatly appreciated

Tara17

hi jellybean—i dont know about the effectiveness of taxol verus taxotere but there is one important side effect difference —wtih taxol the hair grows back. But there are some women who recd taxotere who have had permanent hair loss. Thats though to deal with —a forever reminder of cancer treatment .

Tess111

Hi Jellybean,

There is an ongoing trial called APT that is looking at the results of treatment for HER2 breast cancer with just Herceptin and Taxol in patients that are node negative and have tumors no more than 3 cm. This past year they presented a paper at ASCO looking at a seven year follow-up for these patients. The data looks very promising.

You can read the abstract presented this year at ASCO at the following link: Seven-year follow-up of adjuvant paclitaxel and trastuzumab

Here is a link to a video where Dr. Sara Tolaney discusses the results at 7 years. http://www.cancernetwork.com/videos-breast-cancer/long-term-data-confirm-th-benefit-early-her2-positive-breast-cancer

I know this doesn't exactly answer the question, but I thought it might help. I asked my own doctor why we didn't use Taxol instead of Taxotere and Carboplatin and she said that the data had not yet matured. However, at the time of my diagnosis, the APT trial had only published the three year results. I have often wondered if my cancer had been diagnosed a year later, if she would have used the Taxol treatment instead.

Best of luck to you, Jellybean. Sending gentle hugs and thoughts your way.

Jellybean12

Thank you Tara17. I have read about the permanent hair loss with taxotere- ugh! Anyone having success with keeping their hair using a cold cap on taxotere or taxol?

Jellybean12

• thank you Tess 111! I did read this abstract and my MO feels fairly confident about using the taxol herceptin combo to treat me. I'm just so nervous about choosing the most effective drug combo that will kill those cancer cells! I don't want choose a more aggressive drug therapy and endure the intense negative side effects to find out I could have chosen a more conservative treatment with the same results. At the same time, nervous about choosing the more conservative treatment while I'm young enough to handle the negative side effects of the aggressive therapy, and find the cancer recurring because I chose conservatively. It's a very tough decision!

Cherry-sw

Tess111, thank you very much for the links, I have not seen the latest follow upp of this trial

Maggieroe1

My tumour was 2cm. I was given the option of having weekly Taxol and Herceptin for 12 weeks followed by Herceptin every three weeks for the remainder of the year. I'm done now and have been declared NED. My oncologist, who is highly respected said either would be fine and have the same outcomes. The main decision was committing to an every week schedule. I am doing great

Laxmom2006

I had asked my oncologist about the study regarding the less aggressive 12 taxol plus herceptin treatments and whether or not it was something that I cohld benefit from. She was a part of the trial and said that although the results were favorable, she still recommended the AC then Taxol, Herceptin, and Perjeta. Her explanation was that the study was comprised of 91% stage 1, and only 9% stage 2; and stage 1 almost always has a 100% rate of disease free survival.

I start Taxol, Herceptin and Perjeta tomorrow and am praying that 7 hours in the infusion chair will eliminate any chance of cancer coming back.

Cherry-sw

laxmom2006, this is correct, this Dans Farber trial included patients who were Her2 pos, had clear nodes and had tumors no larger than 3 cm. They have published the recent results, there were four or six distant recurrences per 406 participants. I cannot see your stats but I assume that you are doing neoadjuvant treatment. I did weekly Taxol and was told that it was standard of care for me but I asked my oncologist to discuss my case again with her colleagues because I will rather be overtreated and they offered me three EC that I am doing right now. Good luck with your treatment Cherry

Cherry-sw

Maggieroe1, I was at crossroads, I did weekly Taxol and could have stopped there but due to the high KI67 and the presence of LVI decided that I even want to do an anthracycline chemo and am heading towards my last EC. It has been tough but I asked for the big guns. I am sure that weekly Taxol is enough, it is a pretty strong regimen too. Cherr

Laxmom2006

Cherry-sw- i actually was diagnosed on 9/28 with a 2.4 cm Stage 2A, grade 3, er+, pr-, and her2+ mass. I had a lumpectomy with reconstruction on 10/6 with negative margins. SNB was negative.

I suppose that I'm glad that I'm being treated aggressively, but nobody can seem to tell me that the aggressive treatment will lower my risk for recurrance. Have you received any information about recurrance rates with aggressive vs. less aggressive treatment?

Between chemo, rads, and targeted therapy i will be in treatment for 14 months.

Cherry-sw

Laxmom2006, just to begin with, since you are both ER and Her2+, there is a thread po triple positives under Her2 positive bc, you can find a lot of information and support there. Even a lot of info on different treatments, you can post your questions, there are people who had ben there for years and possess a lot of knowledge. You can also ask user BarredOwl, I have been told that she delivers the most ackuratess answers. She does not hang on TP-thread but you can always send a PM.

To answer your question about the benefits of the aggressive treatment. There are different approaches, there is definitely a trend especially for Her2+ bc that claims that targeted therapies are the future but there is not enough research results that can claim that targeted therapy can replace chemo. Herceptin has always been tried and given with chemo and Her2+ bc are usually high grade and high KI67 which means the patients will benefit even from chemo.

The first oncologist I met told me that if they take ten women with my stats and try to make a forecast they can say that seven of those will probably not need any treatment except for surgery, one of them will recurr no matter treatment and for two chemo and Herceptin will make the difference. They just do not know who need what and treat everybody aggressively. After all who would want to take a chance here? I live in Sweden and I have studied our national guidelines for treatment of Her2+ bc. It says that taxane alone (read Taxotere, Taxol, Abraxane) give larger numerical recurrence than a taxan combined with an anthracycline (AC, EC), the latter will lower a risk of recurrence with 24%. Since both AC and Herceptin are cardiotoxic a taxane with cyclophosphamide can be offered instead. There is also a risk of leukemia with AC but this risk is under 1% and my oncologist told me that she only had two people who got it but only because they participated in the trial where they received large doses of anthracycline. Your oncologist offered you the best and most effective treatment available, but as they all say no one can give you any guarantees. I have been given Taxol only but asked for more treatment and my oncologist was willing to give me that, I asked her whether any patient with my stats has relapsed after receiving Taxol only and she answered no but she also added that this regimen is relatively new and has not been used in Sweden until 2014. I felt that I want to do everything the modern medicine has to offer.

Her2+ have the longest treatment plan, I hear you. Assuming from your user name you have young children, I am myself a mom to a girl who was born 2006, the fact that she is being so young meanwhile I hot this disease has been harassing me and I used to cry a river at a time. Being ER+ means you will have to take Tamoxifen for at least five years but you and me, we will benefit from it greatly. I have been in chemo since the end of August, my last infusion will be in January. Hang in there, read on this forum, there are a lot of women who are years out and still post here, this is very inspiring. Hugs,Cherry

jo6359

What is lvi?

jo6359

Cherry- I was diagnosed with 1.2 cm on Dec. 11 and 2 weeks later another tumor 1.2 cm same breast. Both IDC Grade 3. Hormone neg and Her2 positive. After my surgery on jan 29th, Im scheduled for Taxol 1xwk for 12wks and Herceptin 1xwk for 1 year.