I'm really not sure what to do: ET or no ET?

sweetp6217

I'm at that stage in treatment where radiation will end on 4/10/18 (barring any other delay(s). On April 12, my MO wants to discuss endocrine therapies. Previously he stated that due to my diagnosis, I would be able to try a number of things. Shouldn't there be an obvious choice based on my diagnosis and subsequent therapies?

My MO was previously able to plug in my stats prior to BC treatment (chemo then lumpectomy then radiation, etc.) and come up with that. Why not the rest of the therapy as well? So far, he's produced some names of meds, but it sounds like he wants me to make a decision about them. Since the meds may make little difference (according to him, just "insurance"), he's also giving me the choice to skip them altogether.

Here are my stats (all prior to treatments):

Probe (Her2-NEU FISH), Result (Amplified (Positive)), HER2/CEP17 Ratio (10.80) Lymph nodes

Antibody & Clone (Estrogen Receptor - 6F11) (Progesteron Receptor - 16) (LO-67 - MM1) Lymph Nodes

Percent Positive & Intensity (3% Positive Cells Weak) (< % Positive Cells) (40% Positive Cells) Lymph Nodes

Interpretation (Positive) (Negative) (High) Lymph Nodes

Antibody & Clone (Estrogen receptor - 6F11) (Progesteron Receptor - 16) (KI-67 - MM1) Tumor Cells

Percent Positive & Intensity (15% Positive Cells Weak) (<% Positive Cells) (40% Positive Cells) Tumor Cells

Interpretation (Positive) (Negative) (High)

Metastatic carcinoma consistent with breast primary, IDC, Nottingham grade 3 (Tubules: 3, Nuclear: 3, Mitoses:2)

Longest length of IDC: 17mm

Final: Probe (Her2-NEU FISH), Result (Amplified (Positive), Her2/CEP17 Ratio (11.8)

So, my MO is using these results obtained by biopsies prior to chemo and surgery. I just don't know which way to go because he's giving me the choice. I'm wondering if any of you had similar results and went a certain way with endocrine therapy. You all are my gurus since I work a lot and have no one who's been through this type of therapy and treatment.

Dx 7/7/2017, IDC, Left, 3cm, Stage IIB, Grade 3, ER+/PR-, HER2+ (FISH) Targeted Therapy 7/27/2017 Herceptin (trastuzumab) Chemotherapy 7/27/2017 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 1/4/2018 Lumpectomy: Left; Lymph node removal: Left, Sentinel; Reconstruction (left): Fat grafting Radiation Therapy 2/21/2018 Whole-breast: Breast, Lymph nodes Hormonal Therapy

Lula73

Congrats on coming to the end of rads! ET or as it's commonly referred to: anti-hormonal therapy, is standard of care with an ER+ diagnosis. There is a great rundown on the Femara thread that covers how they work as well as efficacy between types. There are two main types of anti-hormonals: estrogen blockers and aromatase inhibitors. Estrogen blockers can be used regardless of your menopausal status but carries risk of uterine thickening, uterine cancer and blood clots (all of these SEs are rare though). Aromatase inhibitors are only given to post menopausal women including those using ovarian suppression therapies and/or those in surgical menopause. On the estrogen blocker side is 1 main medication: Tamoxifen. On the AI side there are several different medications. When your doc tells you that there are many options or many to choose from he's really telling you that if the SEs on one of the meds are unbearable there is another you can switch to and see if the SEs resolve and/or lessen to a bearable status. If you were to research anything, it would be if you wanted to go the tamoxifen route or the AI route (provided you're menopausal) first.

https://community.breastcancer.org/forum/78/topics/726592?page=323

Georgia1

Hi Sweetpea. Lula is right on your choices. One piece of information I can't quite figure out from your notes is your ER percentage - is it 3 percent in one sample and 15 percent in another? And do you not have the ER score from your final, post-surgery pathology report? That would be helpful, since I'm guessing his "skip them altogether" option is because your scores were low. My ER score was 95 percent, which my MO explained meant Tamoxifen or an AI would work particularly well at preventing recurrence and spread. The same may not be true for you. That would be something to discuss in depth at your appointment.

MelissaDallas

ET = Endocrine Therapy

sweetp6217

Lula: Thank you! and ARGH! I forgot to include vital information. The uterus came out 14 months ago (all but one ovary) and I was menopausal for 15 months prior to that.

Georgia: All of the percentages were from the biopsies prior to any treatments. I just sent a message to my surgeon's office to get a copy of the pathology report and hopefully to get my ER score. I will also ask my MO when I see him. Thank you.

sweetp6217

Ok. I'm taking a look at the Synoptic Report (post surgery) and my Score is 3, whatever that means.