Treatment for stage I < 1cm breast cancer.

HOPE65 · February 2009

I would like to know what treatment others who had a similar diagnosis (stage I < 1cm, lymph nodes clear, ER/PR+ HER2+ grade 3) have done, particularly therapy after surgery and radiation. I have spoken with several oncologists and they differ significantly on their recommendations. Some said the guidelines don't recommend Herceptin, another thinks it's necessary, please tell me what your thoughts on it are, or what treatment are you considering or have gone through and why, how you feel now etc. I have read some articles which say that it would do more damage than good because of the possible severe heart complications. Also, what exams should I be doing and how often? As far as tests go, I have had only mammograms. Any info would be greatly appreciated. I also had a hysterectomy in July and feel awful because of the lack of hormones (and can't take anything because the tumor was ER/PR+), anyone out there who had the same things done? How do you deal with the effects of surgically induced menopause? I'm also not taking the aromatase inhibitor (Aromasin) because it makes me feel even worse, I've tried others but still felt terrible. Thank you.

moonchild64 · February 2009

Hope65, the following report regarding treatment for small HER2+ tumors was released late last year. In a nutshell, it is now recommended that all HER2+ tumors, regardless of size, be treated with Herceptin.

http://www.msnbc.msn.com/id/28200163/

noellech · February 2009

I did chemo/herceptin for a 5 mm Her2+ grade 1 tumor. My onc was on the fence - said 10-15% chance of distant recurrence without the chemo/herceptin. The combination chemo/herceptin and tamoxifen should reduce that risk to 2-5% so I was game. But - if I didn't have small children I probably would have passed on the chemo, especially since I was grade 1 low Ki-67. The thing I hate the most about chemo was the menopause. If you are already in menopause from surgery then there are very few long term effects of chemo/herceptin. Some small risk of neuropathy and heart damage but numbers are very low. Good luck with your decision. I must say I am very relieved that I went ahead and did it now that it is over. It probably depends on whether you can get on with your life without worrying if you don't do the treatment. Noelle

swimangel72 · March 2009

My oncologist didn't realize I was Her2+ (the Fish report never was faxed to him) so he ordered the Oncotype DX and my score came back at 23 (recurrence risk of 14%). He then said I wouldn't need chemo - just Arimidex (since I'm post-menopausal) - but before leaving, he called for my Fish report (expecting it to be Her2-). He was shocked to learn that I was Her2+++ not just because my tumor was less than 1 cm (.9 cm) but because it was also a Grade 1. So he sent it out to be tested at a second laboratory - and it came back higher at Her2++++ so he started me on an unusual treatment with Navelbine every 2 weeks for 4 months with Herceptin for a year. I'll be done at the end of April with the Herceptin - and have had no serious side effects from either drug. I had 3 other oncologists agree with this treatment (as unusual as it is) - and I was told my risk for recurrence would drop to below 7%. WIth Herceptin you need to get muga scans or electrocardiograms periodically - but my onc said the risk for heart problems is very low (my heart has been fine.) Other chemo drugs can cause heart problems - he wanted to avoid that because with my early stage of BC, he felt the best benefit was coming from the Herceptin - that's why he chose Navelbine (which didn't cause hair loss or heart problems).

I hope this information is helpful to you. I should add that Herceptin saves lives and I'm so grateful that this drug was available for me. Her2+ cancer is very aggressive and if your onc recommends treatment, I'd seriously listen. If in doubt, get a second - or even a third opinion. Good luck with your decision!

bluedasher · March 2009

I had TCH (taxotere, carboplatin and herceptin) once every 3 weeks for 6 treatments. I've just finished that and will continue getting herceptin once every 3 weeks for the rest of a year. Another standard treatment that has been around for more years (though since Herceptin is pretty new neither is that old) is AC-TH (adriamycin and cytoxan treatments - usually 4 - and then taxotere and herceptin usually for 4 then herceptin alone for the rest of the year).

The advantage of TCH is that it has lower risk of effecting the heart than AC-TH but is about as effective at preventing recurrence. Herceptin can reduce heart function, but the damage is reversable once Herceptin is stopped. My oncologist and I felt this was the right risk vs benefit (i.e. it won't do more damage than good) trade-off for me.

The BCIRG 006 trial tested TCH vs AC-TH and AC-T arms. There is an informative slide set available on line with the results of the 2nd interim analysis of that study:

http://www.bcirg.org/Internet/CIRG+Achievements/CIRG+at+SABCS+2006.htm

If you do choose to do TCH, there is a very supportive thread, taxotere, carboplatin and herceptin, for that therapy on the chemotherapy forum. It has been going for 2 years and I found it very helpful.

Liz08 · March 2009

Hope-

I'm not telling you what to do but just sharing my story, I was diagnosed with DCIS with a microinvsion (stage T1mic) that was less than 1mm that was hormonally negative but her2+. I consulted with over 10 oncologists and they all recommended radiation after my lumectomy because they felt that the risks of chemo/Herceptin outweighted the benefits for ME having such a small invasive component otherwise I was very healthy.

After reading everyone's posts ,you need to decide on a treatment plan along with you oncologists. If you don't feel comfortable with what your oncolgist is recommending seek other opinions. Remember it's you who will have to ultimately make a decision that you will have to live with for the rest of your life. I'm sure you have learned that life is very fragile. Please research, do the treatment that you feel comfortable with and live life to it's fullest. Sending you the very best, Liz

Halla · March 2009

Hi there! I was in a similar dilemma last year after I was diagnosed. I had a lumpectomy followed by a mastectomy in June. I had a large area of high grade DCIS with 2mm of invasion. The invasive component was ER/PR neg but Her2/neu positive. My lymph nodes were clear. Smile

So, I saw and spoke with many oncologists. I received different advice from each. The bottom line is that we still do not know the natural history of really small Her2/neu positive tumors. So, ultimately, I saw Edith Perez, MD. She is very well respected in her field of breast oncology. She said that my lifetime risk of recurrence was around 15%. She emphasized that this was her educated guess. Based on that, I decided to do the chemo. I did TCH. It was not that difficult, really.

When I saw the article from the San Antonio Breast conference, it scared me. However, that study is not really reliable, if you ask me. It is looking at women who were diagnosed and staged in the 1970's! We didn't have CT scans then or MRIs or PET scans, so my guess is that many of those women were understaged. There is now some data emerging that shows that small Her2/neu tumors are at a higher risk of recurrence that ER/PR positive, her2/neu neg tumors, but not HUGELY at risk. Still, for my comfort level, the fact that these small tumors pose on unknown at this point in time, was enough for me to choose chemotherapy. I will say that I am VERY happy that I did not receive adriamycin. The TCH protocol is emmerging now as a first line therapy. The longer term survival data rivals AC-TH and the side effect profile is much better.

Good luck with your decision. I hope this helps.

hlependu · March 2009

I had DCIS. Did a lumpectomy last May, followed by chemo then radiation therapy. My tumor was small, 10mm, but I was HER2+ and Estrogen positive. the chemo was terrible, i didnt do too well. Radiation was a cinch. I still have another 4 months of herceptin (had a treatment today) - I am taking estrogen blockers and overall I feel very very lousy! nauseous, depressed, frustrated, tired, weak and achy ALL THE TIME. Before all this fiasco, I was super healthy and worked out 5 days a week and surfed and mtn biked on weekends. I'm only 32yrs old and now I just lay in bed most of the time and it hurts to do anything. anyone else having a difficult time with this?

bethanybeane · March 2009

Dear hlependu: You are not alone. I'm finishing Herceptin in July and trying to cope with the AI's se's of foot, ankle and knee pain. After radiation and a few weeks of Arimidex, I also got very depressed but didn't realize at first what was going on. I didn't feel like doing anything -- went to work-- came home and lay on the bed for hours. No motiviation to do any of the things I used to enjoy. My doctor now has me on Lexapro 10mg. Buspar for anxiety, and now also Wellbutrin -- Happily, within a week, although I was still hurting, I could easily tolerate the soreness and stiffness -- and now I think I can cope with the thought of doing this for 5 years -- am a changed person. I am so sorry that this is happening to you at such a young age. You may need some help getting through this -- your body chemistry made need some support. ~ Bethany

jmdtaurus · March 2009

hi hlependu

i am just like you, i have neuropathy from taxotere and aches/pain in joints and bones from femara

i am supp to be on it for 4 more years but read article that says if you metabolize tamoxifen ok, that can be taken after 2 yrs of femara with fewer se i am going to ask my onc about this

jill323 · March 2009

Halla - Confused by your comment about the San Antonio conference study. In fact, that study was a retro active study that looked at diagnosed women from 1973-2003 (not solely from the 1970's). All these women had small tumors (less than 1 cm) and simply looked at their recurrence stats after a long period of time. To get a retroactive look, there has to be a long period of time that has elapsed. In fact, the stats for the 5-10 year outlooks were only run on a data base (approx. 1000 women) who were diagnosed between 1990 and 2002.

Perhaps we are looking at different studies. Are you referring to the MD Anderson study? This one was considered to be quite reputable in its outcome in oncology circles (at least in my Doc's practice it was).

Please find below the actual abstract and poster from that study as opposed to the press release.

First, the link to the abstract

http://www.abstracts2view.com/sabcs/view.php?nu=SABCS08L_444&terms=

Second, the link to the poster - This is where you find they limited the stats to women diagnosed between 1990 and 2002.

http://www.posters2view.com/sabcs08/viewp.php?nu=701&terms=

If you can't get the links to work, cut and paste into your browser.

Hope65 - I was in a very similar situation as yourself other than my ER/PR scores were not very high (ER20%, PR neg.). I did Taxol in order to get Herceptin (Herceptin is not indicated without chemo). This regimen modeled my reccurence risk down to single digits. While not fun, I found it manageable - even working through it. I am currently still doing my year of Herceptin. Feel free to PM if you want additional info. Many of these ladies here have heard my story, and I don't want to bore them yet again.

Jill

wisejill · April 2009

Have you had an OncoDX test to determine if chemo is your best option? I also was Her2+. I had 2 tumors removed and lymph nodes were clear. I also had a hysterectomy 9 mos before I learned I had breast cancer.

Since my OncoDX score was low I skipped chemo and moved to 30 rounds of radiation. After that I want on Arimidex. I have been on Arimidex for 13 months.

I know how bad you feel. Between the surgical menopause and the drugs from my treatment plan I had hot flashes, ached all over and was pretty depressed. I learned about a supplement that my doctors let me try because it is natural. If you want me to send you a sample let me know. I have several survivor friends who take the sample supplements.

Hope that helps. Don't let it get you down, you will find the right treatment plan.

Jill

wisejille@gmail.com

Liz08 · April 2009

Please see my post on 2/13/10

lastminuteD · April 2009

My original diagnosis was similar to yours Hope65. After a mastectomy for DCIS, a .2cm IDC was found, clear nodes, ER+/PR+/HER2+++. Since the IDC was so small, chemo was not recommended so I was put on Tamoxifen. 15 months later I found a lump in my reconstructed breast - 3.5cm IDC however now ER-/PR-/HER2+++, clear PET scan. I had further surgery, chemo (Adriamycin/Cytoxan & Taxol/Herceptin) and extreme radiation. (radiologist said she was going to make me toasty!)

So far, so good but maybe if I'd had the chemo or just herceptin with the first diagnosis, I might not have had a recurrence.

best wishes!

Dawn

Liz08 · April 2009

Dawn-

based on your prognostic factors, this 2nd cancer was a new or different cancer. Your 1st cancer was ER+ and PR+ but your 2nd cancer was ER- and PR-. That's the first sign that the two cancers are not related. Unfortunately, I have been told by my doctors and read numerous times that once you have had one cancer you have a higher chance than the average person of developing more cancers. Also,I have been told by my doctors that I can't panic at every lump, bump, or ache and pain since they are more than likely nothing to do with cancer. I find the last two statements contradicting each other and frustrating. Since my BC diagnosis, I have been diagnosed with 2 skin cancers and one biopsy of a mole came back with abnormal cells but fortunately benign and was completely excised.

I wonder if your 2nd cancer would have never happened or if would have been killed off if your treatment was more agressive with your 1st cancer. Fortunately everything is going well and wishing you the very best.

cookie2009 · February 2010

Hi, I have checked with three different oncologist, and all say no Herceptin for me. I was er, pr , negative, her2 postive. My tumor size was only .17mm. So I had mastecomy and no treatment. They never said about recurrence rate, just that it was very small due to tumor size. Now, I am crazy with worried that I did not due the right thing. My insurance would not pay if doctor did not recommend for me. Can You advise me what to do now?

Cookie

cookie2009 · February 2010

Hi, I didnot get Herceptin either. My tumor size was .17mm, stage 1, er pr negative, and I had a mactecomy with clear margins.

Margie

drman · February 2010

Hi, I just got back after meeting with the Oncologist. I too had a HER2 positive microinvasive tumor for which I had a mastectomy. She felt the risks of Chemo far otweighed the benefits - so no chemo.

Ruta

swimangel72 · February 2010

I found this article linked at Her2support.org - thought it very relevant to this discussion regarding Her2 positive tumors less than 1cm...........Herceptin with chemo is recommended:

Trastuzumab May Benefit Patients with Very Small & Low-Grade Breast Tumors

If your onc advises against chemo, try to get a second and even a third opinion to be sure they are "up" on the latest information regarding Her2+ tumors.

amyob · February 2010

The study posted does not include T1mic. Several large pathology series have suggested that the patients with focal microinvasion diagnosed as an area of invasive disease of 1 mm or less, have a prognosis identical to those patients with pure DCIS.

weety · February 2010

You are right--and there is not much to go on for HER2+microinvasions, let alone even slightly larger tumors (T1a 1-5mm and T1b 5-10mm). Most of the large studies have been on HER2+ tumors that are larger than 1 cm. I had the wonderful opportunitity to hear Dr. Ana Gonzalez-Angulo (one of the oncs in the above linked article) speak about what to do with small HER2+ tumors and this is what she kept saying over and over again. I am quoting from her conclusions out of the notebook they gave us: "With the advent of newer diagnostic techniques, it is very liikely that the number of patients diagnosed with samll tumors will increase, making the management of small node-negative HER2+ tumors a clinical challenge." It also says, "Small HER2+ breast cancers are uncommon, but represent a high risk group and anti-HER2 targeted therapy should be considered in this group of patients." And the last point in her conclusion about trials in this more uncommon subgroup was "The low event rate could limit the feasibility of a randomized trial to discern the real contribution of chemotherapy and/or trastuzamab."

She presented a couple of studies that were interesting. Both of them contained both T1a and T1b node-negative patients.

Study #1 Treatment of node-negative infracentimetric (under 1 cm) HER2+ invasive breast cancer: 56 HER2+ tumors (T1a & T1b) with good prognostic features (low proliferation, low grade, hormone receptors + ect.) were observed and given NO herceptin (I am not sure about the chemo status--this was a retrospective study) 9% of these patients had recurrences. Now for the data supporting the use of herceptin in small, less than 1cm tumors: 40 tumors with POOR prognostic features (important to notice that this group had an even higher risk of recurrence than the first group because of the poor prog features) were given herceptin. There were ZERO recurrences in this group.

This study is retrospective and small, so of course the data could be flawed or incomplete, but Dr.Gonzales-Angulo really felt this was a compelling reason to use herceptin in small tumors.

Study #2 (again might be a little flawed because retrospective and only some in the no herceptin group had chemo while all had chemo in the herceptin group) This study included all tumors less than 2 cm. Here was the breakdown of the 257 tumors: 21% were less than 5mm; 21% were from 5-10mm; 35% were 1-1.5cm; 22% were 1.5-2cm. 108 of the patients received no herceptin and the recurrence rates (within 4 yrs) were 9.3% had locoregional/contrlateral recurrence and 5.6% had distant recurrences. 149 patients received herceptin (and chemo) and the recurrence rates were 1.3% for locoregional/contralateral and 0% (yes, 0%!) had distant recurrences.

Anyways, this is a long post. But the point is, there isn't a lot of research going on with these small tumors, but what there is, is quite promising! Dr. Gonzalez-Angulo kept repeating that with herceptin and the low number events we find with it's use, it really makes it hard for a trial study to be created for this subgroup of women with smaller than 1cm tumors. It would take such a large number of women to get enough data! Her main point in this talk is that in HER2+ tumors, even those 1mm-10mm, herceptin should be strongly considered.

orange1 · February 2010

Swimangel and Weety911 -

This is hugely important information. Thanks for posting.

Jenniferz · February 2010

Here's my 2 cents. My idc was 0.3cm, and my dcis was 0.2 cm. I had a mrm, and clean margins. Nodes were clear also. I had two different oncs. tell me that since they considered my reaction to this disease rather radical, that the mastec. was aggressive enough. I also had no rads. I questioned and begged (the second one especially) for Herceptin, but the answer each time was "no, the se's outweigh the advantages", and I had to be satisfied with that. I just finished my 3 1/2 year checkup, and so far am still NED. However, should the beast ever to decide to raise it's head again, I've printed off report after report, and that includes weety's, and will wave this in my onc's face. (Fired one because he never looked at me....not one time in 1 year.--Even told me that I was cured. Jerk.) My onc. that I have now touches, tests, and listens to a great degree, and even though I begged, still said "no' as I stated earlier. She is also a bc survivor (I just found out), and told me that indeed, do continue to listen and read any and all reports, but that I need to remember that I am fine.

So, what I am so clumsily trying to say is that to you ladies that didn't get Herceptin, and were given the reason that it appears that we all were, and your second opinion is the same, then be vigilant, trust your onc., and know you will be ok. Honestly? For the here and now, that's all I can do!

Jennifer

Liz08 · February 2010

For arguments sake....for us who have a diagnosis of "Microinvasive DCIS that is Her2+++" need our own forum index and I have suggested this to the moderators. Because we don't belong with the plain DCIS forum and we DEFINITELY don't belong with the her2+++ forum either....

NOT ONE OF THE STUDIES YOU LADIES WHO ARE ARGUING ABOUT INCLUDE STAGE T1Mic!!!!!!!!!!!!!!!!!

As most of the breast cancer books state....anyone diagnosed with cancer should consult with at least with 3 different oncologists to help you and follow the majority. Most importantly follow your heart on what you need to do to be able to move on and not look back.

According to more than the 10+...yes over 10 oncologists I consulted including, Dr. Eric Winer from Dana Farber, John Hopkins, Sloan and numerous others all said "Tmic is considered a separate pathologic entity with good prognosis". Several said it is a prognosis to that of DCIS!!!!

We can go back and forth stating our cases but it won't accomplish anything other then confuse the newly diagnosed.

And for the record every member that I have met (that had no chemo/herceptin) on the various breast cancer forum sites not just the BC.org site that had TRULY "Microinvasive DCIS, node negative (even no micromet!!!!) and was her2+++ is doing well years later!

There also are numberous members on the various cancer forums who had "microinvasive DCIS" and don't know their her2+++ and automatically are considered her2- but the truth is they don't know if they are her2+++ or her2- and they too are doing just fine. And I wish them "NED" forever, no matter what their actual her2 status is. Remember the majority of DCIS is her2+++.

I thought that I would post an abstract I found on the ASCO website from 2008-

Microinvasive breast cancer (Tmic): A descriptive mono-institutional report.

Sub-category:

Local-Regional Therapy

Category:

Breast Cancer--Local-Regional and Adjuvant Therapy

Meeting:

2008 ASCO Annual Meeting

Printer Friendly

E-Mail Article

Abstract No:

11508

Citation:

J Clin Oncol 26: 2008 (May 20 suppl; abstr 11508)

Author(s):

A. Ferro, A. Caldara, R. Triolo, M. Barbareschi, E. Leonardi, O. Caffo, M. Pellegrini, M. Frisinghelli, D. Bernardi, E. Galligioni

Abstract:

Background: Tmic is considered a separate pathologic entity with good prognosis, but its clinical significance and management remain controversial. We present our retrospective review of 69 cases of Tmic, among 6,023 BC pts (1%), observed at our institution from 1990 to 2007. Methods: We considered Tmic a single focus of invasive carcinoma < 2 mm or up to 3 foci < 1 mm in greatest dimensions (according to Silver and Tavassoli, Cancer 1998). Descriptive analysis of pts characteristics, treatment and clinical outcome are reported. Results: Among 69 women (mostly asymptomatic, presenting mammographic abnormalities, with median age 52, range 20-78), T< 1 mm in 55 pts (80%) and T< 2 mm in 14 (20%) were observed. Radical mastectomy was performed in 31 pts (45%) due to extended in situ component or multicentric disease, and breast conserving surgery (BCS) in 38 (55%). All pts but 4, received axillary node dissection (61 pts) or sentinel node biopsy (4 pts), with only 1 N+ pt. The "in situ" component presented ductal in 91% and lobular histology in 9% of the cases, with predominant comedo subtype in 45%. All Tmic presented ductal histology with positive hormone receptor status (HR) in 45%, negative in 22% and unknown in 33%. Among 32 HER-2 evaluable pts, HER-2 was overexpressed in 34% and normal in 66%. Adjuvant treatment consisted of radiotherapy in 87% of BCS pts, chemotherapy in 5 HR neg pts, endocrine therapy in 7 and chemo-endocrine in 1 N+ pt. At a median follow-up of 93 months RFS and BC specific OS were 91 and 100%, respectively. Three pts experienced a local relapse (2 DCIS and 1 invasive) and 1 distant metastases (bone). None of relapsed pts had received systemic adjuvant therapy. Three pts died for non-breast cancer causes. Six pts developed a controlateral BC (9%): none of them progressed or died of disease. Conclusions: Our data appear in large part comparable to those of the literature on Tmic and, in our experience, the inclusion of microinvasion > 1 mm and < 2 mm did not change the good prognosis of microinvasive cancer.

The above is cut and pasted word for word. Wishing everyone the very best.

Liz

weety · February 2010

jenniferz, I understand your concern and disgust over the doctor who wouldn't give you the herceptin, but it is true that under current guidelines, you would not be routinely offered herceptin. The current guidelines state that for tumors 1-5mm NO herceptin; for tumors 5-10, CONSIDER herceptin. Mine was 7mm. My onc prescribed the herceptin without question, but I can see why if it was really small, oncs might be more hesitant.

Liz08 · February 2010

The ladies who are arguing your cases for chemo/herceptin have caused unnecessary anxiety in many new members including myself (when I was newly diagnosed) ...while your information is very important but it DOES NOT pertain to stage T1mic that is her2+++ which is microinvasive DCIS that is her2+++. This is a separate pathologic category!!! Additionally you are not oncologists to be giving advice!

Yes, I have had a few scares mainly because of what I have read on this forum about her2+++ but not only those who are her2+++ recur. Right???? Would having had chemo/herceptin make me feel better when I have new aches/pains...NO.... since most of the chemo's cause neuropathy which all my doctors warned me about! Along with other aches and pains which make it even more difficult to evaluate any new aches and pains to determine if cancer related.

There are numerous other SE's from chemo/herceptin that need to be weighed in when making treatment decisions. As far as treatment....the risks and benefits need to be weight in individually by the patient and their doctor. Cancer is a crap shoot...there are perfectally healthy people who have died from chemo or later in life developed another cancer (usually leukemia) from chemo.There are numerous other risks to be considered as well.

If you have any of you have information specifically pertaining to Stage T1mic, node negative that is her2+++, I would love to see it. And I am not referring to her2+++ that less than 1 cm and having a micromet in a node. I mean information on specific to stage T1mic with clean nodes that is her 2+++!!!!

Wishing everyone well.

Jenniferz · February 2010

Thanks, weety!!! This that you just posted does give me alot more hope, and I was disgusted with the 1st onc., not the second. I dismissed him for more than one reason....top one being he never even looked at my scar!!! Much less touch!! My second onc. agreed with the fact that no, I wasn't a candidate. She took it a step further and said she may not have given me Femara even though I'm er/pr+. But, she left me on it, and I'm still kicking!!

Even though this forum is unnerving at times, I still come here to find information.

Liz I sent you a pm.

weety · February 2010

The title of this thread reads: Treatment for stage 1 <1cm breast cancer. That includes all tumors less than 1 cm, not just micro-invasions. Unfortunately, there are not many studies done on the small HER2+ tumors, let alone on the microinvasions. But this thread is for ALL tumors less than 1 cm so the conversations on T1a and T1b certainly qualify and belong here.

Jenniferz, I need to add (and hopefully this will make you feel better, too) that after Dr. Gonzales-Angulo gave her "yes to herceptin for small tumors" side of the debate, another leading onc gave the "no" side. Her arguments were that the very small tumors already have very good recurrence rates without adding herceptin, and there still is the possiblity of long-term unknown risks. Also, in most of the studies, including the ones above, the majority of the tumors were still larger than T1a (Only about 20% in one of the studies were less than 5mm) so her argument was why offer a whole year of therapy for tumors that herceptin has just barely been studied on? She put up two slides that showed her thoughts on giving herceptin for T1a & in some cases T1b: One showed a bazooka shooting a fly and the other slide showed a balance scale with HER2+ DCIS on one end of a balance where the "risks" (of herceptin) were and on the other end where the "benefits" were, was node positive (note this side said node POSITIVE), healthy patients, T1a & b tumors. She said the rest of the patients fall somewhere in the middle of these two extremes and really need to be looked at on a case-to-case basis. She made it clear that it may not be the herceptin itself that is the problem, though. She thinks it is also the harshness and toxicities of the current chemo regimens that are given concurrently with the herceptin that are part of the problem. She was stressing the need for more studies to be done on herceptin given with other chemo regimens that are more tolerable. (I think one of the ones she mentioned that is a little easier is the current trial going on with herceptin & taxol.) On her conclusion slide, it said, "Do the data support HER2 moving a small node-negative tumor into the high risk category? NO"

I think the bottom line is, although they know herceptin works, they do not clearly know to what extent it works in the smallest of HER2+ tumors. Everything is still mostly speculation with these small tumors, and even the leading oncs disagree on what the best protocol is!

Liz08 · February 2010

For those who had Microinvasive DCIS that was her2+++, as of this afternoon, we finally have our forum index (thanks to the moderators!) so please feel free to post there. The forum index is called Micro-invasive DCIS that is Her2+++. Thank you! Sending (((hugs))) to all of you, Liz

Treatment for stage I < 1cm breast cancer.

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