36 year old mom trying to figure out chemo or no chemo

I opted for 12 weeks Taxol + Herceptin, followed by the remainder of the year's treatment on Herceptin only. (I wouldn't have touched A + Herceptin with a 10-foot pole under any circumstances, due to the heart risk! but my onc doesn't even use A with H anymore, because of that.) I felt very stronly that the Taxotere/Carbo regimen would be overkill. IMO the TCH would definitely be overkill for yours. The Taxol/H x 12 is being used more and more commonly for Stage 1 node-negative situations like yours and even for Stage 2a like mine. Sloan, Dana Farber, Stanford, and several other major cancer centers are using Taxol/H quite a bit lately. It's a much easier chemo on your body than TCH! I sailed right through it and so did two friends of mine on the same regimen. This regimen option is  something that you might well want to bring up to the oncologists you've talked to, if you feel more comfortable with a Chemo rather than a No Chemo scenario. 

If you are HER2+ I don't quite understand why "no Herceptin" is being presented as an option. I thought it was pretty much automatic nowadays to recommend it if you have HER2+ BC of any size? AFAIK, you can't get Herceptin by itself without first having a course of it combined with a taxane (either Taxol or Taxotere).

 If you choose Taxol, you get just that plus the Herceptin. If you choose Taxotere ("Taxol's Evil Twin" ) you need to also get a "C" component (either Carboplatin or Cytoxan) along with it.

 I'm ER/PR neg, so have no experience with tamoxifen etc. 

You have kids and you are young.  Please consider chemo + herceptin.  HER2 is very aggressive and chemo is indicated for HER2 (chemo potentiates the Herceptin).  I just finished a year of herceptin and had Taxotere and Carboplatin last fall. It was very doable.   check in with other mothers that have young children.  Wishing you the best.

I think in view of the very poor prognosis her2+ had before herceptin, we need to treat this aggressivly.

The chemo/herceptin/.rads was very do able for me, side effects were minimal and I'm so glad I did everything possible to help avoid a recurrance. I've five years out now, I dont know if it worked but if it diagnosed tomorrow would do the same again and even more so in view of your age.

This is a very aggressive type of cancer that likes to travel and spread, before herceptin the prognosis was a year so I'd advise doing all of the above to give yourself every chance to beat it.

There are no guarantee's, but so far people  treated with this regime are surviving well:)

Check out www.her2support.org for more long term survivors!

Tricia x

I just finished up 4 rounds of Taxotere/Cytoxan 3 weeks ago and did very well. I had virtually no side effects except for fatigue for a few days each round. I started the Herceptin after round 2. Having no issue with that at all so far! I was 43 at diagnosis with a 1.9cm tumor and I would not mess around with the HER2+. I also know people with smaller tumors than mine doing the 12 weekly taxol/herceptin and are doing quite well. At your age and with kids I would try to throw everything at it now.

Good luck with whatever you decide! You can do it!!

Hi--Like Faith316, I did ACTH and my heart is going strong with only a few Herceptins left to go.  Never had a single heart issue.  Good luck to you. Having all those options in front of you must seem overwhelming. 

For me, I made my decision based on wanting to know I had done everything available to me to kill the cancer once and for all.  If it works, then it works.  If it doesn't, I still know I did all I could to fight it.  When I was weighing my options, my dh begged me to do the chemo.  To him it meant I was fighting and he wants me around a good long time.  Most things we do in life have risks.  If we hide from the risks, we hide from life.  That's my humble opinion.

The HER2 positivity is what makes our type of cancer more aggressive and faster growing. Why not utilize Herceptin to reduce that risk?

I agree 100% with you that there is no sense in using an elephant-gun approach to treatment (which is why I wanted TH instead of the originally recommended TCH). But on the other hand I also would not want to completely ignore a strong risk factor that already exists, if there is an option available to me to reduce it. That's why I opted for a prophylactic BMX of my healthy breast; I liked my odds better that way, and knew I could not live with the stress and worry about that breast if I had not done so. I'd have done the same thing even if I'd had a different type of BC.

 

Hi Mommichelle - Despite the debate going on in your thread, I just wanted to offer hugs and support to you.  Ultimately, you are in charge of your treatment. You have to make the best decision for yourself. 

I am 40 years old, triple positive with a high mitotic index, showing that the cancer was very fast growing.  I am opting for chemo and Herceptin (TCH, which I start tomorrow), in addition to hormone therapy, because I am so young. (One of the blessings of bc, is that people keep telling me how young I am.)  I wanted to knock this thing out of the park, in hopes that I will not have to deal with it again.

I would never tell you how to make your decision, but that was how I made mine.  I wish you all the best.  Show those kids how a thoughtful and strong woman deals with this diagnosis!

Michelle, I know that this is a difficult and important decision. I'm sorry you have to go through this.

Much of what PatMom is saying is inaccurate for HER2+ cancer and not supported by the facts in studies. If your cancer was HER2-, then her advice would be pretty good because for HER2- cancers, it makes a lot of difference whether the cancer is horomone postive or not.

HER2+ cancer has a relatively high probability of recurrence regardless of whether it is hormone negative or positive and Tamoxifen hasn't been shown to affect that.

MD Anderson presented results of a retrospective study of women with small (less than 1 cm) node-negative tumors in Dec 2008 at SABC. 5-year recurrence for HER2+ was 23% and about 15% of that was distant recurrence. Recurrence for hormone positive HER2- cancer was much lower (5%) and triple negative was in between the two (15%) but with much lower distant recurrence than HER2+ (5%). That data convinced me that even quite small HER2+ tumors like ours should have chemo. I particularly noticed that recurrence seemed much more likely to be distant (mets) than for the other types. 

BCIRG 006 was a study that compared TCH, AC-TH and AC-T for HER2+ cancer.  The combination of Adriamycin followed by Herceptin (AC-TH) had significantly higher risk of causing lasting decrease of heart function (more than 2% of the participants). TCH did not. Herceptin without Adriamycin sometimes causes some reduction of heart function though it happens much less often. When it is due to Hereceptin alone, the heart recovers when Herceptin is stopped.

TCH was about as good at preventing recurrence as AC-TH in that study. There is a slide set on the 3rd interim analysis of results from BCIRG 006 on the BCIRG website. It includes some slides showing the results for the node negative patients though they mostly would have had larger tumors than us. After 5 years, disease-free survival (DFS) was 90% in the TCH arm and 93% in the AC-TH arm.

So AC-TH is probably not warranted. It may have slightly less recurrence but that isn't worth the risk of heart damage plus the very small risk of leukhemia. TCH carries lower long term risks and it was also lower in short term side effects in the study. 

I think that there is also a study underway on TH (Taxol or Taxotere, I don't remember which, with Herceptin) for Stage I HER2+ cancer. That would be worth considering as a lighter chemo for early stage HER2+. Taking Carboplatin out of the treatment would reduce the side effects - it seemed to be the culprit in most of mine during chemo. 

I chose to do TCH chemo and was very glad that I had when the MD Anderson study came out mid-way through my chemo. My oncologist felt that, for my small tumor, AC-TH was not worth the additonal risks it carries and I agree. 

If the TH study had been available to me, I think I would have chosen it. (It started after I finished chemo.) f the TH study had been available to me, I think I would have chosen it. (It started after I finished chemo.)  

Patmom wrote

[Herceptin]is of no help whatsoever if the cancer is sitting in a lab having been removed during the MX. Tamoxifen on the other hand, is effective in preventing distant recurrence if any cells did escape, and is also protective against new cancers in any remaining breast tissue. 

This is inaccurate. Herceptin of course also protects against distant recurrence. All chemo does as does hormone therapy because all are systemic treatments with drugs that go through most of your body. Chemo plus Herceptin also has been reported as reducing the occurrence of second primary cancers (i.e. new cancers). Cancer usually takes a long time to develop to the point where it is detectable so any treatment may by chance prevent a new cancer.

Bluedasher, thank you for clarifying the issues.  I was scratching my head when I read some of the earlier posts.

I am a mom of young kids-2 yr old and a 3 yr old.  For me, I needed to know that I have done everything possible to be around for my boys.  You are young and her2+, typically that means aggressive.  

I know that options can make it kind of tough. I didn't have an option with chemo, but I was borderline for rads and I decided to do it all.  I don't want this cancer to come back and kick myself for not having done everything I could.  GL on your decision.

V

Bluedasher - I'm not sure if you are citing the same study as my oncologist did. Unfortunately I can't remember the name of the study - but he was very clear that for early stage Her2+ breast cancer, Herceptin works with any chemo. I asked three other oncologists if my onc was telling me the truth and they all agreed - thus I am comfortable repeating this information for women who are so terrified of chemo that they would rather do NOTHING. It's definitely a question that women should ask their oncologists - and then to get a second or third opinion.

Thanks Blue for your explanation - I'm sure you are correct in your analysis - but as my onc (and others told me) - oncology is not just a science, it's also an art - there's a lot of flexibility available given individual patients' dx's. My onc really believed that my tumor would respond to the Herceptin with a light chemo especially since my Oncotype DX score was in the low-intermediate range (22). I was angry at first that I found out after my mx that I'd still need chemo (because my BS dropped the ball and forgot to get the results of my FISH report) - but in a way it was a blessing because my onc had ordered the Oncotype DX prior to knowing my Her2 status. Originally, thinking I was Her2- he was advising against chemo since the tumor was so small and only Grade 1 - he was actually shocked it was Her2+ - and sent it out to another lab for a separate FISH which came back even more highly Her2+..............anyway, not to distract from Michelle's questions and concerns - this is all behind me now (forever I hope) - I just wanted to clarify why my onc gave me a light chemo and to give women the hope of other options besides the heavy-duty chemo.

Michelle - I'm praying that you'll get to the right decision for YOU - hang in there - be tenancious and get a 2nd or 3rd opinion - and then you'll feel comfortable with your final decision.

So, I have a question. How can a pre-surgery HER2 score of "equivocal" 2.7 go to a FISH score of 10? Isn't 10 about the highest?