Her2+ and the brain

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  • marymath
    marymath Member Posts: 3
    edited June 2011

    I haven't been back on this forum since I wrote earlier and am trying to absorb all this information. Wow Happman and Lassbird- your situations are so similar to mine. I don't feel so alone now.

    Is Tykerb another chemo- infusion?  I did have Carboplatin as one of my chemos last year, with Doxetaxel.

    What concerns me this morning is that this is the second time since the WBR that I have tried to wean myself of the decadron steroid and both times my headache resurfaced in full force. Just feel really crappy. I also have had a plugged up ear for over a month and am frustrated that the fluid hasn't drained out of my inner ear ( or is is my middle ear?)  

    Next week is my brain MRI and I am anxious. I have felt hopeful all along but now that it is getting close, I am less so. 

  • lago
    lago Member Posts: 17,186
    edited June 2011

    Marymath if you have fluid in your inner ear that could be what's giving you headaches as well as the steroid withdrawal. Don't get too scared of the MRI. No need to assume the worst. As you know if there is anything that could suggest a problem a good onc will do a scan even if they do believe there isn't an issue.

    I too never got a brain scan from what I remembered and wondered the same thing. Given that my onc has done a lot of research in HER2+ (was one of the oncs in the trails for Herceptin… even mentioned in the book!) I'm OK with no scan. I have a feeling it might be if there is an issue you do get symptoms pretty quickly… not based on any facts though.

  • elmcity69
    elmcity69 Member Posts: 998
    edited June 2011

    hey ladies,

    had my last visit with my oncologist today (he is moving to the West Coast - and don't get me started about how this breaks my heart)

    he unequivocally stated HER2+ gals are NOT higher risk for brain mets. the tx protocol is affected by Herceptin's failure to cross the BBB, but again: we are NOT sitting ducks any more than HER2-. and this from a doc who is brilliant and did a fellowship @ Johns Hopkins. He also doesn't do brain MRIs unless there are sx.

    feeling heartbroken today because he's leaving, but happier about the brain issue.

  • lago
    lago Member Posts: 17,186
    edited June 2011

    Thanks for the update. It does make sense. Sorry about your onc.

  • amlg1
    amlg1 Member Posts: 596
    edited June 2011

    Elmcity,sorry about your onco,It would break my heart if mine ever left.We become so thankful and so close to them.Well that sure makes me feel better,about brain mets.Thanks for asking your onco.

  • marjie
    marjie Member Posts: 1,134
    edited June 2011

    Good to know!  Sorry about your onc...I would be lost if I had to lose mine right now!!

  • stlcardsfan
    stlcardsfan Member Posts: 466
    edited June 2011

    I completed Herceptin treatment December 2010. Everything was going along fine, and then in late February started getting dizzy spells. Wasn't happening everyday but did concern me. I though maybe I was reacting to one of the supplements I had been taking for menopause issues.

    By mid-April it still kept happening, so made the call to oncologist. We went over everything that had been going on since my last Herceptin. He had a theory of what was going on, but went ahead and ordered a brain mri and bone scan, and some additional blood tests. I went back in to see him the following week and all of my tests and scans were clean.   

    Diagnosis - benign positional vertigo! He gave me a prescription for motion sickness meds to help when I get the dizzy feeling again. I went to fill it, and the pharmacist mentioned that the same thing can be bought over the counter. So I got that, used it two times, and guess what - no more dizzy spells.

    I am seeing a ENT specialist to see if there is some other inner ear thing going on. Curious if the TCH might have caused this - who knows. I also suffer from migraines - had them well before by cancer diagnosis, so headaches are not that uncommon for me.

    I too am worried about the whole brain met thing, and my oncologist has assured me several times that I am fine and to go and live my life! I too am thankful for Herceptin! 

  • elmcity69
    elmcity69 Member Posts: 998
    edited June 2011

    thanks, ladies. i am really sad about it - he and I had a great connection. kindred spirits. he even got teary eyed today- which of course made me about to lose it.

    anyway, glad to help with the clarification. it was an issue causing me heaps of anxiety lately.

    xo

    j

  • Iamstronger
    Iamstronger Member Posts: 378
    edited June 2011

    stlcardsfan-YEAH for Vertigo!

    V

  • Fitz33
    Fitz33 Member Posts: 243
    edited June 2011

    Hi everyone.  I'm new here and have been reading your posts.  I've been worried myself over dizziness and wonder if it's the brain.  I think it's the position vertigo though and there is an exercise that I did last night to help with that.  I think it helped a bit as when I had radiation this a.m. I didn't get dizzy.  I finished my chemo & surgery and now am having 32 rads.  My onc told me that Her2 "loves to go to the brain" was exactly how she put it.  She said that the FDA had approved Tykerb only for Stage 4 and that the trials going on are trying to get it approved for the earlier stages.  This same thing was done with Herceptin.  The Herceptin study was cut off early because it helped so many women and I hope to hear the same thing about Tykerb. 

     I'll see my onc in a week & will tell her about the dizziness.  I'm worried about any more radiation as I've had so much since dx. 

     I notice that most everyone has their condition graded but I can't find any info on my path report to do that.  Can anyone tell me how I figure it out? 

  • marjie
    marjie Member Posts: 1,134
    edited June 2011

    I know it's likely true, but I wish you onc hadn't said that !! Frown

    I'm not sure, and hopefully someone on here will correct me if I am wrong, but I understand if your cancer is Her2+, it is grade 3 because it is so aggressive.

  • scuttlers
    scuttlers Member Posts: 1,658
    edited June 2011

    Article on BCO -

    http://www.breastcancer.org/treatment/targeted_therapies/new_research/20110610d.jsp



    WHY ARE NOT ALL HER+++ receiving this combo????



    Why did KonaKat not receive this combo? Or several other wonderful/beautiful/full of life women who are now in the arms of the Angels, the same women I laughed with, and cried with, and hoped with, as we encouraged each other on this journey. WHY DIDN'T THEY GET THIS COMBO? And why me? What is so special about me that I live, and they didn't?

  • lago
    lago Member Posts: 17,186
    edited June 2011

    scutters it's still in trials for early stages.

    Marjie Not all HER3+ is grade III but typically it is. It's also typically not hormone positive or if it is not highly positive. I know my ER is only 30% and PR 5%

  • anonymice
    anonymice Member Posts: 532
    edited April 2012

    Marjie, I am Her2+++(overexpression in almost all tested cells), but my tumor was grade 2.  But I'm definitely not the norm.  I also have IBC, which is rare.

    Scuttlers, I feel "survival guilt" too.  The problem isn't that we don't have cures for cancer, the problem is we don't know when to use what cure and on whom.  Right now it's at least partially luck but they're learning.   

  • MaiTai
    MaiTai Member Posts: 491
    edited June 2011

    Hi All,

    lago, I'm her2+++ and ER+ at 85% which I understand is pretty high. I think my PR is 5% and definately perceived as PR-.

    Do you know if different labs stage the hormone +/- differently? 

  • lago
    lago Member Posts: 17,186
    edited June 2011
    MaiTai Not sure but I think there is only one test, " immunohistochemical staining assay, or ImmunoHistoChemistry". Some get percentages, some get numbers on the path report.. Check this out: linky 
  • Fitz33
    Fitz33 Member Posts: 243
    edited June 2011

    MaiTai, I'm also Her2***, ER+ at 95% and though my PR first tested at 5, my onc said that it's considered a negative so I'm PR-.  I read somewhere on this site that ER+/PR- with Her2*** is rather rare.  Have you heard that?  What makes it rare and is that any other outcome for us? 

  • MaiTai
    MaiTai Member Posts: 491
    edited June 2011

    Thx Lago.

    Fitz33- I'm not sure about the outcome. I read somewhere that those who are both positive (ER and PR), had  better chance to respond to tamoxy, than us.

    BUT, almost every thing I read only speaks about ER and not much about PR. I don't really know...

  • Iamstronger
    Iamstronger Member Posts: 378
    edited June 2011

    Marji,

    I am grade 2, but it was very close to being a grade 3.

  • marjie
    marjie Member Posts: 1,134
    edited June 2011

    I am going to dig out my path report (yet again!!) and look at my numbers .... I know I am Her2+++, but I'd like to see the numbers for ER/PR.  I really didn't pay any attention to them.

  • kathleen1966
    kathleen1966 Member Posts: 793
    edited June 2011
    I scored a Nottingham score of 7, which puts me at grade 2, though I really don't know how you can be grade 2 and Her2+ so I don't put much stock in it. I had less than 10% of progesterone test positive and was told this is considered clinically negative, was estrogen negative. I had the opportunity to go on a Lapatinib trial but declined because I wanted to have surgery as soon as possible and putting the surgery off wasn't going to change the fact that I would still have needed a mastectomy due to extensive DCIS and pagets (the majority of my cancer).  I wish they had told me about Her2 and the brain though and that lapatinib crosses the brain barrier.I had no idea what I was doing at the time... I have gotten conflicting opinions on the brain and Her2+. I also have heard that it likes to go to the brain but only after it has metastasized to another area first.  I think we will see more brain metastasis though as herceptin will prevent system recurrences but not brain recurrence. There was a woman who just posted on here that out of 50 women her doctor treated for Herceptin within the last five years, only two had recurred.  They recurred with brain mets, were treated with cyber knife and are currently doing well. My oncologist did tell me that the brain is not a common site to have a recurrence with breast cancer, though it does happen. I'm still thinking the cross your fingers approach is the approach that's being used but it also seems to be a crap shoot in terms of who goes on to have a recurrrence and who doesn't....We just don't know...I need to just let this go....


  • lago
    lago Member Posts: 17,186
    edited June 2011

    Grade of tumor cells just show how like or unlike the cells are compared to normal cells. Grade 3 having the most distortion. High proliferation rate is associated with higher grades but you can be grade2 and HER2+ and still have a hight poliferation rate do to the HER2+ status.

  • sweetbean
    sweetbean Member Posts: 1,931
    edited June 2011

    Lago, maybe you will know the answer to this. My FISH score was 2.5.  With the cutoff being 2.2, what does that mean?  Is my Her2 somehow less aggressive?

  • lago
    lago Member Posts: 17,186
    edited June 2011

    My understanding is HER2 is on all cells. This is what tells them to grow. The issue for us is we overexpress this gene which causes too much growth (tumor).

    I get the impression that if you fit in the range of too much expression then there really isn't too much difference but I would check with your onc.2.2 is considered amplified. My path report considers anything 2 and above as HER2+. I was 3+ I think they stop counting when the get about the 3 range.

    If you do ask your onc I would be interested in what she/he has to say about it.

  • sweetbean
    sweetbean Member Posts: 1,931
    edited June 2011

    Thank you!  The term she used was "lowly positive."  Which didn't really clear things up.  All I know is, I should have been getting Herceptin starting in February, but I didn't get it until the end of May, so I am worried.  I had a very good response to chemo, but I'm still a little freaked out.  *sigh*  i wish she had ordered the FISH test back when I was diagnosed.  

  • lago
    lago Member Posts: 17,186
    edited June 2011

    Sweetbean don't stress over this. You may not even need Herceptin. You are just taking it as insurance. Not all HER2+ spread. The problem is they don't know which ones do and which don't. I'm sure if you need it it will do it's job.

    I'm only 30% ER+, 5%PR+. Even though it's lower that many others I'm still taking Anastrozole. It's just another gun. It's a good thing you are getting Herceptin even if it's a few months later.

  • sweetbean
    sweetbean Member Posts: 1,931
    edited June 2011

    Thank you so much, Lago. I'm usually really positive, but sometimes I get freaked out.  You have made me feel much better!

  • Fitz33
    Fitz33 Member Posts: 243
    edited June 2011

    Whenever I've read posts about mets going to the brain in Her2+ women, no one is ever very concerned about it because they all say they have a Cyber Knife I think it's called and it takes care of it.  I haven't seen where they have had mets to other sites so it looks like the docs have got it under control even if it does strike which we hope it doesn't.  I'm not going to worry about it much but with my dizziness lately it crosses my mind. 

    I see my onc for my first checkup in another week and am thinking of asking her some questions but for the life of me I can't think of what to ask.  I don't want to know statistics because I don't think anyone can predict that, the recurrence rate seems to have been answered in these posts as two to three yrs. out and you're doing well, I've asked before about eating and was told "everything in moderation" and organic isn't necessary, for each coffee or glass of wine have an extra glass of water, try to walk 20 min. a day.  Is there something I've been missing about asking that's important?  I don't want to worry so much and feel really good except for the dizziness.  Rads aren't bad at all and could be causing it.  Herceptin treatments are okay, just some joint pain afterwards.  A lot of days lately I feel better than I ever have.  Is anyone else like that?  Is it because each day is more precious now?

  • lago
    lago Member Posts: 17,186
    edited June 2011

    Fritz up until Friday afternoon I felt awesome. I'm sure once I heal from surgery I will just as good. I see my onc a week from Tuesday. First time since chemo ended. I'm not sure what I should be asking either. I'm not sure she would have even has the answers but know that breast cancer is her specialty (she was involved with the initial Herceptin trials) I know she's an excellent source for this info… and she doesn't bullshit. If she doesn't know she will come right out and say it.

    So I too need to get my questions together.

    Sweetbean we all need to be talked off the ledge from time to time. So much unknown and a lot of misinformation or misinterpreted information that gets repeated over and over again on this forum can make you crazy.

  • pejkug3
    pejkug3 Member Posts: 902
    edited June 2011

    My pathology report graded me a Grade II/III...I'm not entirely sure what that means? 

    And I'm 80% ER+ and 40% PR+.  I gather that this is in my favor for taking Tamox.

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