Herceptin without chemo

I just turned 70.  My ocologist has given me the option of Herceptin without chemo and an Arithdex for 5 years.  I am going for a 2nd opinion next week.  I also have MS although I appear to have no problems other than the invisible symptoms which are not interfering with my daily functioning.  I am not adverse to the chemo but of course would rather just have herceptin if it works alone.  I've just read the clincial trial info and it is too soon to obtain results of herception alone.  Kerrberlady please keep posting and let me know how your treatment is going.  The only difference other than age in our diagnosis is that I am ER and PR+.

eillenohio,

Some oncs will and some oncs won't. Depending on your comfort level about it, getting other professional opinions might be helpful in making a final decision. Grade 2 would indicate that it is a slower-growing type of breast cancer and opinions may differ among oncs about the need for chemotherapy for somone who is so likely to be postmenopausal and with other aging factors to consider.

I agree with Omaz.  A second opinion would be indicated, b/c you are older, and the risks of chemo with Herceptin (heart damage) are higher.  TCH, I believe, certainly is not as risky as Adriamycin with Herceptin - but still - I'd get a second opinion.  I've read a lot about HER2+ recently, and I know there is a fair amount of controversy about the risks of chemo combined with Herceptin for older patients.  I've heard multiple physicians say they would consider Herceptin alone in this population, even though it has not been studied extensively.   It is worth getting a 2nd opinion, just to be sure.  

I certainly think chemo/Herceptin is indicated with a HER2+ tumor > 5 mm.  The research clearly shows HER2+ is not something to mess around with and should be taken seriously.  I would hate for someone to think I am recommending no treatment.   However, if you are older I think it is important to have a full cardiac evaluation to make sure it is safe to proceed and is not contraindicated.  If it is contraindicated, then perhaps the option of Herceptin only is possible - again, depending on cardiac status.   And, if you have any questions, and are scared, a 2nd or even a 3rd opinion can give one some peace of mind.  Peace of mind about how to proceed is invaluable! 

eileen, I agree with everyone. Get a second opinion. My onc also said he would consider herceptin without chemo for older patients who do not have node involvement. I am glad they are doing trials on this, because as someone wrote in one of the above posts, the reason they rarely recommend herceptin alone is because there haven't been many studies on herceptin alone.

dancetrancer - The tumor was 0.8.  Since it was small one ocologist was hesitant to do anything.  I have been researching and trying to obtain all the info possible in making this decision.  Two ocologist felt that herceptin was better for me alone than combined with chemo because of my MS.  I really feel it will work.  Chemo is a possibility in the future if needed. 

This morning I feel fine.  Just did my volunteer work and picked up 2 ladies from the nursing home and took them to a seniors activity which I host at our church.  Tonight I am working on the Shrove Tuesday Pancake dinner and tomorrow will play Bridge.  I am so determined my life will go on and as long as I stay positive and feel good I should not give in to the minor MS symptoms or dwell on the BC.  I don't mean to sound flippant but living with MS and made me value my independence and I want  to keep it as long as I can.  Of course, I'm aware I may be on here tomorrow whining about the herceptin symtoms.  Thank you all for posts and blessings to you all.

Hi I am currently having herceptin without chemo , second time round for me , first time 5 years ago (at25)had chemo , + herceptin . This time around I choose not have chemo as has came back in liver , lungs , and bones , that was 6 months ago had another ct scan , with fantastic results , no signs in lungs and half the size in liver , and good signs in bones , and I feel great !!

Bev003, I am wondering as well if the herceptin alone cleared up your cancer. I'm only doing herceptin without tx or Als. I would love to get feedback from those doing herceptin a lone.

My hope is my immune system does the trick...killing any possible mircro cancer cells that has the herceptin locked onto it.

I wish there was a 6 month study as I'm not sure I can do it for a year. Three months would be a milestone.

My second infusion is next Monday. Sunday, I was just beginning to feel somewhat normal from the side effects of the first infusion. I'm hoping the future infusions will be somewhat kinder to me.

My mom was just diagnosed FEB 2012 - Stage IIA, (1.2 cm, 3/4 + LN), IDC high grade 3, hormone receptor negative, HER2+ breast cancer; she had a lumpectomy and will be having radiation therapy.  She is 79 y.o., in pretty good health, but relatively fragile and we are worried about chemo. Dr. has recommended Taxol  + herceptin.  Can someone advise on the side effects of taxol?  We are considering going with herceptin alone, although there does not appear to be much data out there in this setting.

Nana2three, I finished chemo in Dec. and will continue Herceptin for a year. I have not experienced any side effects from Herceptin except for runny nose.

BRCAdaughter - I am 70 and just started herceptin alone.  Got 3 opinions and I feel this was best for me.  I have MS which complicates the chemo + herceptin.  I believe the herceptin will work for me.  The studies with stats are not in to affirm this 100% but all the onc's. I talked with believe it will be helpful and unless I want to risk more nerve damage it is a good choice.  Something to look into.

Tomorrow will be the second herceptin infusion.  No problems since the first herceptin infusion.  I do have muscle and leg aches but it may be the MS and not the herceptin.  The runny nose was pronounced the first week.  I have not started the arimidex yet.  I'm thinking that will start within the next few weeks.  I so believe the herceptin alone will work and I just keep focused on this thought. 

I've been doing everything I normally do.  Went to my daughter's and chauffered, cooked, and enjoyed by 3 grandkids while she taught Thursday and Friday.  Making plans for summer trips with my husband and grandkids between treatments.  I realize that I may have given my son and daughter the impression that herceptin is a breeze and we have nothing to be concerned about.  But given a choice I would do the same thing again.  Talked with Teva Pharmaceutical (the company that makes my MS injection) and since they have no data to confirm there will be no interaction with my MS injection and herceptin they do want me to cease taking any MS meds.  All 3 oncologists have agreed with this.  All have stated that the MS is more problematic and the major health issue.  They feel the breast cancer treatments will work but don't want me to become immobile with the MS.  I'm choosing to believe all this will work out.

Blessings,

I'm not sure if I've posted this before, but just re-read it and thought those who are considering herceptin monotherapy for adjuvant tx would want to see it:

Is there a case for anti-HER2 therapy without chemotherapy in early breast cancer? 

 Summary
Trastuzumab in combination with chemotherapy is now standard of care for patients with early HER2-positive cancers larger than 1 cm. Some patients however may not need or simply may not want chemotherapy with its associated toxicities. For example patients with small (≤1 cm,Tla,b) node-negative (NO) HER2-positive cancers were largely excluded from all the large randomized adjuvant trastuzumab trials on the basis of perceived excellent prognosis, yet recently several retrospective studies have suggested that this is not always the case and more active adjuvant treatment including anti-HER2 therapy may be warranted. Subset analysis of one trastuzumab trial (HERA) demonstrated that patients with 1-2 cm cancers derived at least as much clinical benefit from 1-year of adjuvant trastuzumab with chemotherapy as the overall cohort and 2 retrospective audits have confirmed this.

Anti-HER2 therapy including both trastuzumab and lapatinib alone has established clinical efficacy in metastatic disease, with response rates of up to 35% and with some long term remissions. Combination anti-HER2 therapy with trastuzumab/lapatinib and with trastuzumab/pertuzumab have also been shown to have efficacy as second line treatment inpatients after trastuzumab. Trastuzumab and Lapatinib have each been shown to improve time to progression and response rate when given with anastrazole and letrozole respectively as first line treatment for metastatic ER-positive HER2-positive disease. In neoadjuvant trials the combination of trastuzumab and pertuzumab without chemotherapy have achieved pathological complete remission rates in a significant minority of patients, suggesting that a subgroup exists for whom anti-HER2 therapy alone may be as effective as with additional chemotherapy.

Trials and prospective studies are now warranted to investigate this issue further in selected patients and these must be accompanied by tissue collection to try to identify predictive biomarkers. Meanwhile there is already enough circumstantial evidence to justify anti-HER2 therapy alone in selected patients for whom chemotherapy is contraindicated.