Any Naturalists Views On Her2+ treatment??

rozem,

I don't disagree with you or Grey Lady about the recommended standard treatment for HR- young patients.

Genuine honesty with patients who are questioning standard treatment goes beyond that. The truth is that when it comes to HER2 positive patients the medical research profession has failed to scientifically examine and demonstrate adequately which adjuvant patients benefit from the addition of chemotherapy, based on a vague and misleading concept of what constitutes "doing least harm".

I am just explaining that based on the lack of adequate scientific investigation for this group of patients, the value of chemotherapy as a cancer cell obliterating treatment versus the value of chemotherapy as ovarian ablation, versus the value of the combination of the two, is uncertain.

If this person indeed has made up her mind not to do any chemotherapy, it is important to point out that chemotherapy is not just important for killing the still only theoretic last cancer cell, and that part of what chemo does is to increase ovarian ablation. It is important to explain that so that at least she can consider adding some other form of ovarian ablation to trastuzumab if she can find an onc to approve it.

I understand that it is simpler to just present the solution as being trastuzumab and chemotherapy without further explanation.

rozem, I know that is the general conclusion (that hormonal manipulation doesn't benefit those who are ER-) but that too is not absolute. To the degree that it is true, that effect of chemotherapy (loss of ovarian function and all that is involved in that) means throwing those parts of oneself in front of the train without getting any benefit from the damage to ovarian function.

And although I agree that it makes sense to throw trastuzumab in for HER2 positives, I am personally aware that not receiving it made zero difference for me, even though so many consider it life-saving. When will patients like me be spared that expense and difficulty through adequate research efforts rather than blanket administration "just in case"?

Well, to me that is really sad. We buy more and more costly and difficult treatments because we are talked into believing that someone like me was "just lucky", instead of actively pursuing more accurate, and more definite information. Because I actually was going through treatment at a time when HER2 positive adjuvant patients didn't routinely receive trastuzumab (and it was not yet authorized outside of trials then), I am aware that there were MANY like myself who were "just lucky", not just rare individuals. Now that blanket treatment is the norm, it is commonly assumed that everyone who is HER2 positive absolutely will not survive without it, and those of us who do and could are no longer accurately countable. It is even more true for adjuvant care and chemotherapy. The blanket insurance makes it harder to tell.

AA,

It would be nice if the studies and info you seek were available. However, they are not so in discussing this with someone who questions the current recommendations for HER2+ women, the info and studies we wish existed have no bearing on decisions that need to be made here and now.

kayb, as long as the definition of "harm" stays conveniently vague and supportive of the status quo treatments, the perception is that prescribing the present standard treatment "does less harm". But the disease processes involved with treatment are very poorly tracked, and "harm" is not clearly defined. I do "get" that lives saved in terms of bc are all that count, nothing else matters, but also realize that lives lost due to the same treatment are not acknowledged at all. As we all know and mentally manage to dismiss  immediately, chemotherapy IS carcinogenic. We never ask the question, well, if it is carcinogenic, then why is there no percentage allottted on the predictors for the volume of people who die due to treatment? Or does science just make the blind assumption that none do? Do you see any clear acknowledgement in the predictors showing how many die due to treatment with the regimen being tallied? I don't see any.

ruthbru,

How many of those in each group received any treatment of any kind?

AA - i think this isn't factored in because ultimately we can do something to help counter weight gain. Yes it is tough, i deal with it each and every day. I have to work twice as hard for half the results i used to get. Plus, menopause slows your metabolism even exclusive of chemo so those gals who have chosen to do tamox/ovarian suppression have the same issues.

Does chemo slow metabolism further ? im not understanding this since i thought chemo puts you into menopause which slows your metabolism - just earlier you were saying that ovarian suppression is a treatment consideration but both are doing the same thing - slowing metabolism!

Targeted treatment (trastuzumab) improved DFS and OS. Which is a very strong indicator that the addition of chemo does very little for HER2 positive bc. However, since "we've always thrown in chemo" since time began, it should be there with trastuzumab "just in case" it provides "synergy".

And since chemo is carcinogenic in itself, which means chemo can cause cancer, the cancer predictors should include a calculation of percentage for those whose cancers are enhanced by the use of chemotherapy -- but the calculators don't include any estimate of that percentage. ???

Yes, Beesie. That is why I don't understand why there is no allotted acknowledgement shown by the predictors when estimating treatment efficacy, indicating the volume or percentage of deaths due to treatment.

AA - my RO told me that for every 4 local reccurances that rads prevents it also prevents one distant, so yes it does

The belief that chemo kills every last cancer cell is, unfortunately, an urban myth.  No respectable oncologist will ever tell you that you need chemo to kill "every last cancer cell" because that is not the purpose of chemo.  The primary treatment for cancer is surgery.  Without surgery, you will, eventually, die.  With surgery, you have a 50-50 chance of surviving long term.  Chemotherapy (like radiation and hormonal therapy) are adjuvent therapies; therapies done in addition to surgery.  The surgery will; hopefully, save your life.  Adjuvent therapy was never intended to take the place of surgery, i.e. be a life-saving measure; it was developed to reduce risk of recurrence after surgery had been performed.

I think this perception of chemotherapy being able to "kill every last cancer cell" leads to the belief that, if a person has chemotherapy and suffers a relapse that the chemo "didn't work".  But, likely, it did work; without the chemo the patient would have died much sooner, with the chemo, the patient may have enjoyed several disease-free years that wouldn't have happened without the chemo.  Chemotherapy's prime function is to increase disease-free survival not cure cancer.  So far, nothing cures cancer.

We, as a society, have to come to terms with this misconception about chemotherapy, otherwise, we will never be able to accept the realities- and limitations of chemotherapy.  To expect it to do something it was never intended to do will always lead to people trying dangerous alternatives - or maybe nothing at all - in the belief that "chemotherapy doesn't work".  Chemotherapy must be kept in perspective, so that we can recognize fully it's true merit.

Absolutely!

Oh Sassa. That was harsh. Really harsh. You might think that but writing it? Kay

Remember we are here to help one another. I think the seriousness of the diagnosis can be discussed without being cruel.