TRIPLE POSITIVE GROUP

Ladies on Tamoxifin... does it cause insomnia??? I'm thinking their must be a 'topic' on the board, so I'll go look there too.

JustDiagnosedToday,

You probably won't get more than 12 infusions of Taxol. But, typically, MOs will have HER2+ patients do Herceptin for a year (If your heart can take it). At first, you would get the Herceptin with the Taxol. But, then you'd get the Herceptin alone. I'm currently doing Herceptin every three weeks alone.

When I did Taxol, I did it weekly for twelve weeks with Herceptin. After my surgery, I began Herceptin again alone, once every three weeks. Because your lump was relatively small (1 cm), maybe he's considering nine infusions rather than twelve (?). I'm not sure; my lump was pretty big and I did my chemo before surgery.

Oh ok. You did yours before surgery. Plus yours was bigger.

I didn't think the +++ was rare neither. Idk???

JustDiagnosed-What was the histology report?  My invasive cancer was mucinous which is rare-perhaps your histology is rare. 

Bre58-thanks for the info.  I asked because I just noticed a pea sized lump above my incision line that I am going to ask the MO and Plastic Surgeon about this week as have appts. with them already.

Dr Pegram of Stanford discusses optimal pertuzumab ( perjeta) use in Her2-pos breast cancer.

http://www.onclive.com/web-exclusives/Pegram-Discu...

I think that the hercepton can be strong, vs I heard that there is her 3+ . Has anyone come across this? Since I had 2 different gum ours in my left breast and had both removed because we thought it would never come back. I am finding this is not the case, with hercepton + . It can and does come back, but what triggered it? Since they are killing off just about everything that could come back? Anyone know why her2+ slips thru? My BS stated that our bodies can make estrogen, which I am guessing the receptor looks for an attaches to, if it can find it, it can be found in our fat cells? So if the her2+ is still around, I guess it can go mutate, with one of these re grown fat cells that turn into estrogen! Trying to be clear here, with this analytical mind of mine.

Jersey,

Her2 doesn't attached to estrogen. You can be her2 positive and estrogen negative. Here is a short definition of what her2 is and does.

HER2 - or human epidermal growth factor receptor 2 - refers to the HER2 gene and its associated protein. The protein helps to control the growth of healthy cells. But if the HER2 gene is amplified, or the protein is over-expressed, the cells can grow uncontrollably and lead to cancer.

Herceptin is a drug that targets the her2 cells. It supposedly works best when mixed with chemo, but I think they operate under that impression because most of the studies were done with chemo included before it was approved. Some people are getting just herceptin now, I believe. Fairly unusual though.

It is pretty well tolerated, but it can affect your left ventricular ejection fraction, so they monitor it with muga or echos to make sure it doesn't drop too low.

There is a her3 and a 4 I believe, but I don't think they are sure how they impact breast cancer yet. I'd have to look more,but I think one of them is more common with a colon cancer.

On the her2 cells slipping through, they can travel outside your blood stream also. However I am not an expert to comment on why people have a distant recurrence many years after diagnosis.

Herceptin is the drug. Her2 is the problem.

Two separate issues altogether.

Just to elaborate on some of the things in Jersey's post - I think there is some confusion between Her (human epidermal growth factor) - which includes Her 1, 2, 3, and 4, which are types of Her - with Her2 specifically being linked to breast cancer, and the way they result testing for Her2 - which can be 0, 1+, 2+, and 3+, with Her2+++ (or 3+) being the result that is definitively considered a positive result for Her2.  Any breast cancer can return, Her2+ breast cancer is particularly aggressive, and surgery, chemo, targeted therapies, radiation, and anti-hormonals can and may all help, but there is never a 100% guarantee that the cancer won't return or progress.  As fluff and tomboy said - the Her2+ and ER+ function somewhat independently - Her2+ is a genetic overexpression that tells breast cancer cells to replicate, and separately, estrogen fuels the estrogen receptors on breast cells.  Apples and oranges.  Estrogen is produced by our ovaries, adrenal glands, and body fat.  If you are premenopausal, and ER+, you are given Tamoxifen which blocks the receptors on the cells but allows estrogen to circulate and do the positive things it does.  If you are postmenopausal the assumption is that your ovaries are no longer producing estrogen so you are usually given an aromatase inhibitor, which interferes with the enzymatic mechanism which converts androgens into estrogen.  Since body fat is also a source of estrogen doctors will advise maintaining a healthy body weight/low BMI.  It is also important to note that most Her2+ driven recurrence happens within a shorter time period - 2-3 years after diagnosis, but ER+ driven recurrence can happen years later.  This is why we stay on anti-hormonal medication much longer than anti-Her2+ medication.

Chrissie - sorry, but I'm impressed. I don't touch these aliens unless I have to. I could have a child's toy in there and not know it. If MO thinks expander and PS says definately not expander, either call MO back with that info or call BS.

knmtwins-your comment made me smile-they are alien for sure!  I think I will call the BS tomorrow to get her feedback.  Thanks.

SpecialK, we are so glad you stay on these boards to help with all your great knowledge!

Chrissie, all docs are different. After my BMX, no one followed me. Never saw the MO again, and only saw the PS for the exchange and tattoos. My GYN did yearly bloodwork for a couple years, but that was it. This time around, I found the lump myself and followed up with getting it tested. Now after my recurrence (all new docs) I see my MO every 6 months, but he only orders bloodwork once a year. I see him again in 2 weeks and I may decide to switch MO's. He got me through chemo, but I am not very impressed with his follow up. I know others on here have different follow up protocols.