Chemo usually needed?

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Debrose
Debrose Member Posts: 4
edited November 2015 in HER2+ (Positive) Breast Cancer

Hi,

I recently got my final pathology report after my lumpectomy. I was diagnosed with Invasive Ductal Carcinoma Estrogen positive and Her 2 positive. Last week, my the radiation oncologist told me that chemo is often recommended with Her 2 so when I went to the medical oncologist the following day, I was expecting the worst. The medical oncologist told me since my tumor size was only .05 (tiny) Chemo would probably be overkill. Great news! Well. I have a friend who had the exact same diagnosis with a 1 centimeter tumor size who had to have chemo. Is there anyone out there with a similar situation?

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  • Moderators
    Moderators Member Posts: 25,912
    edited November 2015

    Dear Debrose, Welcome to the community. We are very glad that you reached out here and hope that you will find support and information from our caring community of others with shared experiences. While you are waiting for some responses here is a link to some more information on out site with suggested research articles as you are interested in such Her2 Positive. Stay connected, Keep us posted. We look forward to hearing more of your story. The Mods

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  • BarredOwl
    BarredOwl Member Posts: 2,433
    edited November 2015

    HI debrose:

    Is your IDC 0.5 cm (5 mm)?

    Or is it 0.5 mm (i.e., "Microinvasive" Tumor ≤ 1 mm in greatest dimension)?

    Please see my first reply in your other thread:

    https://community.breastcancer.org/forum/131/topic...

    Hi Kayb:

    I completely agree that for small tumors less than or equal to 0.5 cm (5 mm), the risk/benefit analysis of adjuvant chemotherapy plus trastuzumab may lead some patients to reasonably decline such treatment, especially those with "microinvasive" disease.

    The option of adjuvant chemotherapy with trastuzumab for node-negative (N0), hormone-receptor positive, HER2-positive IDC tumors ≤0.5 cm or microinvasive was quite recently added to the NCCN guidelines in 2015. Patients can elect or decline such treatment within the guideline.

    Ditto re second opinion.

    BarredOwl

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  • keepsake
    keepsake Member Posts: 59
    edited March 2016

    I read the NCCN guidelines, too. I am triple positive. My invasive ductal tumor was 6 mm and I had other DCIS tumors. Had negative nodes - pN0 . Unfortunately, I fall into the group for whom NCCN guidelines recommend herceptin and chemo. I just had BMX and don't think my doctors are recommending these treatments for me. Don't know if they will recommend hormone treatment, which is also recommended according to NCCN guidelines .

    My question is: Has anyone here had a 6mm invasive tumor and had no herceptin and chemo treatments recommended?

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  • BarredOwl
    BarredOwl Member Posts: 2,433
    edited November 2015

    Hi Keepsake:

    Have you met with your Medical Oncologist yet?

    With a 6 mm tumor, your IDC is "T1b" size-wise:

    T1b Tumor > 5 mm but ≤ 10 mm in greatest dimension

    A lot of T1a and T1b ladies post here:

    https://community.breastcancer.org/forum/80/topics...

    While it may be appropriate in certain cases to depart from consensus guidelines, I agree that under the guidelines it is likely that most "T1b" size patients would receive a recommendation for endocrine (hormone) therapy.

    Regarding chemotherapy plus trastuzumab (Herceptin), I would distinguish between "recommend" versus "include" the option. The Professional Version 1.2016 as of this date (Nov 2015) provides the following node-negative (N0), hormone-receptor positive, HER2-positive IDC:

    Tumor 0.6–1.0 cm: Adjuvant endocrine therapy ± adjuvant chemotherapy with trastuzumab

    The plus or minus symbol "±" for these T1b size tumors reflects that chemotherapy plus trastuzumab may or may not be selected. Thus, T1b patients will work with their doctors to decide what to do in their particular case in light of their personal risk tolerance and individualized risk/benefit analysis.

    I send you both good energies for decision-making.

    BarredOwl

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  • keepsake
    keepsake Member Posts: 59
    edited March 2016

    Thanks for the updated info Barred Owl. I met only once with the MO, which was after my excisional bx 2 months ago when my 6mm, Her2 positive IDC tumor was excised with close margins. Just had BMX in November, which revealed only DCIS had remained - and all tumor margins are now clear. So, have not met yet with MO after the BMX. Definitely would like to meet with MO again now to see what she would recommend. Perhaps, she'll think the risks of herceptin and chemo tx outweigh the benefits. I'm just worried about the risk of recurrence or having distant mets in the future due to the Her2 status.

    Wishing Debrose the best. Also, thanks, kayb for your input.

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  • Sammy1015
    Sammy1015 Member Posts: 6
    edited November 2015

    I had a similar diagnosis, and did not get any further treatment after a double mast.   My case went before a "tumor board" 3 times and they came to the conclusion.

    Most larger cities have a tumor board (group of oncologists that meet) just for reviewing cases like ours.  

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  • BarredOwl
    BarredOwl Member Posts: 2,433
    edited November 2015

    Hi Sammy1015:

    I see you just posted that in another thread about having the diagnosis of microinvasive disease. So it looks like your diagnosis was a bit different from keepsake (6 mm).

    Glad you are doing well and past the 5-year mark!

    BarredOwl

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  • Debrose
    Debrose Member Posts: 4
    edited November 2015

    Thanks all,

    My tumor is . 05 cm so very tiny. I am very blessed to have caught it so early. The thing that concerns me is that it was in the lymph node as far as I am understanding. This is all so new to me. I am getting a copy of my final pathology report this week because I feel confused on my diagnosis. I am definitely going to get a second opinion. The grey zone, as my radiation oncologist called it, has me conflicted.

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  • wabals
    wabals Member Posts: 242
    edited November 2015

    Mine was 8mm invasive & 1.5mm DCIS and I am in the ATEMPT trial and was randomized to tdm1 which is not nearly as hard as taxol. Ask about it. Her2 + is aggressive. I would follow the guidelines. Find an onc at an academic cancer center and get their opinion

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  • BarredOwl
    BarredOwl Member Posts: 2,433
    edited November 2015

    Hi Debrose:

    It is an excellent idea to obtain a copy of your report, clarify what was found in the node, and to seek a second opinion.

    The guidelines differ depending on the degree of node involvement. Please note that the general information I provided in your other thread was for "node-negative" disease (as noted there). Remember to ask what the guidelines provide for a tumor your size with your node status.

    With a second opinion, you can also seek a review of the pathology (slides sent overnight to other institution). This would permit a review of the determination of HER2 status and node status, the accuracy of which is central to your decision, especially with a 0.05 cm (0.5 millimeters) microinvasion.

    BarredOwl




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