New dx, was told Tamox, why not Herceptin?

Hi Msalter:

While surgeons sometimes comment on possible systemic drug treatments, as Donna notes, the specific drug treatments considered or recommended are within the area of expertise of medical oncologists.

You didn't mention whether you were diagnosed with non-invasive breast cancer (ductal carcinoma in situ ("DCIS")) or invasive breast cancer (e.g., invasive ductal carcinoma ("IDC"), invasive lobular carcinoma ("ILC"), etc.).

Purely "non-invasive" breast cancers are confined to the inside of the ducts, and are treated differently from "invasive" breast cancers (that have broken through the wall of the duct and invaded the surrounding breast tissue).

Endocrine Therapy:

Tamoxifen is a type of "endocrine therapy" that blocks the action of estrogen on certain types of breast cancer cells that have hormone receptors and can grow in response to hormones. The pathology report from your biopsy will include information about the "estrogen receptor ("ER") status" and "progesterone receptor ("PR") status" of your tumor(s). Endocrine therapy is considered or recommended for "hormone receptor-positive" tumors that are ER+ and/or PR+. Your pathology report may also contain important information about the percentage of cells that are ER positive and/or PR positive.

Endocrine therapy may be used to treat non-invasive disease like DCIS or invasive disease.

Pure, Non-invasive "DCIS":

Occasionally, DCIS is tested for HER2 status. However, chemotherapy and HER2-targeted therapies (trastuzumab (HERCEPTIN, pertuzumab (PERJETA)) are not used to treat pure DCIS.

Invasive Disease (e.g., invasive ductal carcinoma, etc.):

Herceptin (trastuzumab) is a type of "HER2-targeted therapy" used to treat some types of HER2-positive invasive breast cancer. It is typically given as part of a combination regimen of {chemotherapy plus HER2-targeted therapy}.

Sometimes, a regimen of {chemotherapy plus a HER2-targeted drug or drug(s)} is given before surgery. This type of pre-surgical treatment is called "neoadjuvant" or "preoperative" therapy. With an invasive HER2-positive tumor, such pre-surgery treatment is often considered with larger tumors (typically around 2 cms or larger) and/or lymph node involvement. Patients with this type of diagnosis should consult with a medical oncologist BEFORE surgery to discuss whether the option of "neoadjuvant" therapy is right for them. If your tumor is estimated to be around 2 cms or more OR you have evidence of lymph node involvement, you should request a referral to a medical oncologist.

Otherwise, after surgery, whether such a Herceptin-containing regimen is either considered (as an option) or recommended by a medical oncologist to a patient with an invasive HER2-positive tumor is based on various factors, such as the tumor histology (e.g., ductal, lobular, other); actual tumor size; and lymph node status (as determined by lymph node biopsy), based on the combined results of pathology from all biopsies, surgery, and and lymph node biopsy (e.g., sentinel node biopsies). Your overall health and presentation, including age and co-morbidities, will also be considered.

Be sure to obtain complete copies of the Radiologist's report from all your imaging to date (mammograms, ultrasound, MRI, which may contain estimates of tumor size), and complete copies of the pathology reports from all biopsies. This information will allow you to confirm what you are being told about the type of cancer (invasive or non-invasive), estimated tumor size, grade, HER2 status, and ER and PR status (trust, but verify), and will help you to understand your treatment plan better.

You will find a lot of support and information here.

BarredOwl