No chemo a realistic option?

Well, it certainly is your decision, but Her+, with nodal involvement, seems a very dangerous situation. If it were me, I would do the chemo, as it is supposed to to be used with Herceptin. In fact, most oncologists won't give you Herceptin without chemo. Another factor is your young age, which is also an indicator for chemo. Best wishes whatever you decide.

I've seen some do herception no chemo but that was mainly for stage 4 or people whose health makes chemo not viable.

If you are worried about your hair there are cold caps, penguin is a popular brand. Ice for mouth sores snd specisl cold mits for hands and feet. And drugs to help with some side effects like nausea.

If I am faced with recurrence I might do chemo.

You asked, so here is my opinion!  Absolutely you should do chemo with your diagnosis.  With Her2 positive you need every tool out there.  I will be 5 years out next month.  I want this for you too, plus plenty more years. Over the last 5 years, I've talked with literally thousands of breast cancer patients.  The only women I met who were Her 2 Pos that did not do chemo were now Stage IV.  And they deeply regretted that they did not have chemo.

I am so passionate about this because I've been down those wheat grass, essiac tea, coffee enemas, and juicing with my beloved father who was diagnosed with Stage IV cancer.  He died.

So when I was diagnosed with an aggressive breast cancer not too long after my father's death, I vowed I would do everything my Oncologist said.  I went to the best Oncologist within 100 miles of my home and never deviated.   I believe I am alive today because I did what he told me to do.   Then my mom and sister were diagnosed with breast cancer - all of us within 3 years.  It has been one long, tough road.  But all of us are here today and for that I am so grateful.  

I do not want you to have any regrets.  None of us wanted to do chemo.  Who would?  But it is doable, and you will get through it.

If you are like me, I get really freightened when people and doctors demand I follow a certain treatment. Take a breath and gather information and decide for yourself. There is so much information out there particularly on personalized cancer treatment. It seems like words patients want to here but it doesn't seem to be true. In your case the standard is surgery, chemo, herceptin then hormone therapy. I dont think many doctors trust hormone therapy as a good enough treatment. It is like having weeds in your lawn round up kills everything weeds and grass you name it. But it isnt a guarantee the weeds wont come back.

Please dont react out of fear, the her+ is more aggressive but the good news is many aggressive cancers are the ones that get successfully knocked down. Herceptin and possible trial vaccine seems effective on it.

Her2 is a very different disease than her2 negative. Taking a pass on chemo has completely different ramifications depending on what type of cancer you have. Her2+ TNBC etc are more aggressive, have higher recurrence rates BUT they are also very responsive to chemo. This is s very important part of our treatment plan. We are lucky that we have great protocols that are PROVEN to lower recurrence. Yes not zero but I believe Herceptin + Chemo reduces your % by 50 %. Those are facts.

Like KayB said. Hecercrptin is given with chemo as this is shown how it's most effective

I wish vaccine trials/treatments were further along but we are not there

You are node-positive, HER2+ and young. All three unfavourable characteristics, at least on paper. I don't have more to add to what has already been said. Chemo is not as scary as it sounds, or looks in the movies. Of course some people do get serious side effects, but the majority manage well. And at least for early stage disease, there is an end date to chemo.

Hi Meow13:

She may understandably be confused by the very different and conflicting feedback above. A newly diagnosed person may not be in a position to understand that your situation--diagnosed in your fifties, with hormone receptor-positive, HER2-negative, node-negative ("N0") disease-- and your decision-- which was made in light of those factors, is not really relevant to the situation of a person with HER2-positive, node-positive disease. The OncotypeDX test for invasive disease that you received provided you with information regarding the average 10-year risk of distant recurrence (incurable metastatic disease) that is associated with your Recurrence Score of 34, and you were able to consider that recurrence risk information in your treatment decision. In contrast, the OncotypeDX test is not offered to HER2-positive patients, as it is not validated in that setting not the least because the recurrence risk profile of HER2-positive disease is very different from that of HER2-negative disease. This fact may be a consideration in why there is a separate forum for HER2-positive disease. There is also a "triple-positive" thread for those who are ER+ PR+ HER2+.

I agree with the HER2+ members above. This would appear to be a situation in which chemotherapy plus HER2-targeted therapy is warranted under all applicable treatment guidelines for breast cancer (e.g., NCCN, ASCO), based on significant reduction in recurrence risks and improved survival benefit shown in clinical trials.

Adjuvant pertuzumab (Perjeta, "P") and ovarian suppression (Lupron) plus an AI (Femara) for 10-years are recommended to premenopausal, HER2+ women with higher recurrence risk profiles. In such situations, chemotherapy plus HER2-targeted therapy cannot be viewed as "unnecessary", as the benefits of this potentially life-saving regimen significantly outweigh the potential risks.

Hi Aleigh36:

If you are not clear on the substantial benefits offered by the recommended regimen, please ask your medical oncologist to explain it to you again. Many members are going through similar treatments, and you will find a lot of support here.

Triple-positive thread: https://community.breastcancer.org/forum/80/topics/764183?page=1007#idx_30200

Best,

BarredOwl

Hi joyandpiece:

I'm not sure what your diagnosis is, and in case it may differ significantly from Aleigh's, please note that the guidelines for HER2+ disease may differ according to factors such as tumor histology (e.g., ductal, lobular, etc.), tumor size, lymph node status, and/or hormone receptor status. For example, for a very small, node-negative IDC, the NCCN guidelines may include chemotherapy plus trastuzumab either as an option ("+/-") or to "consider" (as opposed to an outright recommendation; e.g., a regimen of paclitaxel plus trastuzumab). The actual size of very small tumors may not be known until after the surgical pathology is available.

There is a thread for HER2+ microinvasive tumors (T1mi = Tumor ≤ 1 mm in greatest dimension) here:

https://community.breastcancer.org/forum/111/topics/748406?page=15#idx_438

There is a thread for HER2+ "T1a-size" tumors (T1a = Tumor > 1 mm but ≤ 5 mm (0.5 cm) in greatest dimension) here:

https://community.breastcancer.org/forum/80/topics/781897?page=21#idx_616

NOTE: The NCCN guidelines for both of these smaller HER2+ tumors were changed in late 2015, so the medical advice in the early parts of those threads may not reflect current practice.

If your tumor is very small, in due course, your medical oncologist ("MO") will provide case-specific information regarding your personal risk / benefit profile and treatment advice that accounts for these variations.

Some HER2-positive patients, especially those with larger tumors and/or who are node-positive, consult with a medical oncologist prior to surgery to discuss the possibility of systemic drug treatments administered before surgery ("neo-adjuvant" therapy).

Best,

BarredOwl

So, are you now saying your tumor was Her-???

Aleigh,

No one wants to do chemo. But, I was pleasantly surprised by how manageable it was. I worked through chemo, and never got sick until after my 11th Taxol infusion. (My sons brought home a stomach virus from school, and it left me on the couch for a few days.)

You might want to look into chemo lite, Taxol + Herceptin + Perjeta if available. Herceptin is usually given with a taxane, but Taxol is supposed to be gentler than Taxotere (which has a very very very small chance of producing permanent hair loss). Your MO has recommended TCHP, I see. Does he/she seem like a flexible person who might consider chemo lite?

Taxotere has a 6% chance of permanent hair loss and there is currently a class action lawsuit saying the risks appear to be higher and patients were not properly informed. There is a BCO tread devoted to this. Taxol might be a better bet.

Barredowl, i do realize my situation is different and I did point that out. I dont appreciate your comments.

My intent was to have her look into the information for herself so she didnt feel like making decisions blindly.

Dont worry I wont comment anymore.

I think this is exactly the reason why people stop coming and feel like they cant express themselves. Be respectful of others. I'm not an idiot or uninformed.

Melissa, that makes sense.

Do the chemo! I am 9 1/2 years out from the AC chemo, 8 1/2 years out from the end of herceptin and NED. You need to do all you can to knock the cancer out now so you can make a post like mine nine years from now.

sounds like you used good judgement and sound reasoning- sorry this time it is leading you to chemo.  I have a dmx next week, hoping for clear sentinel nodes and plan to NOT do chemo  (HER2-) but might be given an overwhelmingly good reason once the pathologist has all the results.  Very confusing.  Best wishes for best outcome . . .