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Kitty777
Kitty777 Member Posts: 11
edited January 2017 in HER2+ (Positive) Breast Cancer

I had a lumpectomy to remove a 6mm tumor.I am hr, pr positive and her2 positive. Stage 1, grade 2. I believe the doctors are leaning toward Radiology only. This is scary as everything I've read states over 5mm should be treated with chemo and herceptin. I'm sure they take other things into consideration, but I'm still scared I'll make the wrong decision. Anyone with this size tumor had radiology only(as well as hormone therapy)? Update: I have repeatedly seen articles and posts stating that Her2 tumors over 5mm should have chemo and herceptin , and a few mentioned NCNN guidelines. I just looked up guidelines and they state chemo should be CONSIDERED for Her2 tumors less than 1.0cm.Guidelines do NOT advise this course of treatment. Any input would be greatly appreciated. (Wish I could fInd the posts I'm referring to)

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  • MinusTwo
    MinusTwo Member Posts: 16,634
    edited January 2017

    Kitty - I hope you will head to another oncologist for a second opinion. HER2+ girls can't fool around. Please check with another doc.

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  • ksolo11
    ksolo11 Member Posts: 11
    edited January 2017

    Kitty777 get another opinion. I had 5mm breast cancer removed and had 3 dr's all recommend same treatment - 12 weeks of taxol and herceptin weekly, continuing the herceptin for the year. I tried to post a link for you but am unable to post it on this site. You can research "dana farber study her2 positive herceptin and taxol"

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  • lannama
    lannama Member Posts: 5
    edited January 2017

    Hi Kitty,

    I had a 1.1 cm, HER2 + tumor. 12 weeks of Chemo/Herceptin, 6 weeks of radiation, 9 more months of Herceptin.

    Linda

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  • Tresjoli2
    Tresjoli2 Member Posts: 868
    edited January 2017

    so I had 1.5mm of IDC and I threw chemo and herceptin at it. at it. Good luck with your decision.

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  • BarredOwl
    BarredOwl Member Posts: 2,433
    edited January 2017

    Hi Kitty777:

    It would be helpful if you could fill out your profile, or specify what the tumor histology (e.g., ductal, lobular, etc.) and the lymph node status.

    I note that for ductal, lobular, mixed or metaplastic tumors, that are hormone receptor-positive, HER2-positive, and node-negative ("N0"), where the "Tumor 0.6–1.0 cm", NCCN guidelines (Professional Version, 2.2016, see Chart BINV-5) provide:

    "Adjuvant endocrine therapy

    or

    Adjuvant chemotherapy (z,aa) with trastuzumab (x) followed by endocrine therapy"

    I have posted about this elsewhere in more detail:

    https://community.breastcancer.org/forum/80/topics/781897?page=22#post_4844451

    At that post, you will also find a link to the "Dana Farber" study mentioned above (i.e., "Tolaney (2015)").

    Given the "or" language, the decision entails a case-specific personalized risk/benefit analysis, with some exercise of clinical judgment in light of all relevant considerations. In such a case, you may find a second opinion to be helpful.

    Best,

    BarredOwl

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  • Germangirl16
    Germangirl16 Member Posts: 97
    edited January 2017

    Hi Kitty! My tumor also was small, stage 1, no lymph node involvement. My MO recommended 12 weeks of taxol and herceptin following my lumpectomy, and radiation which I am currently doing, along with aromatase inhibitor for 5 years. I continue to get herceptin every 3 weeks. They feel after all of this, the chance of reoccurrence is 2%. Well worth it, as her2+ tumors are nasty things. I am 65 years old, and it was very doable!

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  • Kitty777
    Kitty777 Member Posts: 11
    edited January 2017

    Barred Owel,

    Thank you so much. Will fill out info when I am on a computer.

    Dx was Invasive Carcinoma with ductal and lobular features, moderately differentiated, grade 11/111: tubular score=3, nuclear score =2, mitosis score=1.

    Also, Ductal Carcinoma in Situ, solid type (intermediate nuclear grade) without necrosis or calcifications is present)

    No lymphovascular invasion is present.

    I am actually seeing an oncologist at DF. I will definitely show him the study. I will also check out the link on NCNN guidelines. The booklet I saw was dated 2016, but I don't think it had nearly this much detail. I actually like my Onc and am very comfortable with him.

    I'm on my phone, so it's a little hard to do.

    If you have any more advice, please share.

    Thanks to all of you. It's a scary place to be!!

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  • BarredOwl
    BarredOwl Member Posts: 2,433
    edited January 2017

    HI Kitty777:

    As a layperson with no medical training, I have no opinion what you should choose. The medical advice you receive and your personal risk tolerance are key factors in this decision. My advice would be to ask your medical oncologist as many questions as you need to. Ask for some discussion about what is and is not known about distant recurrence risk without chemotherapy plus trastuzumab in patients like you with T1b-size tumors (with or without endocrine therapy), and the possible benefits of such treatment. Be sure to ask (and write down) what specific clinical and pathologic factors of your case are seen to weigh in favor of, and what factors weigh against, any recommendation you receive regarding chemotherapy plus trastuzumab. Do not hesitate to inquire about the risks of any proposed treatment in light of your medical history, as they are part of informed decision-making and any risk / benefit analysis.

    You may also wish to inquire with your medical oncologist whether your case could be considered by the "tumor board" at your institution.

    You are at an excellent center (Dana Farber is an NCI-Designated Cancer Center). If you find yourself still undecided or wishing for more discussion and an additional professional perspective, a second opinion from an independent institution remains an option.

    Sending positive vibes for decision-making to you.

    BarredOwl

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  • Kitty777
    Kitty777 Member Posts: 11
    edited January 2017

    BarredOwl,

    I can't thank you enough. Those are excellent questions to ask and I will do so.

    Didn't even know there was a tumor board.

    Good luck to all of you ladies and thank you all!!!



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