90% non-recurrence rate wondering about additional treatment

Aside from positive (or not positive) lymph nodes, cancer cells can be carried through the lymphovascular system. Do you have lymphovascular invasion? No one talks about this much but I don’t know why because it seems just as important as lymph nodes.

R

I thought that Her2+ was now treated at your size of 7mm due to how aggressive it can be. I’m assuming that the cancer you have was Invasive. You feel you need to treat it...get a second opinion. Best wishes and please let us know what you decide

today, more and more patients who are HER 2+ and have tumors between .5 and 1 cm are being offered chemo and herceptin and now perjeta. Please seek a second opinion OR have your case presented before a tumor board.

Good luck

voracious, have you found something relating to the data from kaiser, I am not sure how many cases they have with these smaller tumors since they are usually found 1cm or greater.

They say 16,975 her2+ patients but I am not sure if they were all less than 1cm.

knots--I will be following this thread closely. This is my mindset:

I am absolutely good with zapping the shit out of a breast that's misbehaving. I like that rads will be in my treatment plan. The rest of what I believe will be recommended this time around I was very leery of. Like you, I look at the probabilities with no further treatment and see that they're pretty good. Actually, *really* good. I don't like the idea of putting a lot of heavy chemicals in my body, and the idea of taking a pill for 5-10 years was kind of repugnant to me. BUT. . .

I've been doing a lot of research and PM-ing with some of the fine women here on BCO, plus I had an unintentional 5-minute conversation with my BS when I saw him for a post-op check last week. He said that rads and an AI give the biggest bang for the buck. He said if it were a family member refusing an AI, he'd crush it up and sneak it in her food--he is that big a believer. No he's not an oncologist but he knows a lot about BC and that short conversation brought me around on taking an AI. (Plus the fact that my tumor this time is highly ER/PR+ makes me think getting rid of as much estrogen as possible is probably a very good idea.) I have also read (and read and read) about what a game-changer Herceptin has been for HER2+ patients. I can see being talked into that. However, I still don't think Taxol is warranted. That's what I've been stressing about--I have my initial consultation with an MO on Monday (I didn't need one last time around), and I am wondering what she'll say when I tell her I'm willing to do Herceptin but do not want the Taxol. This one sit-down has caused me more angst than any of the procedures/treatments I've had so far. I've told several friends/family that maybe I'm blowing this out of proportion and she'll say rads + an AI are enough. That would surely make my day, but I guess we'll see come Monday.

A ten percent risk, while small, is significant. The treatment for your tumor has relatively low toxicity. You could do Taxol (the gentler of the taxanes) and Herceptin only, as was done in the APT trial, which had extremely positive results. If you do cold caps, you get to keep your hair. Herceptin has very few side effects, and any effects that you may experience are relatively benign.

In my province, Herceptin was previously denied for tumors that were less than 1 cm. But in 2011, the government changed its position because it was determined that Herceptin provided significant benefit for small tumors. This means a lot in the context of our universal health care system; the government is willing to pay for the treatment, even for small tumors, because it works.

When I was making treatment decisions, I couldn't shake the image of the risk analysis grid we use at work. We measure the likelihood of adverse outcome (in your case, 10% risk of recurrence, which is low), against the impact of that adverse outcome (in your case, recurrence, possibly leading to premature death). Even though the odds of a recurrence are low, you still get a "medium" risk score due to the potential catastrophic outcome.

You'd also have to factor in toxicity related to treatment, but here, that is small.

meow...according to the 2018 NCCN Breast Cancer Treatment Guidelines....ER+ HER2 positive tumors smaller than 5 mm should consider chemo and herceptin. Tumors 5mm and 1 cm, are offered it. And over 1 cm there is evidence that chemo and herception is recommended.. If you read the NCCN guidelines, it is in the footnotes that explains the dilemma for tumors under 1 cm. Dancetrancer created a thread all about the dilemma. That said, you are correct. Most HER 2 positive tumors are usually discovered once they are greater than 1 cm. However, with better imaging and more patients getting screened, more small tumors are being found. Ethically speaking, there will not be a randomized study for those small tumors because iphysicians do NOT want to exclude from offering the combination because of the aggressive nature of HER 2 positive tumors.

I did seek a second opinion from Johns Hopkins and the team there recommended the exact same treatment as my oncologist. Both said they are treating smaller and smaller HER2+ tumors using chemo and Herceptin. Perjeta is added regardless of size 1cm and under if lymph node positive. Radiation is used for lumpectomy or if lymph node positive. I asked about Herceptin without Taxol, and there are some trials using this regimen. However, general consensus seems to be that Herceptin needs the Taxol or another chemo to get it started. Many of these protocols are relatively new, even Perjeta, and now Neratinib, so it is difficult to ascertain long term data as well as long term side effects. There are also two other new drugs showing promise in trials. Only time will tell. Even most oncologists admit that they are still working out how to best sequence and pair HER2+ treatment across the board.