Her2 +ve, ER/PR -ve, Targeted therapy before or after surgery

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Novice300861
Novice300861 Member Posts: 2
edited January 2020 in Just Diagnosed

Ive been recently diagnosed with IDC stage 2a with HER2 positive and er/pr negative.

I've 2 lumps in same upper region of breast, one measuring around 1.1 cms and another 3.5cms.

Pet scan shows that it hasn't spread to axillary lymph nodes.

My oncologist has given me plan for getting partial lumpectomy with diep flap reconstruction first , then chemo and target therapy for 1 year and then radiation.

As I'm reading through the forum, most of the people have gotten chemo and targeted therapy first even though their tumor sizes were small, yes i understand that no two people are same, but my doc never even mentioned of getting therapy first.

So should i go along as per my oncologist plan or should I go for second opinion?

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  • MinusTwo
    MinusTwo Member Posts: 16,634
    edited January 2020

    With HER2+, the normal treatment is usually neoadjuvant chemo. I'd at least discuss that with your MO and still maybe get a 2nd opinion.

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  • DATNY
    DATNY Member Posts: 358
    edited January 2020

    I concur with minustwo, get a second opinion. With this type of cancer chemo is usually first, unless things have changed since I was treated in 2017.

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  • Ingerp
    Ingerp Member Posts: 2,624
    edited January 2020

    A lot of us triple positives had surgery first. (FWIW--I've never had any reconstruction. Even with a large chunk taken out on the left side, the difference in my two breasts isn't noticeable when I'm wearing clothes. I know a lot of women who've had serious issues with reconstruction/implants.)

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  • DogMomRunner
    DogMomRunner Member Posts: 616
    edited January 2020

    I have seen neoadjuvant chemo when the tumors are larger than 1.6 and larger. Mine was 1.1 and the BS thought she could get good margins. So I had the lumpectomy, then chemo and then rads. The neo chemo seems to be when a lumpectomy is the better choice and they want to shrink the tumor down to get negative margins on the surgery. Also if there is lymph node involvement.

    I did not have any reconstruction just the lumpectomy.

    Welcome Novice. It's a club none of really want to be in but very supportive.

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  • Moderators
    Moderators Member Posts: 25,912
    edited January 2020

    Novice300861 - We're sorry to read about your recent diagnosis but you've come to the right place for support from others who understand, welcome!

    If it helps you can read helpful tips on Getting a Second Opinion at the main Breastcancer.org site, including why, where and when to get them, and what to expect.

    Wishing you well and hope to hear from you again soon.

    The Mods

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  • HeartShapedBox
    HeartShapedBox Member Posts: 172
    edited January 2020

    I would definitely get a second opinion. Not just because you seem like a standard candidate for neoadjuvant chemo (with a HER2+ 3+ cm tumor, and planning for lumpectomy not mastectomy, why not try to shrink it first??), but also because I question them "giving you a plan" for a lumpectomy when you have multiple known tumors (did they even present you with info on other options?)

    I'm not trying a to scare you away from a lumpectomy if that option is important to you, but when I was trying to decide on surgery I saw several stories of women who had to undergo multiple surgeries because more cancer was found after a lumpectomy, and for myself, I knew I didn't want to risk that.

    I had neoadjuvant chemo and was given the choice of lumpectomy or mastectomy, and I'm glad I chose mastectomy because they did find other, undiagnosed areas of DCIS in my removed breast.


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  • Novice300861
    Novice300861 Member Posts: 2
    edited January 2020

    Hi, thank you for taking out time and giving a suggestion.

    I actually went to 2 surgeons and 1 medical onco and all of them said why do you want to get chemo first, you donot have axillary node involvement meaning your tumor hasn't spread so remove it first.

    Even though the surgeon was very sure on getting clear margins and getting lumpectomy done, MO clearly said given your age it's not needed. And as i read so much on her2 being more aggressive , i just couldn't wrap my head around getting lumpectomy done.

    So, finally had my Mastectomy surgery MRM with port insertion on 8th Jan. Surgery went well, discharged in a day, 10th day arms and chest are tight with shooting pain once in a while.

    Got my biopsy results yesterday confirming her2+ , er/pr -ve with 1 lymph node involvement. And tumor had increased to 4cm.

    Now waiting for my drains to be removed, and then will schedule an appointment with MO for further treatment plan.


    Hope everything turns out well.


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  • HeartShapedBox
    HeartShapedBox Member Posts: 172
    edited January 2020

    Thanks for updating us. I'm sorry to hear you had a positive node, it sounds like neoadjuvant chemo would've been the right call, so I'm surprised all your Drs were against it. The good news for you is that HER2+ cancer responds very well to herceptin, which will be part of your chemo protocal. Good luck with chemo and recovering from surgery!

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  • ElaineTherese
    ElaineTherese Member Posts: 3,328
    edited January 2020

    HeartShapedBox,

    Use of neoadjuvant chemo for HER2+ cancer varies. For example, in Canada, many HER2+ patients don't get neoadjuvant chemo. The big advantage for me was that it indicated how responsive my cancer was to the chemo regimen in question.

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