Chemo/Herceptin Treatment Question

Hi. Sorry you need to join this community but this is a great group with a lot of compassionate and knowledgeable people. The protocol you described sounds standard for Her2 positive stage 1 breast cancer although I can't speak of the low ki67 score. Cancer Centers of America is a for profit facility and I can't imagine why you need to be there for three days to get a second opinion other than to redo tests and charge more money (just my jaded view). Search for posts about them using the search function on this site. Perhaps get a second opinion at Georgetown or GWU?

Have you tried University of Maryland Medical Center? They are also NCI affiliated, and an excellent hospital, located in West Baltimore (about 10-15 minutes from Hopkins). I too am suspicious of CTCA, and of them telling you that you need to be there for 3 days -- where are you going to see them? Philly? If you're going to go to Philly, you could also check out U Penn Abramson Cancer Center or Fox Chase, both excellent facilities.

Good luck.

PJAL - If I am reading your original post correctly I am seeing your second mass, the one that is 1cm was equivocal on IHC testing, but positive on FISH testing, as the reason for the chemo/Herceptin decision, correct? While hormonal receptor testing done with IHC yields a percentage - such as your 95% ER+, FISH scoring is different because it is a different type of testing platform. A FISH result of 3.5 falls into the positive status as the range for positivity is any result greater than 2.2. I don't believe that would be considered a low result, but rather is solidly positive. Most tumors are initially tested by IHC for Her2 status because that test is markedly less expensive. An equivocal result is then reflex tested by FISH, or another different testing platform, to see if there is a more refined result. Standard of care for a 1cm Her2+ breast cancer would indeed be 12 weekly infusions of Taxol plus Herceptin, then continuation of Herceptin for the balance of the year, per ASCO treatment guidelines. Your anti-hormonal therapy directed at the ER+ aspect would commence at the conclusion of Taxol, but during the Herceptin only phase. Something else to consider is your low PR+ percentage, potentially signaling more aggression. This was the case for me as well. Ki67% is considered useful info by some oncologists, but it is a somewhat subjective measure and is not always regarded as accurate. Ki67 below 6% is considered low, 6-10% intermediate, above 10% is high, so you are on the lower end of high, but not in the low categor. I am linking an oft-cited study, and the 7 year follow-up, for patients with your diagnosis, and encourage you to come over to the Triple Positive thread, which I will also link - lots of people who post there have had this same chemo/Herceptin regimen and can offer encouragement and support, and will gladly answer any questions you may have regarding treatment. Wishing you the best as you move forward!

https://www.nejm.org/doi/full/10.1056/NEJMoa1406281

https://www.ncbi.nlm.nih.gov/pubmed/30939096

https://community.breastcancer.org/forum/80/topics/764183?page=1289#idx_38649