85 y.o. Her2 pos
Hello all. It's been some time since I posted. My 85 year old stepmother was diagnosed through FNB with ER+, PR-, Her2+ breast cancer. Diagnostic tools estimated the tumor at 4 cm. Lumpectomy revealed 2 mm of ILC and the rest was LCIS. She had a port placed during lumpectomy, plus SNB, two nodes were clear. Current thought is radiation, Herceptin, AI. What was treatment recommendation for anyone out there for similar tumor. Initial biopsy said grade 1, but Her2 aggressiveness was high 3+?, not sure of how that is measured. Thank you for your thoughts. Personally I'll be ten years out in February. Wahoo!
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farmerlucy - good to see you, sorry for the reason. And yay for the 10 years! Can you clarify the size of the ILC portion? Is it 2mm, or .2mm? Anything under 5mm is up for grabs as far as how to treat with a Her2+ tumor - some oncologists might opt for more aggressive treatment than others, but particularly for an 85 year old, careful thought should be a consideration. NCCN guidelines indicate systemic treatment should be considered, but it is not an automatic. Grade is low for a Her2+ mass, it may have been driven more by the hormonal aspect, as grade in Her2+ tumors is usually higher. As far as the Her2 being 3+, that is the test scoring method that indicates positivity - anything less is equivocal or negative. Here is the info from BCO explaining:
"IHC test (ImmunoHistoChemistry): The IHC test uses a chemical dye to stain the HER2 proteins. The IHC gives a score of 0 to 3+ that measures the amount of HER2 proteins on the surface of cells in a breast cancer tissue sample. If the score is 0 to 1+, it's considered HER2-negative. If the score is 2+, it's considered borderline. A score of 3+ is considered HER2-positive. If the IHC test results are borderline, it's likely that a FISH test will be done on a sample of the cancer tissue to determine if the cancer is HER2-positive."
It appears that the plan includes Herceptin, but not chemo. There should still be an echocardiogram done prior to starting to determine cardiac health, especially in light of her age. Additionally, she should have a current Dexa scan before starting an AI to see what the condition of bone density is. The AI can cause some issues with arthralgia and bone density loss, but Tamoxifen might be a possibility as it can build bone in postmenopausal women as long as there is no clot risk in her medical history.
Wishing you both the best!
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Hi farmerlucy!
Congrats on getting close to ten years, my fellow Okie!
Re: the Grade -- yes, most HER2+ is either Grade 2 or 3, but I've seen a few HER2+ patients with Grade 1 tumors.
For most patients with an invasive HER2+ tumor of 2 mm, they would not get chemo. Typically, chemo is recommended for invasive HER2+ tumors of 5 mm and above.
Herceptin alone? That varies, but the best thing about Herceptin is that most people tolerate it well. I had no side effects from Herceptin. They should keep a close eye on her heart as Herceptin can cause (usually temporary) heart damage. She should be scanned before Herceptin (for a baseline) and then during Herceptin to make sure that her heart continues to function well.
Her treatment plan seems appropriate, but it all depends on how well she tolerates the Herceptin and the AI. Best wishes to your step-mother!
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Special K and Elaine!! Yes it is 2 mm not .2 mm thank you. I corrected. So great to see you both! Thanks for the great info. I will bring up Tamoxifen. It was much easier for me thanthe AI. Merry Christmas to you. Take care my sisters!
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Special - great info on 3+ info. Good to know that it the normal score for positivity.
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Hey, FarmerLucy,
I’m so sorry to read this about your stepmom. I hope whatever RX she lands on is kind to her.
I hardly am on bco anymore after they started advertising and showing our posts. I thought I would check in and see how people are doing.
Herceptin is much kinder than the Herceptin/Perjeta mix for > stages.
I hope she does well.
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there was new research about Situations just like this one:
https://www.breastcancer.org/research-news/can-older-women-w-early-her2-pos-bc-skip-chemo
sounds like the plan for your step mom is very consistent with this research.
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Beatmon - it's been a while for me too. Nice to see some friends still here. I really wish my SM just stopped with the mammograms. Would have saved her a lot of anguish with the same outcome, But that's me. Hope you are managing. Enjoy your holidays. This weather. . . . Amazing but kind of unnerving. .
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Thanks for the link Smoothoperator!
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The thing about tamoxifen is the accumulating data, and trials investigating, that it may not work well against ILC, compared to an aromatase inhibitor.
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ahhhh good to know!
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