Herceptin for Her2Neu Positive Expression?

[CGTMHI]

This is a WONDERFUL forum and I thank you for taking time to answer so many questions.

I recently had a mastectomy and my tumor was 1.2cm.  This is my 2nd round with cancer.  The 1st was more than 10 years ago and my tumor at that time was 2.1cm.  The tumor was tested and came back as being Her2Neu positive - it was SO positive that it registered beyond 100% on the graph.

The Medical Oncologist I saw wants me to have chemotherapy, but I have only one functioning kidney.  He also told me that chemotherapy would likely only give me a 10% decrease in the chance that the cancer will return.  For me, a 10% decrease isn't worth risking damage to my only good kidney.

The thing I find odd is that he never mentioned Herceptin to me.  A neighbor told me about Herceptin and said that it is specifically for Her2Neu positive tumors.

My questions are:

1) How can I figure out the benefits vs. risks of chemotherapy?

2) Is Herceptin turning out to be a good drug for Her2Neu tumors?  I know it's only been approved by the FDA since 1998.

3)  Is it advisable to take Herceptin without using another chemotherapeutic such as Taxol or Taxotere?

Once again, thank you all for this wonderful place!!

Cindy

[CCF-RN,MSN-rf]

Dear Cindy:  1) Benefits vs. risks of chemotherapy is technically difficult to determine.  As a general rule, chemotherapy reduces the risk of recurrence by about a third.  That means the higher the risk of recurrence, the bigger the benefit.  For example, if you have a 60 percent chance of recurrence, chemotherapy will reduce it by 20 percent.  So the key to determining benefit is to determine your risk.  There is a nice chapter in Dr. Susan Love's breast book that discusses this.  Your doctor should be able to help you determine your risk.  As an aside, her2neu positive cancers have a tendency to be a bit more aggressive.  This may increase your risk of recurrence (and, therefore, increase benefit of chemotherapy).  2) Herceptin can be very effective in treating Her2neu + tumors.  It has been approved by the FDA for use in recurrence.  Clinical trials are underway to determine whether it has benefit in the adjuvant (after surgery when no disease is present) setting.  3)  Herceptin is generally combined with chemotherapy, although it may be given alone in some protocols, usually after chemotherapy.  In the adjuvant setting it is generally given following chemotherapy - and this is part of the protocol.

[surgeon]

at the present time, herceptin is being used mainly in the situation of recurrance with spread, and failure of other drugs. As the comment above mentions, there are studies directed at using it as a first-line treatment; but the data aren't there yet as to its role in that situation.

[CGTMHI]

Thank you to everyone who responded!!  This is absolutely wonderful - I can't believe that in one day I can ask a question and receive 3 responses.  WOW!

I'm going to speak with my doctor again about my "risk factors" as I don't think he described them clearly enough.  I have Dr. Love's book, so I'll also read about risk factors, there.

Again, thank you all!  I'm still incredulous that this forum is available.

Cindy

[palmqueen]

Hi!  This is the first time I have logged a comment, but when I read your question, there are such similarities between us, that I had to reply to you.  I had breast cancer-1.8cm and strongly positive for Her2 expression.  I, also, have one functioning kidney.  I had 4 treatments of AC and 4 of Taxol. Additionally, I elected to participate in a study for early stage BC and was given herceptin weekly for a year.  I completed all the treatments in August 2002.  My health is great. Thus far, no kidney damage has been seen.  Good luck!