IIB Triple Negative Occult Cancer with CHF

My 56 y.o. Caucasian mother was diagnosed in February...after bilateral radical mastectomy, they cannot find the tumor in the breast- it had only been detected after MRI (she also had DCIS in other breast, detected in mamogram (mammogram), not triple neg).  12  nodes were removed; two had cancer.  To complicate things, she had two stents put in back in September after having 30 percent ejection function from idiopathic cardiomyopathy.  Docs are talking a chemo cocktail of TCH- is this Herceptin?  If so, why since she's HER2/NEU negative?  I understand that it has minimal cardiotoxicity, but is it less effective against this cancer? And with this being such an unusual cancer, is it worth the investment (can afford it) to go to a teaching hospital ie MSK or Anderson?  What about prognosis?  Just an idea would be nice.  

[PaulMD]

Hi there.

The H in TCH can very well mean Herceptin.  And I agree with you that this drug may not work on Her2Neu negative tumors.  The heart condition of your mother really makes things complicated since one of the most active drugs for breast cancer, adriamycin, has cardiotoxic effects.  I suggest you discuss this with her oncologist/doctors since Herceptin may not benefit her much (if her2neu negative), and her prognosis will be dependent on her stage of disease.  You can also inquire about the less cardiotoxic drugs such as epirubicin and the non-cardiotoxic drug methotrexate (though this drug is already outdated in breast cancer treatment).

Regards and God bless.