Taxol or not?

I am 36 years old and was diagnosed with Ivasive ductal carcinoma on 1/25/06 in my right breast - grade 3, Nottingham score=9. I had a bilateral mastectomy on 2/7/06(due to strong family hx of CA - my mother had ductile and lobular CA at the age of 46, as well as a great aunt and great grandfather dying from breast cancer in their early 50s).  My tumor was 1.7x1.5 cm with 0/9 nodes being positive.  My tumor's estrogen receptor assay showed 1-2+ intensity in approx. 60% and the progestoerone receptor assay showed 1+ intensity in less than 1%.  I did not get a HER2 status (was told because my nodes were negative).  I did have genetic testing which showed a BRCA2 mutation 6296del5.
I have 3 questions:  I have just completed 4 rounds (dense dose) of AC and am now getting conflicting recommendations from 2 different oncologists regarding the need for Taxol - one doctor said no because my tumor is ER+ and my nodes were negative, while another said yes because my tumor is PR-, family history, my age, etc.  What is your thoughts on this?  In addition, these doctors are conflicting regarding how soon I need to have a hysterectomy and oophprectomy, the one that says no to taxol is saying to have the precedure done within the next 2-3 months, while the other says complete taxol and then have the surgery next year. What are your thoughts?  Also, do I need to get my HER2 status (if possible)?

[CCF-RN,MSN-rf]

Dear floridastar:  HER2 is an antigen that is present on the surface of some breast cancers.  This antigen has some prognostic implications but its primary use is to determine whether the use of herceptin (a drug that treats HER2 positive cancers) would be of value.  The absence of cancer in the lymph nodes does not mean that the tumor is HER2 negative.  The standard of care for dose dense therapy is AC plus Taxol.  This is independent of hormonal status.  Positive hormone receptors would dictate whether additional therapy (such as tamoxifen) would be appropriate following adjuvant chemotherapy.  

If your plan regarding the oopherectomy is to prevent a possible ovarian cancer, this can technically occur any time after chemotherapy has been completed and your blood counts have recovered.  It is not necessarily emergent in the absence of any problems.

[squiggles]

Hi,

I just had a long talk with an oncologist at a major research hospital about taxol a few days ago.

First, most pathologists test for HER2Nu overexpression using a more basic test than FISH.  If this test was clearly negative, they probably decided that a FISH test was not necessary.

From what I understand, taxol is given to women at higher risk for recurrance than you seem to me. It is the standard of care for stage IIB and higher cancers - women who either have a very large tumor, positive lymph nodes, or hormonally negative tumors. If you had negative nodes and a small tumor, the benefit from adding taxanes is often not considered large enough to outweight its toxic effects.  That is probably why you are seeing a disagreement between doctors over whether you should have it.

[floridastar]

Squiggles,
Thanks so much for sharing your information.  After much consideration, we have decided to not do the taxol and instead go ahead with the tamoxifen and schedule me surgery for later this year.