75 year old with Her2+ breast cancer with heart problems - 1262988

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75 year old with Her2+ breast cancer with heart problems - 1262988

One month ago, my 75 year old mom was diagnosed with ER-/PR-, Her2 positive breast cancer with two positive lymph nodes out of 15 that were removed. Ten days ago, she underwent modified radical mastectomy.

She has a history of atrial fibrillation and type 2 diabetes. Due to this, the doctor recommends no adjuvant treatment (no Herceptin). Since her tumor is Her2 positive, we are concerned about the high risk of recurrence and metastases.

Would she be a candidate for any treatment in the USA, without cardiac toxicity ? Even though the surgery and follow-up was done at a very good cancer center in a developing country, the doctors may be on the conservative side. We can arrange for her travel to this country, if there are better treatment options for her here. Please let me know your suggestion.

Thank you,


Dr West
Reply To: 75 year old with Her2+ breast cancer with heart

It would really depend on the specifics of her breast cancer and the other medical issues she has. While chemotherapy would often be prescribed as a general rule with Herceptin (trastuzumab) for an ER negative, PR negative, HER2 positive cancer, there is definitely a possibility that this will be overtreatment in a 75 year old with other medical issues with heart disease and diabetes, particularly if the cancer isn't large and/or some of the features of the cancer under the microscope are on the more favorable side.

This is a very individualized situation, so the most we could say is that it is an open question and I believe it would depend on the specifics of the case, but that chemotherapy with or without Herceptin is not a mandate. A second opinion, whether in the same region or in the US, is a reasonable idea.

Please note that we are not legally permitted to provide medical advice, so it's not possible for any of the doctors here to make a recommendation, even if you were to provide more details.

Good luck.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education