HER2neu recurrence treatment discussion? - 1250439

Mon, 11/19/2012 - 19:02

37 yo WF with infiltrating ductal 1.2cm lesion,Right Breast lumpectomy =T1N0,sentinalnode neg,and 4extra nodes neg; Markers HER2 +3, Er+ Pr-in2001. Treatedw/FEC 6cycles then 2years of Tamoxifen and 3 of Zolidex injections.
2009 normal mamo,requested MRI(read article):MRI done and Pos for recurrence,same breast with same cancer and markers and by PET it showed no spread outside theRight breast (span 10cm) scattered in breast. Did Taxotere/Carboplat/Herceptin for 5cycles(not tolerated bad neuropathy) and 1 year of Herceptin with Bilateral Mastectomy with DIEP flaps after Taxotere and Carboplat. Started Arimadex but hurt hands so much could not function, so only one year. PET 2010 & 2011= negative for any disease. Had Hysterectomy in 2011. Now 2012 PET scan showed + node on opposite axilla 4cm. Had axillary node dissection Level1,2,3, and 30 nodes taken 3 positive. The original node 5cm/and 2 sized .5cm all in level 1. MRI brain neg CT of ABD neg. So I guess this must be across Met?
SO NOW what??
Taxotere with Pretuzunab? studies ?

vs.
Herceptin,Lapatinib,with Arimidex : studies?

what about studies on radiation to the area?

Lastly what about TDM1? is it going to be available? Am I a good canidate?

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Dr West

I'll ask Dr. Cianfrocca, a breast cancer expert, but I need to qualify that we can't tell people what they should do...it's illegal for us to provide medical recommendations for someone who isn't our patient. Your situation will be one in which there are several possibilities and not one right answer. I'll hope Dr. Cianfrocca can provide some useful general thoughts, but only your own medical team, the people directly involved with the details of your care, can actually make a recommendation about the specific options for your care.

Good luck.

-Dr. West

dr cianfrocca

As Dr West indicated I cannot make a treatment recommendation. Some things that came to my mind when reading your post however are:

1. You don't mention what imaging you had on the left breast. That would be important. While the disease in your left axilla could certainly be metastasis from your original tumor, it could also be from a separate, new tumor in your left breast. You also don't mention whether ER, PR and HER2 were re-checked on the axillary disease. That would also be important.
2. If we assume that this is metastasis from your original tumor and it is still ER and HER2-positive, the goal of therapy should be to make you free of any disease that can be seen on scans. Ideally, that would involve the use of surgery (which it sounds like you've already had), systemic therapy with chemotherapy and herceptin +/- pertuzumab or lapatinib, consideration of radiation therapy and endocrine therapy. TDM1 may become commercially available within the next few months however I don't recommend waiting until then for treatment.

All the best,
Dr Cianfrocca