For HER2-positive breast cancer, after one year of treatment with trastuzumab (Herceptin), it is important to evaluate the patient's individual situation, including the response to treatment and any potential side effects. Continuing treatment may be recommended based on the oncologist's assessment, which could include additional cycles of trastuzumab or other therapies. It is essential to discuss this with the healthcare provider to determine the best course of action?
Dear Dr.
Hu,
1.
My mother is 63 years old.
She was diagnosed with left breast cancer in August 2008, with ER(+), PR(+), and HER2/neu(-, IHC).
She underwent a left mastectomy followed by adjuvant chemotherapy (with Adriamycin) and adjuvant hormonal therapy (with Letrozole and Tamoxifen) for 10 years, after which she remained stable.
2.
In April 2023, there was a recurrence of cancer in the same breast, located on the chest wall and adhering to the bone, with ER(-), PR(-), and HER2/neu(3+, IHC).
Due to its location on the chest wall, surgery was deemed inappropriate, and even if attempted, there were concerns about achieving clear margins.
Consequently, she began a series of chemoradiation treatments in June, which included 6 cycles of chemotherapy (with Oxaliplatin and out-of-pocket Platinum), 30 sessions of radiation therapy, 6 cycles of out-of-pocket Herceptin, and 16 sessions of National Health Insurance-covered cancer treatment, with the treatment expected to be completed by April 2024.
3.
Other: The most recent ultrasound and PET scan indicated that the tumor has completely resolved with no signs of distant metastasis.
The PET scan showed a very faint residual lesion on the left chest wall.
4.
Question: Since surgery is not an option, my mother is very concerned about coexisting with cancer cells and feels anxious relying solely on follow-up.
Most information found online pertains to cases involving surgery.
I would like to ask for your advice: should she continue with Herceptin to consolidate the treatment effects, or is follow-up sufficient? The information we found suggests administering Herceptin for one year, but our situation does not involve surgery.
If we continue, it will be out-of-pocket, which is a concern and may affect her treatment morale.
We worry about spending money without significant results, and there is uncertainty about how long to continue and the frequency of administration, as well as considerations regarding drug resistance.
Thank you for your time and assistance in addressing these concerns.
Mr. Chen, 30~39 year old female. Ask Date: 2024/05/27
Dr. Hu Ziren reply Oncology
It is recommended to consider the following options: 1.
The PET scan shows a very faint residual lesion in the left chest wall; should consideration be given to resecting the residual lesion to enhance treatment efficacy? 2.
Continue maintenance therapy with anti-cancer treatment every three weeks; 3.
Pulsatile oral chemotherapy.
PS: It is advised to discuss in detail with the attending physician to formulate the best treatment and follow-up plan for the patient.
Reply Date: 2024/05/27
More Info
In the context of HER2-positive breast cancer, the decision to continue treatment after one year is complex and should be tailored to the individual patient's circumstances. Given the details of your mother's case, there are several factors to consider.
Firstly, HER2-positive breast cancer is known for its aggressive nature, and the treatment typically involves targeted therapies such as trastuzumab (Herceptin) in conjunction with chemotherapy. The standard recommendation for patients who have undergone surgery and have received adjuvant therapy is to continue trastuzumab for a total of one year. This approach has been shown to significantly reduce the risk of recurrence.
In your mother's situation, she has experienced a recurrence of breast cancer that is now classified as HER2-positive (3+, IHC). This change in the cancer's characteristics is crucial because it indicates that the cancer cells are now expressing the HER2 protein, which can be targeted with specific therapies. The fact that she has undergone extensive treatment (chemotherapy, radiation, and targeted therapy) and has shown a complete response, with no signs of distant metastasis, is encouraging. However, the presence of a residual lesion, even if faint, raises concerns about potential residual disease.
Given that your mother has not undergone surgery due to the location of the tumor, continuing trastuzumab (Herceptin) could be beneficial in maintaining the therapeutic effect and preventing further recurrence. The recommendation to continue trastuzumab beyond one year, especially in cases of residual disease or recurrence, is supported by some studies suggesting that extended therapy may improve outcomes in certain patients. However, this is often a decision made on a case-by-case basis, weighing the potential benefits against the costs and the patient's overall health status.
Regarding the financial aspect, it is understandable that the cost of continuing treatment can be a significant concern. If the treatment is not covered by insurance, discussing alternative options with the healthcare provider is essential. There may be clinical trials available or other financial assistance programs that could help alleviate the burden.
Additionally, the issue of drug resistance is valid. Continuous treatment can sometimes lead to the development of resistance, but this is more commonly a concern with prolonged use of chemotherapy rather than targeted therapies like trastuzumab. Regular monitoring through imaging and blood tests can help assess the effectiveness of the treatment and detect any signs of recurrence early.
In summary, while the standard recommendation is to continue trastuzumab for one year after surgery, your mother's unique situation—specifically the recurrence and the current status of her disease—may warrant a discussion about extending treatment. It is crucial to have an open dialogue with her oncologist to explore the best course of action, considering both the medical benefits and the financial implications. The oncologist can provide personalized recommendations based on the latest research and guidelines, ensuring that your mother receives the most appropriate care for her condition.
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