UCSF Opinion: Adjuvant Therapy

I met with Dr. Moasser, a medical oncologist specializing in Her2 breast cancer, at UCSF Medical Center yesterday.  He gave me a short physical exam, reviewed my mammogram, MRI, surgical, and pathological records with me and then issued his opinion.  Despite the positive factors (clear nodes, small invasive component), he recommends a combination of Herceptin + chemotherapy [b] due to the aggressive nature of Her2.  He offered 3 different regimens:

1)  ACTH —  Adriamycin and Carboplatin followed by Taxotere and one year of Herceptin (higher likelihood of heart toxicity side effect)

2)  TCH —  Taxotere and Carboplatin with one year of Herceptin (lower angiotoxicity regimen than #1)

3)  Taxol/Herceptin —  Lower toxicity than both #1 and #2, becoming more popular for lower recurrence risk cases.

He said there is a roughly 15% recurrence risk for my case with no chemo or Herceptin, based on the MD Anderson study [2] of recurrence risks for node-negative, <1cm tumors; that research found a significantly higher rate of recurrence of Her2+ breast cancer, compared with otherwise similar Her2- cases.  Looking back at my notes for that publication from a couple of weeks ago, I think the 15% figure included all invasive tumors up to 1cm in size, thus both T1a and T1b tumors.  Keep in mind the T1b (>0.5 cm, <1.0cm) are generally associated with higher risks of recurrence when compared with T1a (<0.5cm).

Dr. Moasser postulated that with such an extensive DCIS lesion, it is very possible for more invasive components to have been missed by the pathologists, simply because it’s infeasible to exhaustively examine every cell in a sizeable sample divided into a finite number of slices.  These additional invasive components, furthermore, could be larger than the 0.3cm x 0.2cm tumor that was found, which would then put me at an even higher risk of recurrence.

In other news, Dr. Jeske said through email:  “They have resubmitted additional sections from your pathology specimen and these show no evidence of any invasive cancer. In addition, the entire specimen was reviewed by a second pathologist who concurs with the diagnosis.”

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