Treatment for HER2+ Breast Cancer
When I received my cancer diagnosis I did what each of you are doing, I sat down in front of a computer and opened Google. I was terror-stricken with what I read about HER2 and how aggressive it spreads and grows. It is a scary diagnosis but because a diagnosis of HER2 used to be a death sentence it became one of the most research focused types of breast cancer over the last twenty years and due to that attention some phenomenal treatments now exist. For instance, we not only have multiple chemotherapy drugs that work to kill this cancer but targeted treatments as well. If you are a movie person, look up the movie Living Proof and watch it. It stars Harry Connick, Jr. as Dr. Dennis Slamon from UCLA, who was the mastermind behind Herceptin, the first targeted chemotherapy treatment for HER2+ breast cancer. You will feel 100% better after watching it and also have the overwhelming desire to only buy Revlon make-up. I highly recommend it.
As you move forward, you will have decisions to make and you might hear the terms neoadjuvant, before surgery, or adjuvant, after surgery. In my case, I was not given a choice when my treatment would start (I had to have surgery first because of how fast the tumors were growing, check out the blog post I Have Cancer for more information ) so all of my treatment would begin after surgery. However, not every breast cancer patient starts treatment after surgery, some will begin their treatment before and have surgery last. Below you will find numerous medicines that might be part of your treatment plan. As a reminder this page is meant to be used for informational purposes only. You should always discuss treatment with your team of doctors to determine what will be the best course of treatment as no two breast cancers are the same. All treatments are determined on a case by case scenario based on your unique cancer pathology.
I will do my best to update this page as new clinical trial results are released.
Surgery
Mastectomy vs. lumpectomy
You may have the choice of a mastectomy, full removal of the breast, or a lumpectomy, the removal of the tumor and surrounding tissue. I was not given a choice due to how many tumors and the size but I had a lumpectomy in the past on my healthy breast. You can read all about my experience having a bilateral mastectomy with tissue expanders here. If you are given a choice know that there is no right or wrong choice. When you look at the statistics of reoccurence having one verses the other showed no difference. Keep in mind that choosing a lumpectomy you will most likely need to have radiation to make sure all the cancer cells are dead. If you were to chose a mastectomy know that there is still a chance of needing radiation if the cancer has spread into the lymph nodes. Again the best thing to do is talk with your doctors, ask questions, communicate with your partner, boyfriend or girlfriend, husband or wife but ultimately it is your body and your call to make.
If you selected a mastectomy you will typically be given the choice of having both breasts removed or only the breast that has the cancer inside it. In addition to this preference you will need to determine if you want to have your breast reconstructed or leave them flat. I opted to remove both of my breasts and then have reconstruction. If you are interested in learning more about this I suggest you check out the blog for more details and pictures. However, since I don’t have experience going flat I suggest you check out the following websites below that also have Facebook, Twitter, and Instagram accounts.
The last procedure that you will most likely need is a sentinel node biopsy of your lymph nodes. For me this procedure was done at the same time as my bilateral mastectomy but I have talked to enough women to know that not everyone has at the same time, instead being done as a separate surgery before a mastectomy or lumpectomy. I highly recommend reading my surgery update post about this operation.
Radiation
Not all treatment paths will require radiation. The most common reason you will need radiation is if you choose to have a lumpectomy, OR, if your pathology from the sentinel node biopsy comes back positive for cancer. As stated above if you choose a lumpectomy your team of doctors will most likely recommend radiation to make sure that all cancer cells are dead. Once pathology comes back you will know if radiation is needed and how many rounds of treatment are required. I did not need radiation because my nodes were negative with my first diagnosis, however, with the second diagnosis my cancer was in my nodes making radiation a must.
Together your radiation oncologist, oncologist, and surgeon will work to determine the best treatment plan for your specific cancer. The next step is meeting with your radiation oncologist to go over your diagnosis, pathology results, and to determine if your skin is ready to handle the treatment. At that time you will find out how many rounds of radiation are needed. Once the doctor determines your skin is ready treatment can begin.
There are a few steps before you actually receive your first radiation treatment. First, you will have a “pillow” fitted to your body so that you are in the same location for each treatment. Then you will have a CT scan done. The images taken at this time will be given to the radiation oncologist to create a map, or grid, of your body and lay out the exact location all radiation needs to treat. Second, you will be tattooed with three dots to ensure that each radiation session you are perfectly lined up with the machine. Because radiation is an exact science all of this is done to make the treatment as successful as possible. Last, you will have a dry run through on the radiation table. It will be the first time in the actual room you will be receiving the radiation. At that time they will take a few more images to document that the map, or grid, is correct from the original CT images. At this time they will go over the procedure and ask you for any questions.
I needed a total of 25 rounds of radiation. Radiation is given every day Monday through Friday, allowing time to recover over the weekend. There is typically no additional breaks unless your skin begins to open or get significant wounds. The treatment sessions last around 15 minutes from start to finish. It is good to know that you will probably be there for closer to an hour. If the person before you is late or has trouble getting in position then you will continue to get pushed back. Also, you will have to change into a gown each day before treatment, so you need time to change before and after. Radiation itself is painless. You can not feel the “beam” penetrating your skin. If I felt anything it was a warm feeling overcoming me, as if someone moved the heater vent directly onto me in the car. The side effects are minimal with the largest and most common being tiredness.
My biggest piece of advice is to use the lotion or creams that your radiation center recommend, stay hydrated, and sleep. You can read more about my radiation experience in the post, as the fire starts to die, or from the National Breast Cancer Organization provided in the link below.
Chemotherapy and targeted chemotherapy
Herceptin
This drug has been approved for both early stage and metastatic breast cancers. According to the Herceptin website, this drug has been approved for the treatment of early-stage HER2+ breast cancer. The cancer may or may not have spread into the lymph nodes and is estrogen receptor (ER) and progesterone receptor (PR) negative or be considered high risk by your team of doctors. Typically, Herceptin is combined with the following chemotherapy drugs: doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel. You may be told you are going to be receiving AC or TC as your treatment plan. Another treatment course is a combination of the chemotherapy drugs docetaxel and carboplatin. This is called TCH. Most often a patient will finish chemotherapy drugs and continue on with Herceptin for a full year. The medicine is given through an IV every three weeks. For more information on Herceptin, please follow the below links that will direct you to the specific page to learn more or to hear about how I handled my first round of TCH and the side effects I endured check out Chemosabe is a bitch. You can also click on any picture above and it will take you directly to the blog post about that specific round.
PERJETA
Perjeta is also for HER2+ hormone receptor negative patients in early stage and metastatic breast cancers. This drug is added to the TCH regimen of treatment and is often referred to as TCHP. Similar to Herceptin, you will receive this treatment every three weeks for a year through an IV. Commonly, this is added to a treatment plan if the pathology report shows that the cancer has spread into the lymph nodes. For more information on Perjeta, please follow the below links that will direct you to the specific pages to learn more. I did not need this drug because my lymph nodes came back as negative.
kadcyla
Kadcyla is for HER2+ breast cancer that has spread to other parts of the body after completing treatment with Herceptin. However, a new study released at the San Antonio Breast Cancer Symposium in December of 2018 known as the KATHERINE TRIAL found that this treatment was found effective at treating early stage breast cancers. Specifically, it had control groups use Kadcyla instead of Herceptin in their treatment plan. The findings were fascinating and ultimately showed that Kadcyla was more effective at preventing re-occurrence than Herceptin. This is a new discovery and should be discussed with your doctor. Below are links that will provide more in-depth information on Kadcyla and the KATHERINE TRIALS. The link to the New England Journal of Medicine is filled with lots of medical language. If you want something in laymen’s terms try the Targeted Oncology link. This is also called TDM1.
Nerlynx
Nerlynx is the first of its kind to be offered after adjuvant therapy has finished. The trial for this was called the ExteNET TRIALS which you can read about on The Lancet’s webpage below. This is for all stages of breast cancer that have finished chemotherapy and targeted chemotherapy treatments. If you are stage 4 discuss with your team of doctors about how this drug can help you thrive as it can be taken alone or combined with the chemo Xeloda. It is different from the treatments above because it is not given by IV but comes in pill form. Nerlynx is also used to help prevent the possible re-occurence of breast cancer.