herceptin for breast cancer

Hi, You have had a history of breast cancer 17 years ago, treated with adriamycin. Now you had a 0.7 cm recurrence, and underwent mastectomy. The tumor showed a 3+ positivity for Her2Neu by IHC. Let me give you a brief background of HER2/Neu, and of Herceptin (Trastuzumab). Her2/Neu is a protein receptor which is useful in normal cell proliferation. Normal cells contain 2 copies of the gene for Her2/Neu, while cancer cells contain 50 to 100 copies. About 25 to 30% of breast cancer patients test positive for Her2/Neu. Tumors with a positive Her2/Neu status are more aggressive. Herceptin is a monoclonal antibody that specifically targets the Her2 Protein, and if used alone or in combination with chemotherapy, benefits patients with Her2/Neu positive metastatic breast cancer. Because of impressive results in advanced cancer, trials were conducted to check if similar benefits could be given to early stage breast cancer patients. Results of five large trials (HERA, NSABP B31, NCCTCG N9831, BCIRG, FinHer) involving over 13000 women with early breast cancer are now available. Results show that adding Herceptin halves the recurrence rates. HERA study also demonstrated a 30% reduction in mortality rate. You are right when you point out the two short comings of the Herceptin trials: a relatively short follow-up period (original publications reported a follow-up of between 23 and 36 months), and an unknown long term toxicity profile. About your concern about cardiac toxicity, the largest study (HERA) found severe heart failure in only 0.6% of patients. A milder decrease in cardiac function was noted in 11.3% of patients in these studies, and this was reversible in the majority of cases. Most women in these studies had received anthracycline (adriamycin) based chemotherapy prior to getting Herceptin. Also, Herceptin is not particularly associated with risk of leukemia. One more point you should consider is that your tumor was 0.7 cm in size, and these trials have been enrolled women with tumor size over 1 cm or with axillary node involvement. The data with regard to Herceptin in smaller tumors is limited. All the Best, and God Bless!

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