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This question was answered on Tue 24, Jan 2012 08:17pm by bobby s, md

Herceptin monotherapy for breast cancer


    
Asked by dragonandtiger (Female; 49; See below; Relevant drugs:Cytoxan. Herceptin. ) on Tue 24, Jan 2012 07:12pm
Priced at $49.00

Hello, my lady has stage3b breast cancer. Had lumpectomy 10yrs ago. Triple positive. Had neg nodes then. Minimal chemo. Had recurrence at scar site nov 2010. Tried "black salve" which ulcerated the skin. Had rt mastectomy in oct 2011. Had single positive intra-mammary node and neg sentinel nodes. Had staph infection postop w abscess. Started chemo recently and had drop in wbc to 900, zoster, and varicella-like rash. Placed on rocephin, vanco, and acyclovir. Wbc overshot to 15-19000. Then had severe diarrhea. Possibly c dif. Cultures pending on flagyl. Now we are wondering if chemo is really necessary or using herceptin only. No sign of mets at present. I am a retired neurologist and would welcome your thoughts including any medical articles.

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Answer by bobby s, md  on Tue 24, Jan 2012 08:17pm:

Hello,
I am sorry to hear about her recent recurrence of breast cancer, as well as the complications accompanying treatment.
I have no knowledge about "black salve", so cannot comment on this specific issue. About the other recent adverse events: Post-op infection is an unfortunate but not unknown complication of breast surgery, and especially after re-surgery with suboptimal skin closure. Chemo leading to WBC drops is expected, and counts rising (rebounding) to high levels as a result of growth factors is also common. severe diarrhea following antibiotics could be in fact triggered by these very antibiotics. In any case, metronidazole is a reasonable therapy, and cultures should indeed provide a clue.
About your question about safety/efficacy of chemo-plus-Herceptin versus Herceptin alone: I would suggest that first an evaluation of ER, PgR, and HER2 status in the recurrent tumor be performed (if not already done). There is often a discordance between primary and recurrent tumors, and treatment strategy should be tailored to biomarkers currently expressed on the tumor tissue. If she is still ER-positive, then hormone therapy can be considered (the exact hormonal drug to be given should take into consideration previous hormone therapy received (if any), and menopausal status). Chemo can still be cautiously restarted, with secondary prophylactic measures in therms of antibiotic and growth factor support. Anti-HER2 therapy must continue to be part of strategy if the recurrent tumor is HER2-positive. A consultation with the radiation oncologist should be taken for evaluation and advise.
I am not sure if I have answered your question specifically, but I do feel that there is not enough clinical information provided. Please feel free to ask additional questions, or request clarification.
All the best, and God Bless!

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