In February of 2007, I was diagnosed with HER2+ stage IIIC inflammatory breast cancer. I had no idea what that meant. Fortunately for me and for anyone whose cancer is HER2+, what used to be a very alarming diagnosis is less so, due to more effective approaches to treatment and new drugs that specifically target your cancer. HER2+ refers to human epidermal growth factor receptor 2. HER2 is a growth hormone, and having a mutation that multiplies this protein means that your cancer is programmed to grow, and to grow quickly. When I was treated in 2007, Herceptin was just coming into use as standard treatment for HER2+ breast cancer. It dramatically changed the HER2+ breast cancer story.
Herceptin was the first of many new drugs that target the HER2 protein.
After Herceptin (trastuzumab) came Tykerb, and then other new drugs. Herceptin showed remarkable promise with metastatic breast cancer patients, and subsequently became standard protocol as neoadjuvant (before surgery) chemotherapy. Adding Herceptin to standard chemotherapy has statistically improved outcomes both for early-stage and metastatic breast cancers. After Herceptin became standard treatment for HER2+ breast cancer, other targeted therapies became available. Currently there are HER2+ vaccines being developed, which are showing promise in preliminary trials.
HER2+ breast cancer has a high risk of recurrence without treatment.
With the advent of Herceptin used with standard chemotherapy, recurrences have been dramatically reduced. Recurrences with this subtype of breast cancer are most likely to occur earlier rather than later. Any breast cancer can recur after five years, although it is less likely. Breast cancer can recur decades after treatment. A review of the study literature shows that hormone-sensitive breast cancers are more often the ones that recur later. HER2+ and triple-negative breast cancers have higher recurrence rates in the first two to three years after treatment. After five years, cancers that are hormone-receptor positive are more likely to recur. That may mean a tougher treatment plan in the beginning, but a better outcome after five years.
Dose-dense chemotherapy improves outcomes for aggressive cancers.
When I was diagnosed, standard chemotherapy treatment was one infusion every three weeks. My oncologist told me that I had an aggressive cancer, and that she was going to take an aggressive approach. She used a standard chemotherapy regimen of four Adriamycin and Cytoxan infusions, followed by four Taxol/Herceptin infusions. I continued the Herceptin for one year, which was new at the time but now is standard for HER2+ cancer. Her choice for me was dose-dense chemotherapy, so instead of three weeks between treatments I had only two. She told me at the time that she believed that dose-dense would become the standard protocol in the future, and now, more than five years later, I am seeing it offered to more and more patients.
Chemotherapy targets fast-growing cells. Cells that are growing very fast often respond very well to chemotherapy drugs. The challenge is to kill them all. Dose-dense treatment decreases the opportunity for cancer cells to adapt and become resistant. Outcomes are statistically better with dose-dense chemotherapy. It is a difficult regimen, but methods for managing side effects have improved dramatically.
When I received my diagnosis, my only understanding of HER2+ breast cancer was that there was targeted therapy for me, which was good news. If you are facing this diagnosis now, be reassured that oncologists have a better understanding of your cancer than ever before, and more ways to treat it effectively.
Sources:
Personal Experience
The Oxford Journals
NBOCC Guidelines
More from Elizabeth Danu:
Getting the Most from Treatment with Taxol
Understanding the Treatment Protocol for Inflammatory Breast Cancer
Herbs and Chemotherapy: A Dangerous Combination