Wade Smith, MD, as told by Kara Mayer Robinson
A diagnosis of HER2-positive breast cancer can be scary at first, especially when hearing the words “aggressive cancer.” But there is reason to be optimistic about the progress of treatment today. There is no one-size-fits-all approach, but your doctor can help you choose the one that’s best for you.
Its treatment is unique
HER2-positive breast cancer is different from other types of breast cancer, so your treatment may not be the same as someone with other breast cancers. This may also differ from the therapy of another HER2-positive patient.
Every cancer is unique, so doctors try to develop the best treatment for you. Things to consider include the size of the tumor, whether the cancer has metastasized (spread), or the overall risk of recurrence.
Treatments to consider
The most common treatments for HER2-positive breast cancer are chemotherapy and HER2-directed therapy. This is followed by surgery, and then HER2-directed therapy continues. This is often best for patients with large tumors or cancer of regional lymph nodes.
For targeted therapy, your doctor may recommend a family of drugs commonly called monoclonal antibodies. These include trastuzumab (Herceptin), the first-in-class precision therapy drug approved by the FDA for the treatment of HER2+ breast cancer.
It’s less common, but surgery may be done first, followed by chemotherapy and HER2-targeted therapy. Your doctor may choose this sequence if you have a small tumor that is not in your lymph nodes.
Your doctor may also recommend endocrine therapy. This treatment involves taking a daily pill for at least 5 years after chemotherapy and surgery are completed.
Pros and cons
Each treatment has its pros and cons, and you may be a candidate for some types of treatment but not others.
Here are some things to consider:
- Chemotherapy is highly effective, but is known to cause side effects during and after treatment. The type and severity of these side effects vary depending on the medication prescribed. The most common side effects are hair loss, nausea and vomiting.
- Chemotherapy combined with HER-2-directed agents are highly effective.
- The advantage of trastuzumab (Herceptin) is that it is given intravenously (intravenously) and can usually be given at the same time as chemotherapy.
- You should not take trastuzumab (Herceptin) if you are pregnant.
- Do not take trastuzumab (Herceptin) if you are breast-feeding or plan to breast-feed.
- Trastuzumab (Herceptin) and related HER2-directed therapies can cause serious heart problems.
Cost of treatment
If you are concerned about the cost of your care, talk to your care team. Most approved cancer therapies are covered by insurance. But if you feel overwhelmed with coverage issues, get help.
One of the benefits of being cared for at a top cancer facility is that they can help you navigate the process.
Even with all the therapies currently available, there is always more to discover. Clinical trials not only promote scientific progress, but can also benefit patients.
Your doctor may recommend a clinical trial if they think you will respond best to a new therapy or combination of therapies. If your specialist recommends a clinical trial, this may be a good option for you.
Make sure you understand what the trial is about. Talk to the care team.
Use reliable information
Always ask questions of your care team and focus the conversation on your specific case.
Remember that the diagnosis is unique. Be careful when reading advice from online discussion groups, message boards and social media. These sources may provide some support, but may also contain untrue or outdated information.
Talk to your doctor
It is very important to feel comfortable with your doctor and to have a doctor who listens to you and addresses your concerns.
I recommend going to a research-based cancer center to get treatment, a second opinion, or both.
Find a care team that specializes in your type of cancer. Highly trained physician-scientists stay up-to-date on new treatment options, which is important because cancer is complex.
Learn what you can do about HER2-positive breast cancer and ask questions. It is a good idea to write down questions before the meeting.
During your meeting, take notes or ask if you can record the conversation on your phone. Tell your doctor how much information you want and don’t be afraid to speak up if you don’t understand something they’re explaining.
I also recommend that patients involve their families in decision-making. Technology offers many good opportunities to involve family or friends in the process. Telehealth and apps like FaceTime make it more convenient to include family members in the visit.