HER2

January 12, 2015

My world got rocked today.

My medical oncologist asked for an appointment, which was today.  I thought it was to discuss my HER2+ status more in depth, and I thought it was just to confirm that I’d need to have Herceptin for a year.  Well, the appointment was to discuss my HER2+ status more in depth, that’s for sure!

Dr. Priya would like to start with neoadjuvant therapy, aka start with chemo first. Surgery would then be after chemo, followed by radiation.  In a previous post I’d mentioned that I wanted to know if I was a candidate for Perjeta (pertuzumab)…well apparently I am.  Studies have shown that Perjeta before surgery is highly effective in treating 2 types of HER2+ cancers, and Perjeta has been approved for treatment before surgery. It has not yet been approved for therapy after surgery; while there’s nothing to say it’s not effective post surgery, because it hasn’t yet been approved for this, insurance won’t pay for it.  At $8000 per treatment, it’s not something I can afford out of pocket, so pre-surgery it is!

Having chemo before surgery will reduce the size of the tumor, which, if logic follows, means that during surgery less tissue will have to be removed.  Further logic follows that perhaps I won’t go from a C cup to a B cup, but maybe a C- or B+ instead!  🙂

What I did not realize is that because I’m HER2+, my chemo regimen is not 12 weeks, but 18 weeks.   Now I know some of you will think this crazy, but this change in my treatment plan actually is better for me at work.  We are in the middle of a huge database conversion and we go live on July 15; with this new plan, I will likely be done in June, and have some time to recover while we go live.  Because the tumor will be reduced, there’s not a huge urgency to have surgery, so I can honor my commitment to chair a conference in early August, then have surgery.  If I proceed with surgery on January 28, have a 6 week recovery, then 18 weeks of chemo, I’d not only miss critical times during conversion but perhaps would have to miss the August conference.

The chemo treatment plan is Perjeta plus TCH (as opposed to THC  🙂  ).  Taxotere (docetaxel), Carboplatin (paraplatin) and Herceptin (trastuzumab).  I had also misunderstood the Herceptin regimen:  while the treatment lasts 52 weeks, the infusions are every 3 weeks.  So I start the Herceptin along with the other chemo drugs, and I continue it while I recover from the other chemo, through surgery, through radiation.

There was discussion about whether there should be biopsy of the sentinel lymph node before I start chemo.  Dr. Priya says that current thinking, at least among medical oncologists, is that it’s not necessary; the chemo will reduce anything in the lymph node as well, and the lymph node will be removed during surgery anyway.  In my case, the MRI showed nothing in the lymph node, which Dr. Ching did not mention (or I forgot), so it’s especially true that I won’t need surgery to remove the lymph node before chemo.  I’m pleased to know that nothing showed up in my lymph nodes on the MRI; chances are that my cancer is Stage 1 with this news.  Pure speculation on my part, but considering the factors which decide stage, that’s what I’m going believe.

It’s all good, right?  I mean, no matter what I need 18 weeks of chemo, so I might as well have it first.  So why was my world rocked?  The way I’m able to deal with this whole cancer thing is to break it down into goals or milestones.  I was completely focused on getting through the surgery first, then I’d move onto chemo, and then onto radiation. I’m goal-oriented, and it helped me to think of my treatment plan this way.  Flipping chemo and surgery was just something to which I needed to adjust.  Now that I have, I’m good!

December 31, 2014

Happy New Year’s Eve!

I had a consult with Dr. Lundahl, the radiation oncologist yesterday, but couldn’t post because we went from the appointment to the Foster Farms San Francisco Bowl game. Despite the chilly temps, Stanford played very well and was victorious, so it was worth braving what for us were freezing temps.

Dr. Lundahl has a dry sense of humor, which I love.  His first words were that no, you won’t be radioactive during treatment.  He must get this question a lot!  He explained that they’d be irradiating the entire breast from 2 directions, that radiation therapy is 1-2 weeks after I finish general chemo (not the targeted therapy of Herceptin), and that the treatment will likely run 5-6 weeks.  Treatment is 5 days a week for those 5-6 weeks, but each treatment is only 30 minutes or so.  Not much new information for me, but it was good to meet him.  He also said that Dr. Ching does a great job of not being overly aggressive in removing breast tissue.  One of the questions I had was since Dr. Ching is concerned about how close the tumor is to my skin and that she may not be able to get clear margins, whether that will have any affect on the treatment plan.  He didn’t think so, but did reiterate that if clear margins aren’t achieved, a second surgery is needed.

While I was tailgating before the bowl game, Dr. Priya called to see how I was doing, and asked that I call her back.  I called her back today, but she’s out until Monday.  I did talk to her nurse, who said that Dr. Priya actually wanted me to come back in to talk to her, probably about the HER2 positive diagnosis and how this will affect the chemo treatment.  The nurse will call me back next week after she’s had a chance to talk with Dr. Priya.

I’m also expecting a call from Dora, Dr. White’s surgery scheduler, to book pre-op appointments.  This is my life now, going from appointment to appointment.

These arrived the other day.  I have awesome friends.

and reminds me of this post I saw on Facebook the other day:  IMG_3092.2014-12-29_174435

I’ve only told a few people about my diagnosis at this point, but everyone has been amazing. Thank you, Julie & Kelsey, for the beautiful flowers.  Love you!

Enjoy your New Year’s celebrations – stay safe!