What to consider when choosing treatment

By Wade Smith, MD, as reported to Kara Mayer Robinson

Being diagnosed with HER2-positive breast cancer can be daunting at first, especially when you hear the words “aggressive cancer.” But there’s reason to be optimistic given today’s advances in treatment. There’s no one-size-fits-all approach, but with the help of your doctors, you can decide what’s best for you.

Your treatment is unique

HER2-positive breast cancer is different from other types of breast cancer, so your treatment won’t necessarily be the same as someone else who has a different type of breast cancer. It can also differ from the therapy of another HER2-positive patient.

Every cancer is unique, so doctors try to develop the course of treatment that works best for you. Things to consider are the size of your tumor, whether the cancer has metastasized (spread), or your overall risk of recurrence.

Treatments you may consider

The most common treatment for HER2-positive breast cancer is chemotherapy plus HER2-targeted therapy. This is followed by surgery and then HER2-targeted therapy. This is often best for patients with large tumors or cancer in regional lymph nodes.

For targeted therapy, your doctor may recommend a family of drugs commonly known as monoclonal antibodies. These include trastuzumab (Herceptin), the first precision therapy drug in its class to be approved by the FDA for HER2+ breast cancer.

It’s less common, but you can have surgery first, followed by chemotherapy and HER2-targeted therapy. Your doctor may choose this sequence if you have a small tumor that isn’t in your lymph nodes.

Your doctor may also recommend endocrine therapy. This treatment involves taking a daily pill for at least 5 years after the completion of chemotherapy and surgery.

Advantages and disadvantages

Each treatment has advantages and disadvantages, and you may be a candidate for some types of treatment but not for others.

Here are some things to consider:

• Chemotherapy is highly effective, but it is known to cause side effects during and after treatment. These side effects vary in type and severity depending on the medication prescribed. The most common side effects are hair loss, nausea and vomiting.
• Chemotherapy and drugs targeting HER2 are highly effective together.
• An advantage of trastuzumab (Herceptin) is that it is given intravenously (via an IV) and can usually be given at the same time as chemotherapy.
• If you are pregnant, you cannot take trastuzumab (Herceptin).
• If you are breastfeeding or planning to breastfeed, you should not take trastuzumab (Herceptin).
• Trastuzumab (Herceptin) and related therapies targeting HER2 can cause serious heart problems.

treatment costs

If you’re concerned about the cost of your care, talk to your care team. Most approved cancer therapies are covered by health insurance. But if you’re feeling overwhelmed by coverage issues, ask for help.

One of the many benefits of receiving care from a high-level institution that specializes in cancer is that they can help you navigate the process.

Clinical Trials

Despite all the therapies available that we have now, there is always more to discover. Clinical trials not only help us make scientific advances, they can also benefit patients.

Your doctor may recommend a clinical trial if they think you are responding 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 study entails. Talk to your care team.

Use reliable information

Always ask questions of your care team and focus the conversation on your specific case.

Remember that your diagnosis is unique. Be careful when reading advice from online discussion groups, bulletin boards, and social media. These resources may offer some assistance, but they may also contain untrue or outdated information.

Talk to your doctor

It is very important that you feel comfortable with your doctor and that you have a doctor who will listen to you and address your concerns.

I recommend going to a research-based cancer center for treatment, a second opinion, or both.

Find a treatment team that specializes in your type of cancer. Highly specialized medical professionals and scientists keep abreast of new treatment options, which is important as cancer is complex.

Learn about HER2-positive breast cancer and ask questions. You may want to write down questions before your appointment.

Take notes during your appointment 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 that’s being explained.

I also recommend that patients involve their families in their decision-making. Technology gives us many good opportunities to involve family or friends in the process. Both telemedicine and apps like FaceTime make it more convenient to include family members in a visit.