Local Recurrence on mastectomy site - HER2 + - choosing treatment options


I am 48. I was diagnosed with IDC in 08/2011. 2cm tumor, ER+ PR+ HER2+. With a close margin. I went through 6 * (Abbraxane + carboplatin + herceptin), 1/3wks. Then I finished 12 * Herceptin. 1/3wks. and Tamoxifen.

12/2013, I found a 1cm local recurrence ER+ PR - HER 2+. My oncologist plans to give me Adriamycin + Cytoxan, and Lapatinib and pertuzumab for HER2. 

I read information on AC on the web and found information on side effects on heart several years after treatment, on the mouth, etc. Could Someone that have gone through AC long time ago, please let me know whether the medication have long term side effects on heart years afterwards?

Another oncologist suggest that I use Abbraxane again for 6 treatments, and also use herceptin + peyeta for HER2. He is also planning to put me menapause.

I am wondering which course I should go about. Any suggestions?


  • RozHopkins
    RozHopkins Member Posts: 578 Member

    I have jaw bone disease which was caused by or made worse by chemo and 2 and a half years of Tamoxifen followed by six month of drugs to kill off ovaries.  Signs of this is aching in the jaw, cheeks and teeth, ears, sensitive teeth.  Dentists don't always pick it up and give you route canals, when the pain still exists in the tooth after route canal then it is a TMJ problem or jaw bone disease.  I don't know about the heart.

  • 2ndxyvonne
    2ndxyvonne Member Posts: 41
    same dx

    I had idc stage 1b in 2008 1 cm tumor 1/9 mets to lymph glands.  I had modified rad mx, left side.  It was ER+pr-HER2+.  This past October I had another lump in the axillary area, back by underarm, biopsied, scan, now I have mets.  Mine is ER+PR-HER2+ again.  They are treating me with 15 weeks of taxol, every 3 weeks I get Perjeta, herceptin and taxol.  I'll be getting the Herceptin and perjeta ongoing after I finish the taxol.  I am tolerating it very well.  My oncologist went to some breast cancer conference in December and this is what they recommend for treatment for me.  I am post-menopausal (1998) but I'm still making estrogen so they got to keep that in check.  They tried taxotere but I was allergic to it, had only one treatment of that stuff.  Not saying this is right for you, just that I have almost the same dx so, you might ask your onco.  Hopefully, you don't have the mets.  I am stage 4 so that might have something to do with the treatment option.  I get 15 treatments because she is using a smaller dose to cut down on side effects.  I have read the herceptin can harm your heart. But I go every 3 months for an echocardiagram,  had one before I started any chemo.   Ask your drs. and do research on this site. I am 63, was first dx at 58.

  • CypressCynthia
    CypressCynthia Member Posts: 4,014 Member
    First, I am so sorry about

    First, I am so sorry about your recurrence.  Cancer sucks!  I am truly sorry you are battling it again. Frown

    I don't have a good answer for you.  You can get a 3rd opinion (and I think I personally might) with the oncologist's having such different opnions.  I love my oncologist, but, when I get nervous, I always seek another opinion and my onc always seems fine with this.  You will probably get another suggested chemo regimen, maybe even two.  It can all be so confusing, can't it? My oncologist says if you ask 3 oncologists about what chemo regimen to use, you will get at least 4 suggested regimens...lol. 

    Here is my story: My original tumor (Stage 3) was ER + PR + her2 unknown (No testing in 1987).  I had mastectomy, chemo (cytoxan, methotrexate and 5FU), rads and 7 years of tamoxifen.  Long remssion of 18 years, then mets to lung and bones.  Bone biopsy ER + PR neg Her2 neg, so then I had arimidex (later faslodex) and xgeva.

    Last year, I had liver mets and it was ER neg PR neg and Her2 +.  Weird huh?  I was put on docetaxel, herceptin and pertuzumab for 6 treatments and I am now on herceptin and pertuzumab indefinitely.  The good news now is that I am back in remission - scans look really good.

    I originally took cytoxan and had no problems except a "sterile cystitis" (like a bladder infection but can be dangerous) - for that I skipped one month of cytoxan. 

    With my liver biopsy, my onc insisted that I have Caris molecular testing.  I don't know if you had this? I had to fight my insurance company to cover this, but they finally did.  The nicest thing about this testing is they send you a summary of potential agents with potential benefit as well as those with potential lack of benefit.  It is not too late to send a biopsy as they usually almost always have saved specimens.  http://www.carislifesciences.com/oncology-molecular-intelligence

    Adriamycin is fairly cardiotoxic and the effects can be long lasting. I have never taken adriamycin.  However, Stage 4 cancer is even scarier (which I have now been battling for 8 years) to me than adriamycin.  Herceptin can also be hard on the heart, but if monitored carefully (muga or echo) and stopped at any sign of trouble, the effects are usually reversible

    "Heart problems, like cardiomyopathy (enlarged, weakened heart) and congestive heart failure, have been linked to the use of doxorubicin and epirubicin, and to the use of trastuzumab [37-38]. (Learn more about trastuzumab.) These conditions can sometimes be reversed if the drugs are stopped at the first sign of heart damage [38].  

    For some chemotherapy drugs extra care is taken. For example, before you begin chemotherapy with the drug doxorubicin, your heart function will be measured to make sure there are no pre-existing heart problems."  http://ww5.komen.org/BreastCancer/LongTermSideEffectsofChemotherapy.html

    What it all finally comes down to is trust.  Finally, you have to decide who you trust the most.  At that point, I let it go and say a prayer. 

    Best of luck to you and keep us posted.  And welcome to the message board no one wants to be a member of.  Big (((hugs))) and prayers!

  • joanwayne
    joanwayne Member Posts: 10
    It definitely

    affected my heart, they did a scan prior to each treatment to measure the damage.