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

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.

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

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!