What to consider when choosing a treatment

Wade Smith, MD, as told by Cara Meyer Robinson

Being diagnosed with HER2-positive breast cancer can be scary at first, especially when you hear the words “aggressive cancer.” But there is reason to be optimistic about modern advances in treatment. There is no one-size-fits-all approach, but with the help of doctors, you can choose what is best for you.

Your 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 who has another form of breast cancer. It may also differ from the therapy of another HER2-positive patient.

Every cancer is unique, so doctors try to design the best course of treatment for you. Consideration should be given to the size of your tumor, whether it has metastasized (spread), or your overall risk of recurrence.

Treatments you may want to consider

The most common treatment for HER2-positive breast cancer is chemotherapy plus HER2-targeted therapy. Surgery is then performed, followed by HER2-targeted therapy. This is often best for patients with large tumors or cancer of the regional lymph nodes.

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

This is less common, but you may have surgery first, followed by chemotherapy and HER2-targeted therapy. Your doctor may choose this sequence if you have a small tumor that is not in the lymph nodes.

Your doctor may also recommend endocrine therapy. This treatment involves taking pills daily for at least 5 years after completing chemotherapy and surgery.

Pros and cons

Each treatment has pros and cons, and you may be a candidate for some treatments but not others.

Here’s what to consider:

  • Chemotherapy is very effective, but is known to cause side effects during and after treatment. These side effects vary in type and severity depending on the drug prescribed. The most common side effects are hair loss, nausea, and vomiting.
  • Chemotherapy and drugs that target HER-2 are very effective together.
  • The advantage of trastuzumab (Herceptin) is that it is given intravenously (through an IV) and can usually be given at the same time as chemotherapy.
  • You cannot take trastuzumab (Herceptin) if you are pregnant.
  • You should not take trastuzumab (Herceptin) if you are breast-feeding or plan to breast-feed.
  • Trastuzumab (Herceptin) and related therapies that target HER2 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 treatments are covered by insurance. But if you’re feeling overwhelmed by coverage issues, get help.

One of the many benefits of receiving care at a top cancer care facility is that they can help you navigate the process.

Clinical trials

Even with all the available treatments we have, there is always more to learn. Clinical trials not only help us achieve scientific breakthroughs, they can also benefit patients.

Your doctor may recommend a clinical trial if they think you will respond best to a new treatment or combination of treatments. If your specialist recommends a clinical trial, this may be a good option for you.

Make sure you understand what the trial involves. 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, message boards, and social media. These resources may provide some support, but they may also contain incorrect 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 deal with your concerns.

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

Find a care team that specializes in your type of cancer. Highly specialized physician-scientists keep abreast of new treatment options, which is important because cancer is a complex disease.

Learn all you can about HER2-positive breast cancer and ask questions. You can write down questions before the meeting.

Take notes during the meeting 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 is being explained to you.

I also encourage patients to involve their families in decision-making. Technology gives us many good options to include family or friends in the process. Telehealth and apps like FaceTime make it more convenient to participate in visiting family members.

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