Early-stage breast cancer, HER2-positive, Subcentimeter tumors, T1aN0M0, Very small tumors

Doctor Interviews

Doctor interviews are much easier to understand than reading medical trial reports or retrospective studies. A few interviews I found to be helpful are linked on this page.

Dr. Edward Romond helped run some of the trials for trastuzumab before FDA approval. Here is what he says about adjuvant treatment for most T1a tumors, emphasis mine:

“The guidelines indicate that for node-negative, T1a and T1b tumors, chemotherapy plus trastuzumab can be considered. But we discuss with our patients who clearly have T1a cancers whether risk for distant recurrence approaching 1% is worth a year of treatment.”

Read more from Dr. Romond’s interview on small and very small tumors from December 2016 here: http://www.ascopost.com/issues/december-10-2016/treatment-of-early-her2-positive-breast-cancer-one-size-does-not-fit-all/

Usually when a doctor says “de-escalation” of treatment, that means to ease the dose or duration of heavy drugs like chemotherapy. Dr. Sara Hurvitz says this strategy is gaining popularity, and she talks about that in a March 2018 interview, although she does not specify what she means by “small” tumors: http://www.cancernetwork.com/mbcc/management-early-stage-her2-positive-breast-cancer

De-escalation was a hot topic at the Annual ASCO meeting in 2018, but again, “very small” tumors were not specifically addressed: https://am.asco.org/progress-and-considerations-de-escalating-therapy-her2-positive-breast-cancer

The emphasis is mine on this next quote: “This is the first large study to demonstrate that the smallest lymph node-negative HER2-positive breast cancers have a very low chance of returning,” said Lou Fehrenbacher, MD, medical director of Kaiser Permanente Oncology Clinical Trials. This statement is part of a trade journal article that you can read here: https://bit.ly/2Lp2nZ6 (the full retrospective report the doctor is talking about is here: http://ascopubs.org/doi/full/10.1200/JCO.2013.52.0858 — and you can see that link plus others like it on the Retrospective Studies page.)

And one doctor specifically talked about tumors that are just 1 millimeter to five millimeters in size. Here’s what Dr. Patrick Borgen, director of the Breast Center at Maimonides Medical Center, said in an interview on Oncology Live (emphasis mine):

“One of the questions that comes up with HER2-positive breast cancers, is at what size in the node-negative setting do we think about HER2 blockade? Would you do it for a 1mm invasive cancer? Probably not. 5 mm? Maybe. 7mm or 8mm? Yes, absolutely.”

A link to that interview with Dr. Borgen is here: https://www.onclive.com/web-exclusives/expert-emphasizes-importance-of-neoadjuvant-therapy-in-her2-breast-cancer (sign up for that website is required, or try searching the title of the page on Google to get the web cache: “Expert emphasizes importance of neoadjuvant therapy in HER2+ breast cancer”



The information contained in this blog is not intended to be used for medical diagnosis or treatment. It should not be used in place of the advice of your doctor or other qualified health care provider.
















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