What to consider when choosing a treatment

By Wade Smith, MD, as told to Kara Meyer Robinson

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

Your treatment is unique

HER2-positive breast cancer is different from other types of breast cancer, so your treatment will not necessarily be the same as that of another person with a different type of breast cancer. It may also be different from treating another HER2-positive patient.

Each type of cancer is unique, so doctors try to develop the course of treatment that is best for you. Things to consider include the size of your tumor, whether the cancer has metastasized (metastasized), 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, then continued with 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 group of drugs known as monoclonal antibodies. This includes trastuzumab (Herceptin), the first precision therapeutic drug of its kind approved by the Food and Drug Administration for HER2+ breast cancer.

It’s 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 birth control pills every day for at least 5 years after completing chemotherapy and surgery.

Pros and Cons

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

Here are some things to consider:

• Chemotherapy is very effective, but it is known to cause side effects during and after treatment. These side effects vary in type and severity based on the medication prescribed. The most common side effects are hair loss, nausea, and vomiting.
• Chemotherapy and HER-2-targeted agents are very effective together.
• The benefit of trastuzumab (Herceptin) is that it is given intravenously (through a vein) 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 plan to breastfeed, you should not take trastuzumab (Herceptin).
• Trastuzumab (Herceptin) and related HER2-mediated therapies may cause serious heart problems.

treatment cost

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 feel overwhelmed by coverage issues, ask for help.

One of the many benefits of receiving care from a top-class cancer treatment facility is that it can help you get through the process.

Clinical trials

Even with all the treatments we have available now, there is always more to discover. Not only do clinical trials help us make scientific progress, they may also benefit patients.

Your doctor may recommend a clinical trial if he or she thinks you will respond better 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 situation.

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

Talk to your doctor

It is very important that you are comfortable with your doctor and that you have a physician who listens to you and addresses your concerns.

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

Find a care team that specializes in your type of cancer. Specialist doctors and scientists are kept abreast of new treatment options, which is important because cancer is complex.

Find out what you can about HER2-positive breast cancer and ask questions. You may want to write down questions before your appointment.

During your appointment, take notes 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 being explained.

I also recommend that patients involve their families in the decision-making. Technology gives us a lot of good options to include family or friends in the process. Telehealth and apps like FaceTime make it more convenient for family members to share a visit.