Received a call from Dr. M on Tuesday and he started by saying that he should be hiring me (Ferit said it was a polite way of saying that I was too nosy) - I had sent a 5 page fax to Dr. M asking the following questions:
1. Why did they need to do a FISH test since my original IHC was .9 which
was not even close to borderline?
2. What is the relevance of FISH showing Equivocal on my treatment plan ?
3. Will I benefit from a second (or third look) at my individual situation,
particularly by a clinician expert in HER2 positive disease states.
4. Do equivocal results themselves merit Herceptin treatment under close
supervision, due to the known benefits of decrease in recurrence with this
monoclonal antibody?
5. Being ER/PR+ with equivocal HER2+ status is Herceptin treatment of merit?
(This point is driven by data suggesting ER+ status crosstalks with HER)
Here is what he said in a nutshell:
He is very confident in their HER2 expertise saying that they were one of the pioneers who worked with UCLA.
The tumors are not heterogeneous so different parts might show different results ( IHC showing HER-, whereas FISH showing Equivocal. The result is not very surprising and it happens a lot.
From these 2 test results apparently my HER+ is not established and is not highly positive.
Herceptins benefit is directly proportional to the degree of HER positivity so it will not be very beneficial for me.
Even if I was proven HER+ at this point my treatment plan would not change because the benefit I will gain from Herceptin will be greatly be offset and exceeded by the potential cardiac toxicity that a treatment containing Adriamycin topped by Herceptin could cause.
The chemo regimen I received Dose Dense 4 X AC and 4 X Taxol is a perfect chemo for a possible HER+ situation.
( here I have to thank him because I had wanted to drop the Taxol, since the research establishing the fact that HER- patients had not benefited from taxol was published at the beginning of my treatment, and he had not let me drop it )
He said if I wanted to I could still send the slides out to UCLA but I would need to think whether a different outcome will change my treatment plan ( probably not)
He also supported his view of removing my port during surgery ( the other oncologists usually want to leave it in for 2 years in case there is a recurrence)
- To leave the port in is a negative thought.
- The likelyhood of getting an infection or other complication related the port is higher than the risk of recurrence.
- I will be getting surgery anyways (getting the expanders replaced by silicone implants)
The radiation delay ( I will be starting radiation about 8 weeks after my last chemo) did not worry him for my situation either.
So he pretty much put my mind at ease which is what I desperately needed now. I am happy that I am able to believe him and trust his judgments.
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