Rounds with the Investigators 2012 | Breast Cancer

DR NEIL LOVE: We got a couple of cases from an oncologist in a small town in Illinois, and both of the patients have — I’m not going to identify the insurance company, but apparently not very good insurance that this doc takes and nobody else does. But both patients, the lack of coverage actually affected the management. And they’re both young women that this physician is asking about, Sara. The first one’s 38. Again, difficult time, wasn’t able to get worked up because of the lack of insurance coverage.

In any event, the bottom line is when she finally did get worked up, very similar to what we just talked about, she had a 5-millimeter, ER-positive, HER2-positive FISH 5.7 ratio. And this physician was thinking about TCH, but I guess it kind of again gets back to the discussion we just had. But very strongly ER- and PR-positive, Sara — 5 millimeters. What would you be thinking?

DR SARA HURVITZ: I would use [the] TCH regimen. And I would try to get her to use tamoxifen in [the] adjuvant setting during the maintenance trastuzumab as long as possible, childbearing wishes set aside 5 years. But I think there’s very good preclinical evidence that, in HER2-driven tumor that has estrogen receptor expression, the estrogen pathway is less important. It’s less of a driving force, or it’s a secondary driving force to the HER2. So I would treat her for the HER2 positivity.