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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Have Invasive Lobular Cancer With Sentinel Node Metastic Carcinoma. Radical Mastectomy. Help?

I have had a modified radical mastectomy plus a simple mastectomy for invasive lobular cancer - grade iii stage ii with sentinel node metastatic carcinoma at 76 years of age. I have an ECG that shows (when compared to an ECG in 1998) the presence of an anteroseptal infarction . Should the Class I, II or III chemotherapy agents even be considered in my situation? I am not interested in contributing to statistical longevity but in quality of life. The tumor is ER+, PR+, HER-2 CISH amplified 9 and oncotype DX score of 29. Should the silver bullet herceptin even be considered?
Mon, 25 Mar 2013
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Oncologist,  's  Response
Hi
Thanks for writing in.

Because of your age, cardiac disease and emphasis on quality of life, I would not recommend chemo for you. However I would strongly recommend endocrine therapy with aromatase inhibitor (anastrozole, letrozole or exemestane) for 5 years as these are the mainstay of therapy in lobular carcinoma at your age. Herceptin may be considered but only if the cardiac ejection fraction on echocardiography is fine and that too with very careful cardiac monitoring during therapy.

Best Wishes,
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Have Invasive Lobular Cancer With Sentinel Node Metastic Carcinoma. Radical Mastectomy. Help?

Hi Thanks for writing in. Because of your age, cardiac disease and emphasis on quality of life, I would not recommend chemo for you. However I would strongly recommend endocrine therapy with aromatase inhibitor (anastrozole, letrozole or exemestane) for 5 years as these are the mainstay of therapy in lobular carcinoma at your age. Herceptin may be considered but only if the cardiac ejection fraction on echocardiography is fine and that too with very careful cardiac monitoring during therapy. Best Wishes,