Expert: Claes-Gustaf Nordquist, M.D. - 12/30/2009

Question
My wife was diagnosed with HER-2 breast cancer 33 months ago with the following treatments bilateral mastectomy, 16-18 chemotherapy series through power port using Navalbene, Herceptin, and one other drug I cannot remember.  Radiation treatments on the surgical area were performed (35 daily treatments).  By month 30 all appeared to be going well, no loss of strength or balance, no weakness, nausea, loss of appetite or hair loss during all treatments and definite shrinking/elimination of metastic cancer lesions in her liver, a small spot in the right lung, and a small spot near her spine.  Beginning of month 31 she experienced a sudden onset of intense headaches and nausea prior to diagnosis of 7-8 metastic HER-3 lesions scattered throughout the brain.  The largest two lesions near the base of her brain were surgically removed (one near her brain stem but uninvolved; and a second between and beneath the two cerebellum hemispheres.  After surgical recovery, she received 15 full brain radiation treatments, and will be receiving MRIs on both her liver and on her brain during month 34 to determine current status.  She now has major hair loss facial swelling that is gradually subsiding after completion of steroids for brain pressure reduction, but is left with almost no energy, little gross body strength, gross coordination problems, and tremors in her hands.

I assume from the avoidance of the question by the health care professions that the probable prognosis is terminal unless there is some form of divine intervention.  Based on what I have described, would you anticipate that her anticipated life span will be measured in months or years?  

Answer
She has obviously a VERY aggressive cancer. HER-2 positive cancers usually are. Though her cancer seems to be more so than usual. It is also already a stage 4 cancer and those are at present incurable. Now any stage 4 cancer that has spread to the brain must be regarded as terminal since neither surgery nor radiation therapy & chemotherapy can eliminate all cancer cells there. So her cancer there will most probably return and since there are upper limits to how much radiation that can be given (and to how much surgery that can be done) treatment options are more limited with diminished chances of any positive result. It is hard to predict survival time with any precision but my estimate is that unfortunately her survival time most likely will be measured in months not years. I'm sorry I have nothing better to tell you!


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