Why would one her2 positive woman be given just trastuzumab whilst another, with same size tumour/grade 2, be given Phesgo? I know I shouldn’t compare but can’t help it. I thought treatment was standard across the board in the UK. Also, are bone infusions a normal part of this treatment for primary her2 pos with no lymph node involvement? Thank you in advance!
Hello sarahfinchclarke, phesgo is only licenced to be given with chemo alongside. If patient refuses chemo, as in my case, they cannot have phesgo. I am now on trastuzumab monotherapy post surgery. Nb i was her2 pos at biopsy and her2 neg post op. There is a kind of flowchart for treatments and which route one is sent down depends on all sorts of factors. Love Tulip x
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Not saying @Tulip29 is wrong in why they are having trastuzumab and not Phesgo, but it can’t be the only reason. I am also having trastuzumab for 12 months, but have also had 4 doses of chemotherapy alongside.
I believe it is something to do with the number of HER2 receptors (or some similar measure). The MacMillan site talks about Phesgo binding to different sites of the HER2 protein so it will be given for some clear clinical reason.
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Thanks for the reply. I thought Trastuzumab was also only licensed for use alongside chemo? So much to know! Dreading the treatment but have been told it’s with curative intent so I hope so! Good luck to you going forward 
Thank you. I will ask at my next appt. I guess everyone is different. I have 12 x weekly chemo plus Trastuzumab x 9 every 3 weeks. So, chemo for 3 months and Trastuzumab for 6 months.
Sorry if this is a long answer:
My understanding is that Phesgo and trastuzumab (and Herceptin) are different names for more or less the same drug with the difference being how they’re administered. I was told by my oncologist that Herceptin (which I had) had to be begun whilst having chemo (that is how it’s licensed), but could then be continued after chemo ended. So I had 3 lots with chemo then 15 injections after. I believe that dosage is much reduced now.
My cancer hadn’t affected my lymph nodes but was (obviously) HER2 positive.
I have bone infusions - could have had daily alendronic acid tablets but opted for 6 monthly infusions as felt I’d be less anxious than the daily pill. No side effects, fortunately, and my bone density has improved 4%. Bone infusions are to try and offset the effects of the anastrozole I’m on for 10 years. I had to have a tooth out last month and was concerned about the potential effects of the infusions on my jaw but all ok.
The things I have now learned about breast cancer, drugs and therapies - so wish I hadn’t had to learn…
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Thank you for your detailed answer. I understood that pertuzumab PLUS trazusumab are called Phesgo when given together? I am on trazusumab only (herceptin). Yes, so much to learn that we didn’t want to I agree. Have you started your bone infusions yet? Or is that when everything else is done?? 10 years?? Jeez… I’ve got 3 years and I thought that was bad. I hope you are doing okay?
Sorry, in my (too long!) answer, I wasn’t clear. I’m on anastrozole for possibly 10 years, not the bone infusions. 10 years on anastrozole is longer though so suggests my HER2 levels were high. I’m doing fine. I’ve had 5 bone infusions and due to have 6 or 8, I think. I’ve been absolutely fine on them-they’re doing their job.
I’m doing well. I still have my anxious moments-doesn’t everyone?- but try to remember the surgeon’s comment to me that ‘We’re all going to die but you’re not going to die of this’. Not sure I’m convinced that he could be so definite…
Hi Sarah
Thanks for posting.
Like you, many people wonder why they haven’t had the same treatment as others. However, treatment for breast cancer is tailored to the individual according to the features of their cancer and the risk of their breast cancer coming back.
As @JeanAnn says, Phesgo is the brand name for the combination of trastuzumab (Herceptin) and pertuzumab (Perjeta), which can be used in people who are prescribed both of these drugs for HER2 positive breast cancer.
Pertuzumab can be given after surgery along with trastuzumab to people with HER2-positive early breast cancer at high risk of their breast cancer coming back.
People who are given pertuzumab and trastuzumab or combined as Phesgo, will also receive chemotherapy.
Bone infusions (bisphosphonate drugs) can also be given to people as part of their treatment for primary breast cancer.
As you can read via the above link, bisphosphonates are usually prescribed for post-menopausal women who have had treatment for invasive breast cancer that has spread to the lymph nodes under the arm.
They may also be prescribed when women don’t have cancer in their lymph nodes when other factors increase the risk of cancer returning.
As you’ve said, it sounds as though it would be helpful for you to ask your treatment team to explain the reason why they haven’t recommended either pertuzumab in addition to trastuzumab or bisphosphonates for your situation.
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