Is it harder to treat ER/PR+ with Her2?

[Cathya]

I have been working on a plan for myself which involves taking Arimidex daily (for the ER/PR+), supplements, herceptin and having tumor markers taken just before each herceptin treatment. In this way I hope to be able to catch any cancer growth early on and fight it into submission. However, while herceptin aided with supplements can control the her2 side of things, the hormones could be feeding the cancer on the other side of things. Then today I read about brain mets for her2 types and how they are a real threat as herceptin doesn't cross the blood/brain barrier. It seems to me that the hormone negatives would be better off in this case than the hormone positives. I am happy for all the hormone negatives but wondering how to take the hormone +ivty into my action plan. Yes, supplements and arimidex but what markers, etc. plus how do you cut out more hormones especially post menapausal??

Best regards to all,

Cathya

[karenann]

I read an article and I can't find it now that said er/pr- cancer is a more aggressive cancer in general and tends to spread to the brain, so I don't know if when it is combined with her2 it would also spreads more easily (than er/pr+) to the brain or not. Anybody know?

Karen

[Becky]

I cannot answer if hormone positive Her2 mediated cancer spreads to the brain any differently than being negative but I can make some comments. I keep up with this because I am ER positive (but PR negative). Being hormone positive is a good thing. It is good because there is medication to stop and slow cancer cells that are hormone positive (the aromatase inhibitors - like Arimidex, Aromosin and Femara as well as Tamoxifen). In conjunction with Herceptin, you are blocking at least 2 known growth pathways (3 if you are also progesterone positive which most are if they are ER positive). This is a very good thing.


Secondly, the (anti) hormonal drugs DO cross the blood brain barrier and that is a good thing too so there is some protection that being hormone negative does not have.

The Arimidex itself can take your hormone levels to almost non existant if you are postmenopausal (you can't take this drug if you are premenopausal anyway). Some ways to get your estrogen as low as it can go include:

1. be at a normal or below normal body weight
2. exercise
3. eat a high fiber diet (because bowel movements trap excess estrogen in the colon and if you "go" more often, it carries estrogen (and carcinogens) out of the body before they can be re-absorbed).

Lastly, be cautious about soy and flaxseed (but not the oil). You can eat a couple of servings a week of them (I do of flaxseed) but don't have several servings per day of each of them (they contain phytoestrogens and there isn't enough data on whether they are good or bad for women who already have breast cancer that is hormone positive. There is some minor information that it can be preventative).

So, even though many Her2 + women are hormone negative, it is a much better prognostic factor to be hormone positive.

I am sure you have read many of RB's posts on balancing the Omega 3s and 6s. I am a firm believer in this as it modifies the inflamation factors that are fed by the Cox 2 pathway (which also is relative to the cholestrol and insulin factor pathways) so... eat fatty fish, walnuts, flaxseed & oil (the seed in moderation due to being hormone positive - you can boost this with fish oil tablets) and use only olive oil as your fat. Watch all processed foods big time. Take an extra vitamin D and one whole aspirin (or ibuprofen if you can't take aspirin) as a Cox 2 inhibitor. Get walking and breath in the new Spring air.

Also, it is well documented that Her2 + disease that is also hormone positive is not as aggressive as hormone negative disease (but this is a general statement and every one of us is an individual - with breast cancer so... I think you get my point).

I hope I have helped.

Warm regards

Becky

[RhondaH]

I'm SO glad you made the above point:

"3. eat a high fiber diet (because bowel movements trap excess estrogen in the colon and if you "go" more often, it carries estrogen (and carcinogens) out of the body before they can be re-absorbed)."

and it makes SO much sense. I was thinking the other day how I used to have problems when I was younger ( I didn't have period pain, I had constipation at one point I would only go once a week...now THATS pain) which, as you said, "logically" would keep the "toxins" in the body longer and able to cause more damage...hmmm. I won't get into my current "bathroom visits", but I can tell even if I eat ONE thing off my diet, I am SOOOO regular, but you know the diet I do and that would explain it:) Take care and God bless.

Rhonda

[Unregistered]

Becky;

This IS very helpful to me. I didn't realize that Arimidex crossed the blood brain barrier. Do you know how Arimidex works? I have wondered why it is the same little pill regardless of weight and was told it is the activation...but I don't understand that?

Thanks so much,

Cathya

[karenann]

Becky,

Is it all of the aromatase inhibitors that cross the blood brain barrier or just Arimidex? This is very exciting!

Karen

[Becky]

First, I will explain how aromatase inhibitors (Arimidex, Femara and Aromosin) work and how Tamoxifen works. Although all do cross the blood brain barrier, it is more important that Tamoxifen does and I will explain why (IMHO) below.



Aromatase inhibitors (Ais) work by preventing the conversion of androgens to estrogen by the catalyst aromatase. Androgens are made after menopause by the adrenal glands and adipose tissue (fat – this is why I stated to be at a normal or below normal body weight). It is NOT important that aromatase inhibitors cross the blood brain barrier (but they do) because they are effective because they prevent the production of estrogen. No estrogen, no binding to the estrogen receptor – no growth and reproduction of cancer cells.



Tamoxifen works (much like Herceptin’s mechanism) by binding to the estrogen receptor (whereas Herceptin binds to the Her2 receptor). Since tamoxifen is bound there, then estrogen cannot bind there and excite the cell to grow and reproduce. It is much more important that tamoxifen be able to cross the blood brain barrier because if there is a cancer cell in the brain, you need tamoxifen to get there and bind to those receptors. In the case of aromatase inhibitors – they just make sure there is no estrogen being made to be able to bind to the receptor. I hope I have made this part clear.



Please be aware that there are many studies showing that aromatase inhibitors work better than tamoxifen overall no matter what your Her2 status is (although you can only take an AI if you are postmenopausal) and that AI’s are better than tamoxifen especially if you are:


Her2 positive or progesterone negative (but naturally estrogen positive or else you wouldn’t need to take one).

As far as the amount of medication being the same, I am not 100% sure of the answer but I do know that there were many trials on how much Arimidex to give and they found that the dose we all get is optimum. They did the trial going up to 10X that dose and it was not beneficial at all and caused lots of side effects (I read this one and will look for it).



Hopefully I have helped out.



Warm regards



Becky

[DeborahNC]

How does this work for those of us who are only weakly ER+/PR-? My onc has suggested an AI when I am done with Herceptin (which will make my one year of no periods, menopausal). I am very concerned about brain mets.

Deborah in NC