Is there more than one kind of her2+ breast cancer

[Lani]

ie do those that are er+ behave differently than those that are er- (perhaps with careful testing/observation there are even more types):



Citation: European Journal of Cancer Supplements Volume 4, No. 2, March 2006, page 164

S. Paluch-Shimon1, R. Catane1, N. Ben-Baruch2, L. Zach1, J. Kopolovic1, A. Kruglikova2, T. Modiano1, I. Wolf1, A. Yosepovich1, B. Kaufman1

1Sheba Medical Centre, Tel Hashomer, Israel
2Kaplan Medical Centre, Rechovot, Israel

Background: HER2/neu over-expression (HER2+) occurs in approximately 25% of breast cancers and is often associated with a more aggressive disease. In this study we examined the effects of hormone receptor (HR) expression on clinical characteristics and natural history in HER2+ breast cancer.
Methods: A retrospective review of 137 patients (pts) with HER2+, metastatic, breast cancer was performed. HER2+ was defined as positive if immunohistochemical staining was +3 or if FISH was positive. HR was defined as positive if either estrogen or progesterone receptors staining were positive, regardless of intensity.
Results: Median age was 48 (range 24–80). At the time of diagnosis 60% were 50 years old or younger. The vast majority (92%) had invasive ductal carcinoma and 70% had grade III disease. Positive HR staining was found in 55 (40%) of the pts and negative HR staining in 82 (60%). No significant differences between the study groups were found in age, tumor histology, grade and number of involved metastatic sites at time of first recurrence.
At first recurrence, HR positive (HR+) pts had significantly lower rates of liver or brain metastasis compared to HR negative (HR-) pts (23% vs. 48%, respectively, p = 0.004) but significantly higher rates of soft tissue, bone or lung metastasis (93% vs. 74%, respectively, p = 0.006). Overall thru-ought the course of the disease, 96% of the HR+ pts developed soft tissue, bone or lung metastasis, compared with 85% in the HR- group (p = 0.043), and 50% developed liver or brain metastasis compared with 72% in the HR- group (p = 0.012).The mean disease free interval in the HR+ group was 24.5 months, compared to 15.4 months in the HR- group (p = 0.023). The mean overall survival was 101.4 months in the HR+ group, compared to 63.8 months in the HR- group (p = 0.015).
Conclusions: Compared to HER2+ HR+ breast cancer patients, patients with HER2+ HR- disease have a greater propensity for liver and CNS involvement and a markedly shorter disease free interval and reduced overall survival. These results suggest that metastatic breast cancer with HER2/neu over-expression is a heterogeneous disease, with HER2+, HR positive tumors, having a distinct and favorable biological nature compared with HER2+, HR negative tumors.

[Unregistered]

Gloomy stats.

Types is not a subject I have directly followed in my wanders but from what I have seen;

1. Cancer is essentially a highly individual disease.( yes there are fixed elements mutations etc. but it appears that 90% are environmental triggers of some sort - given our different lifestyles and the impact of lots of small factors on the body why should the manifestations be sublty different AND change in reponse to continuing environemantal change drugs diet etc - which from what I read we are begining to see)

2. Cross talk occurs between HER1 and HER2 (and why not 3 and 4)

3. Females seem to have greater adaptability in genetic terms. A trial that produced a genetic variation that was fatal to males saw some females surviving (to between the lines the surprise of the reporters). The flip side of which might be the ability under "environmental" stress to start randomly producing new pathways etc which for the vast vast majority will equal disease.

4. Changes in prognosis of type have been obeserved both between local recurrences and distant occurence.


Lani you are a one woman information source at the moment. 10/10 for quality and effort.

RB

[Becky]

In the 2006 European BC Symposium, there is a link to an article on a study that looked at the differences between Her2+ disease that was hormone negative versus hormone positive. Likewise, there was another study that looked at the difference between hormone positive breast cancer that was her2 + versus Her2-.


What they found is that Her2 disease is very different depending on hormonal status. Therefore, they view them as different diseases. If you add on top of that someone's Her1 or VEGF status (among dozens of other marker combinations), we truly each have our own unique disease going on.

Truly there are dozens of combinations of interactive events that revolve around the cancer cell (that are awry). It is so interesting and complex. One day, it will be well understood in terms of prevention and hopefully a long lasting cure.

Becky

[Unregistered]

Re Stats.

I wonder if trials were conducted in Israel. It would be interesting to see the equivalent Japanese and say Italian figures.

Israel is reported as having high intake of polyunsaturates, and the surprising result of lack of cardiac protection and from memory worse heart figures.

On the grounds that there it is established that there is a connection between omega 3 and HER, and omega six is accepted to promote inflamation, and these are a factor in cardiac health are these Israeli figures worse than might be expected elsewhere?

( the trialists refered to above were long suffering mice in case any body was wondering - sorry I should have included that fact)


RB