IHC2+/FISH+ (amplification 2.71)

[mcgle]

This is my first posting, so here goes...

Had a quadrantectomy in November 2005 and have only just received my path report! Until this arrived, I believed my prognosis (http://www.breastcancercare.org.uk/content.php?page_id=2445) was good (small tumour, clear margins, no lymph node involvement or vascular invasion.) Now I’m not so sure as finally know that I am HER2+ (scored 2+ on the IHC test and tested positive on the FISH test.) Actually, ‘FISH yielded amplification 2.71.’ Does anyone know what this means?

I now know that my DCIS was high grade, which is why a grade 2 tumour escaped. But I truly was not expecting to be in any way positive for HER2.

Am strongly positive for ER (8/8) but weaker for PR (6/8), so should be receptive to tamoxifen. However, I have read that being HER2+ might lessen the effectiveness of this drug, so am worried about this, too.

In addition, I was not prescribed chemo, just radiotherapy, so would not have been a candidate for herceptin, even if it was available for early stage bc. And is the cancer more likely to come back being HER2+?

Can anyone offer any advice? Not going to see my onc till the middle of May, so am in ‘Limboland’ once again, and the emotional rollercoaster ride continues…

Thanks for reading this.

Mcgle

PS I see that some of you ladies post as being HER+++. Don’t quite understand what the pluses mean. I thought you were either positive or negative.

[sadie]

Her2 comes in different grades. Her2+++ being the highest grade.
I was Her2+++ on the biopsy; But was Her++ on the lumpectomy.
I don't know why the difference.
I got my path report from the biopsy from my onc, but they did not include the path report from the lumpectomy. I have to ask for it again.
My stats:
dx Oct 2005 DCIS;1cm; sentinole node negative; ER+ / PR weakly+; HER2+++
Grade 3
Herceptin IS available for early bc patients.
I received Adriamyacin & Cytoxin 4 rounds (1 every 3 wks).
I just now finished my 9th round out of 12 of Herceptin/Taxol combo.
I will then get 6 weeks radiation & will continue the Herceptin every 3 weeks until Feb '07.
The cutoff for getting Herceptin was 1cm; I was borderline & made the choice to get it. Because of the success rate with Herceiptin, they were considering making the cutoff/borderline .5cm;
I don't know if that final decision was made yet.
If you were .5cm or more, you should speak to your onc about receiving Herceptin.
I hope I answered a couple of your questions; I am still quite new to all of the too.
Sadie

[mcgle]

Thanks for replying so quickly, Sadie.

I live in the UK, where herceptin is only licenced for metastatic spread!

Since I don’t meet the criteria, I won’t get it. But I’m wondering whether I actually need it with an IHC (2) result and a 2.71 FISH result, which I believe is weakly positive. All other factors are favourable and I am four years post menopause.

Tried to speak to an onc today, but he did not ring back. Am feeling quite distressed about all of this, as they should have known my results before giving me a treatment plan.

Ah, well…

Mcgle

<O:p

[kat in the delta]

Hi,
My ICH test was positive--My surgeon said that it is done by the human eye looking to see if the biopsy was partially stained++/ or heavily stained=+++. She told my that there was about a 2 percent chance that it could be read wrong, and told me to be sure I was 3+ on the FISH before the Herceptin would help me. I was +++ on both tests, and my tumor was a little over 4.5 cm with 3 positive lymph nodes(didn't know the lymph nodes were also rated). I had 4 weekly A/C treatments, followed by 12 of each Taxol and 12 Herceptins, weekly, adn radiation.
I am still taking a stronger dose of Herceptin every 3 wks for at least another 10 months or longer. My Heart muscle is checked every 3 months, as Herceptin can possibly damage it.
I am trying to NOT feel like a patient anymore, since this a like an adjuvant drug----- like some Breasts cancer survivors are on Tamoxifen, aromasin(sp?), but it is very hard to get it out of my mind.---Kat in the delta

[mcgle]

Sorry to read you have had such a rotten time of it. And I know exactly what you mean about it occupying your mind endlessly.
<O:p</O:p

Here in the UK, FISH is scored either positive or negative, so I don’t know what your FISH +++ means. My FISH score is amplified by 2.71, but I still do not really know whether this is serious or not.


Mcgle
<O:p</O:p

[mcgle]

I have also read that the HER2 gene can be either active or inactive, and there is a test for this. But what puzzles a layman like me is that if the tumour is found to be overexpressing the protein, then surely it must be active!<O:p</O:p

Mcgle<O:p</O:p

[sadie]

Kat,
I,too, am having a hard time dealing with being so close to end of the chemo part of my treatment. Even tho I still have 6 wks of radiation to go thru and Herceptin thru Feb '07, I am nervous about that "microscopic" bit of cancer that may have gotten loose before I started treatment. I talked with my onc about it, and she said almost everyone feels that way at the end of chemo. She said I have to re-train my thinking to live life like I did before all of this started.
I know it's silly, but everytime I start feeling "free", I am afraid that I am letting my guard down and it will come back. I feel like I'm afraid to let myself be happy again because I might get shot-down.
My onc assures me that she believes everything is gone. She said nothing is written in stone, but she would be shocked if I were to have to come back in the future. I'm trying my best to erase the "c" word from my brain, but it's very difficult. It sure would be nice not to think about it on an almost minute by minute basis for a change. I'm trying my best for now.
Good Luck to You.
Sadie

[sadie]

MCGLE,
From what my surgeon and onc told me, the HER2 gene is active in the CURRENT cancer; It does not mean that you have HER2+ cells thru out your body.
The Herceptin is given to kill off any other active cells that may have escaped to somewhere else from that current cancer. They both told me that IF I did happen to get a NEW cancer in the future, it will not necessarily be HER2 positive.
I've never read anything about any of this, but this is what both my surgeon & onc told me.
Sadie

[mcgle]

You may have heard about an HER2+ victim here in the UK (Anne Marie Rogers) being refused herceptin for early stage breast cancer.
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Well, yesterday, there was a court ruling in her favour, so I suspect that women will now be able to get herceptin, if their clinician deems it necessary!<O:p< font O:p<>

My multidisciplinary team are going to investigate my case, as they were not expecting a positive result. So the waiting continues.<O:p< font O:p<>

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Mcgle


PS Thanks, Sadie, for that extra bit of information.<o:p></o:p>

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[mcgle]

Ladies

I had some good news on Thursday. Realising how distraught I was about the FISH positive result, my onc has consulted with an expert in this field and things do not seem nearly so bad now. The benefit of herceptin for me would be negligible, so he would not be recommending it. He also re-evaluated my survival odds (given all the other good prognostic indicators) and there has only been a minor change here. And let’s face it, life is a gamble anyway...

I think it was really good of him to go out of his way to get me this information, especially with Easter looming. Now I just need to accept my situation and get on with life. But it is good to know when we are distressed by news like this, that our concerns are taken seriously. And oncs, surgeons, nurses are only human after all, and must be used to reactions like mine!

Having researched FISH, I think my level of amplification may be relatively low. Apparently, the path people will be ringing me to explain this in due course. You can't ask fairer than that.

So really, I think I have been treated very well and pretty quickly.

Perhaps I can now relax a bit!

Happy Easter to you both.

Mcgle