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Lani · 09-16-2006, 08:24 AM

They have found (when looking at all breast cancers, not just her2neu+ breast cancers) that the peak of recurrence occurs x number of months (around 24 for her2+ and triple negative as Becky said,with another later "blip" peak of recurrence for those ER+her2-) after surgery NOT x number of months after the lump was discovered. In those who delayed after finding their lump or who were unable to get access to health care right away (this is a global disease) they found the peak occurred x number of months after the surgery even if the tumor had been there quite a long time before.

The thinking is that the surgery starts an inflammatory process and that the gene signature of breast cancer looks a lot like the gene signature of inflammation and that some of those growth factors etc let loose or stimulated by the act of surgery "start the clock ticking"

This is one reason why they are moving toward needle and core biopsies,
hoping to mimimize the inflammatory reaction by minimizing the surgery.
It is another reason why increased usage of preop MRIs to better define the extent of disease and minimize repeat operations to obtain better margins may improve cancer care in the future.

Noone it seems has studied whether the 1-5 day course of various types of accelerated partial breast irradiation produce more or less inflammatory cytokines but if/when the long term results of APBI come out, if they are better than conventional radiation this should be one avenue of research as to why.

It may be that breast cancer is indeed a stem cell disease and that the "tumors in waiting" are those slowly dividing cells in the bone marrow which get activated by inflammatory cytokines etc just like the mold in bathroom grout gets activated by moisture no matter how much you use Tilex or other bleach-containing compounds.

The group in Germany that has been advocating getting preop and post treatment bone marrow biopsies is starting a clinical trial to see how this would influence treatment and the course of disease. They need to test the bone marrow cells not only for cytokeratin but also double stain them for her2 neu as those with her2neu positive isolated tumor cells in the bone marrow have been shown to be associated with a much higher rate of recurrence than those in the graphs Robin P has pointed out. If this, or a more specific and accurate way of isolating circulating tumor cells can become more widespread and found indicative of residual disease there will be a way in those treated adjuvantly rather than neoadjuvantly ie, when there is no longer a tumor present to judge whether there is or is not a response to therapy, to assess whether the best treatment is being utilized.

Sorry to be so serious on a Saturday...Have a great weekend!

09-16-2006, 08:24 AM	#13
Lani Senior Member Join Date: Mar 2006 Posts: 4,778	interestingly They have found (when looking at all breast cancers, not just her2neu+ breast cancers) that the peak of recurrence occurs x number of months (around 24 for her2+ and triple negative as Becky said,with another later "blip" peak of recurrence for those ER+her2-) after surgery NOT x number of months after the lump was discovered. In those who delayed after finding their lump or who were unable to get access to health care right away (this is a global disease) they found the peak occurred x number of months after the surgery even if the tumor had been there quite a long time before. The thinking is that the surgery starts an inflammatory process and that the gene signature of breast cancer looks a lot like the gene signature of inflammation and that some of those growth factors etc let loose or stimulated by the act of surgery "start the clock ticking" This is one reason why they are moving toward needle and core biopsies, hoping to mimimize the inflammatory reaction by minimizing the surgery. It is another reason why increased usage of preop MRIs to better define the extent of disease and minimize repeat operations to obtain better margins may improve cancer care in the future. Noone it seems has studied whether the 1-5 day course of various types of accelerated partial breast irradiation produce more or less inflammatory cytokines but if/when the long term results of APBI come out, if they are better than conventional radiation this should be one avenue of research as to why. It may be that breast cancer is indeed a stem cell disease and that the "tumors in waiting" are those slowly dividing cells in the bone marrow which get activated by inflammatory cytokines etc just like the mold in bathroom grout gets activated by moisture no matter how much you use Tilex or other bleach-containing compounds. The group in Germany that has been advocating getting preop and post treatment bone marrow biopsies is starting a clinical trial to see how this would influence treatment and the course of disease. They need to test the bone marrow cells not only for cytokeratin but also double stain them for her2 neu as those with her2neu positive isolated tumor cells in the bone marrow have been shown to be associated with a much higher rate of recurrence than those in the graphs Robin P has pointed out. If this, or a more specific and accurate way of isolating circulating tumor cells can become more widespread and found indicative of residual disease there will be a way in those treated adjuvantly rather than neoadjuvantly ie, when there is no longer a tumor present to judge whether there is or is not a response to therapy, to assess whether the best treatment is being utilized. Sorry to be so serious on a Saturday...Have a great weekend!