HER2 Support Group Forums - View Single Post - ER+, HER2+

Hopeful · 10-14-2008, 12:45 PM

I am profoundly interested in this topic, as I am one of the "oddballs," with Her2+++, 80% ER+, 50% PR+ bc. I post as many articles on this topic as I can find. It seems the "highly" hormone positive, Her2+++ cases are a small subset of all Her2+++, which are a small subset of Her2+++ in general. As such, there is not much study that reflects how we will respond to treatments that address either predominantly ER+ patients OR predominantly Her2+ patients. I posted recently a correspondence between medical authorities trying to categorize tumors based on ER and Her2:

http://her2support.org/vbulletin/sho...eferrerid=1173. One of the authors suggests that ER+ Her2+ tumors are actually hybrid tumors, that are either part "luminal A" (usually ER+/Her2- with a good prognosis) or part "luminal B" (which are generally ER+/Her2- tumors with a high proliferation gene signature, a poorer prognosis than luminal A) AND part Her2+ tumor. Unfortuately, being able to categorize the tumor like that gives absolutely no information on how to treat it or how it will behave.

For ER+ tumors in general, the findings of the Early Breast Cancer Trialists' Collaborative Group at http://www.ctc.usyd.edu.au/cochrane/...BCTCGpaper.pdf state, in pertinent part:

"Extrapolation of the 15 year results for the untreated women in the Tamoxifen trials suggests that even if they had received a treatment that persistently halved their annual breast cancer mortality rate, at least a sixth of those with node-negative disease and a third of those with node positive disease would still eventually die from breast cancer during the first, second or third decade after diagnosis (in the absence of other causes of death during those decades.)"

So, while ER+ bc is seen as "more favorable" by diagnosticians than ER- bc, that seems to be a short-term way of looking at it - the risks of relapse from ER+ bc remains higher than that for ER- bc many years after dx.

Which brings us back to the original quesiton, one I asked my onc: Would ER+/PR+ Her2+ bc be more likely to recur earlier or later? He thought earlier, but I cannot imagine there are enough patients in the data base on which to base that conclusion - I think he, like everyone else, is too freaked out by the Her2+ component of the bc to really consider how the various histiological components might work together here.

My personal opinion is that triple positives carry the same long term risks as ER+/PR+ Her2- patients do, because I don't see a way to rationalize away the conclusions I quoted above from the EBCTCG just because the tumor is also Her2+. But, again, I don't know.

Thanks for raising this discussion. I look forward to other comments.

Hopeful

10-14-2008, 12:45 PM	#4
Hopeful Senior Member Join Date: Aug 2006 Posts: 3,380	I am profoundly interested in this topic, as I am one of the "oddballs," with Her2+++, 80% ER+, 50% PR+ bc. I post as many articles on this topic as I can find. It seems the "highly" hormone positive, Her2+++ cases are a small subset of all Her2+++, which are a small subset of Her2+++ in general. As such, there is not much study that reflects how we will respond to treatments that address either predominantly ER+ patients OR predominantly Her2+ patients. I posted recently a correspondence between medical authorities trying to categorize tumors based on ER and Her2: http://her2support.org/vbulletin/sho...eferrerid=1173. One of the authors suggests that ER+ Her2+ tumors are actually hybrid tumors, that are either part "luminal A" (usually ER+/Her2- with a good prognosis) or part "luminal B" (which are generally ER+/Her2- tumors with a high proliferation gene signature, a poorer prognosis than luminal A) AND part Her2+ tumor. Unfortuately, being able to categorize the tumor like that gives absolutely no information on how to treat it or how it will behave. For ER+ tumors in general, the findings of the Early Breast Cancer Trialists' Collaborative Group at http://www.ctc.usyd.edu.au/cochrane/...BCTCGpaper.pdf state, in pertinent part: "Extrapolation of the 15 year results for the untreated women in the Tamoxifen trials suggests that even if they had received a treatment that persistently halved their annual breast cancer mortality rate, at least a sixth of those with node-negative disease and a third of those with node positive disease would still eventually die from breast cancer during the first, second or third decade after diagnosis (in the absence of other causes of death during those decades.)" So, while ER+ bc is seen as "more favorable" by diagnosticians than ER- bc, that seems to be a short-term way of looking at it - the risks of relapse from ER+ bc remains higher than that for ER- bc many years after dx. Which brings us back to the original quesiton, one I asked my onc: Would ER+/PR+ Her2+ bc be more likely to recur earlier or later? He thought earlier, but I cannot imagine there are enough patients in the data base on which to base that conclusion - I think he, like everyone else, is too freaked out by the Her2+ component of the bc to really consider how the various histiological components might work together here. My personal opinion is that triple positives carry the same long term risks as ER+/PR+ Her2- patients do, because I don't see a way to rationalize away the conclusions I quoted above from the EBCTCG just because the tumor is also Her2+. But, again, I don't know. Thanks for raising this discussion. I look forward to other comments. Hopeful