HER2 Support Group Forums - View Single Post - determining which patients benefit from more than 5 years of antihormonal therapy--

Lani · 03-22-2014, 12:20 PM

her2 may be involved. It is unclear if it is just because her2+ bc usually is less endocrine sensitive or if there is some other mechanism coming into play

from MedPage Today website:

Some Breast Cancers Require Longer Tx

Published: Mar 21, 2014
By Charles Bankhead, Staff Writer, MedPage Today

Breast cancers with high-level estrogen sensitivity had a significantly greater risk of late recurrence, possibly indicating a need for more than 5 years of adjuvant hormonal therapy, British investigators reported.

HER2-negative tumors with a high score on the estrogen panel of a genetic test had a recurrence rate of 13.6% during years 5 to 10 after diagnosis, more than double the recurrence rate during the first 5 years.

In contrast, women with HER2-positive, highly estrogen-sensitive tumors did not have an increased risk of recurrence beyond 5 years, as reported at the European Breast Cancer Conference (EBCC) in Glasgow, Scotland.

"Our data suggest that these patients, who are those that appear to benefit most from the current standard 5 years of endocrine treatment, may also benefit from adjuvant hormone treatment that extends beyond 5 years," Mitchell Dowsett, PhD, of the Institute for Cancer Research in London, said in a statement.

The results add to the longstanding recognition that estrogen receptor-positive tumors have a higher risk of late recurrence compared with ER-negative tumors, added Jack Cuzick, PhD, of Queen Mary University, also in London.

"This work makes it clear that even within ER-positive cancers, the level of expression is important," said Cuzick. "Further work is needed to see if genetic expression profiles are better at doing this than more conventional quantitative immunohistochemistry."

The findings came from a new analysis of the landmark Arimidex, Tamoxifen Alone or in Combination (ATAC) randomized trial, which showed improved survival in breast cancer patients who received 5 years of adjuvant hormonal therapy with an aromatase inhibitor instead of tamoxifen.

The analysis included 1,125 ATAC participants whose tumors were evaluated by the OncoType DX 21-gene test, which assesses the risk of distant recurrence in patients with ER-positive breast cancer. Gene expression evaluated by the test includes four genes involved in estrogen signaling (the E-module), one being the estrogen receptor.

The subgroup included 1,009 patients who had HER2-negative tumors.

The analysis showed 215 recurrences during 10 years of follow-up. Overall, the recurrence rate was similar during years 0 to 5 and 5 to 10. However, the recurrence rate and pattern varied markedly according to HER2 status and E-module score.

HER2-positive tumors had a higher recurrence rate during years 0 to 5. HER2-negative tumors had a higher recurrence rate during years 5 to 10.

Further analysis showed that the recurrence pattern of HER2-negative tumors varied by E-module score. A low E-module score was associated with similar rates of recurrence during years 0 to 5 and 5 to 10. The combination of HER2-negative status and high E-module scores was associated with more than a twofold increase in recurrence during years 5 to 10.

"Similar overall recurrence rates between years 0 to 5 and years 5 to 10 hide substantial and therapeutically important subgroup differences," the investigators concluded. "Importantly, HER2-negative cases with high estrogen signaling are generally considered relatively low risk but showed increased recurrence after 5 years, coincident with cessation of treatment and may be candidates for extended endocrine therapy."

The ATAC analysis was one of several noteworthy studies reported at the EBCC.

Primary source: European Breast Cancer Conference

Source reference: Dowsett M, et al "Estrogen module of 21-gene recurrence score predicts increased late recurrence for ER+ HER2- breast cancer" EBCC 2014; Abstract O-216.

03-22-2014, 12:20 PM	#1
Lani Senior Member Join Date: Mar 2006 Posts: 4,778	determining which patients benefit from more than 5 years of antihormonal therapy-- her2 may be involved. It is unclear if it is just because her2+ bc usually is less endocrine sensitive or if there is some other mechanism coming into play from MedPage Today website: Some Breast Cancers Require Longer Tx Published: Mar 21, 2014 By Charles Bankhead, Staff Writer, MedPage Today Breast cancers with high-level estrogen sensitivity had a significantly greater risk of late recurrence, possibly indicating a need for more than 5 years of adjuvant hormonal therapy, British investigators reported. HER2-negative tumors with a high score on the estrogen panel of a genetic test had a recurrence rate of 13.6% during years 5 to 10 after diagnosis, more than double the recurrence rate during the first 5 years. In contrast, women with HER2-positive, highly estrogen-sensitive tumors did not have an increased risk of recurrence beyond 5 years, as reported at the European Breast Cancer Conference (EBCC) in Glasgow, Scotland. "Our data suggest that these patients, who are those that appear to benefit most from the current standard 5 years of endocrine treatment, may also benefit from adjuvant hormone treatment that extends beyond 5 years," Mitchell Dowsett, PhD, of the Institute for Cancer Research in London, said in a statement. The results add to the longstanding recognition that estrogen receptor-positive tumors have a higher risk of late recurrence compared with ER-negative tumors, added Jack Cuzick, PhD, of Queen Mary University, also in London. "This work makes it clear that even within ER-positive cancers, the level of expression is important," said Cuzick. "Further work is needed to see if genetic expression profiles are better at doing this than more conventional quantitative immunohistochemistry." The findings came from a new analysis of the landmark Arimidex, Tamoxifen Alone or in Combination (ATAC) randomized trial, which showed improved survival in breast cancer patients who received 5 years of adjuvant hormonal therapy with an aromatase inhibitor instead of tamoxifen. The analysis included 1,125 ATAC participants whose tumors were evaluated by the OncoType DX 21-gene test, which assesses the risk of distant recurrence in patients with ER-positive breast cancer. Gene expression evaluated by the test includes four genes involved in estrogen signaling (the E-module), one being the estrogen receptor. The subgroup included 1,009 patients who had HER2-negative tumors. The analysis showed 215 recurrences during 10 years of follow-up. Overall, the recurrence rate was similar during years 0 to 5 and 5 to 10. However, the recurrence rate and pattern varied markedly according to HER2 status and E-module score. HER2-positive tumors had a higher recurrence rate during years 0 to 5. HER2-negative tumors had a higher recurrence rate during years 5 to 10. Further analysis showed that the recurrence pattern of HER2-negative tumors varied by E-module score. A low E-module score was associated with similar rates of recurrence during years 0 to 5 and 5 to 10. The combination of HER2-negative status and high E-module scores was associated with more than a twofold increase in recurrence during years 5 to 10. "Similar overall recurrence rates between years 0 to 5 and years 5 to 10 hide substantial and therapeutically important subgroup differences," the investigators concluded. "Importantly, HER2-negative cases with high estrogen signaling are generally considered relatively low risk but showed increased recurrence after 5 years, coincident with cessation of treatment and may be candidates for extended endocrine therapy." The ATAC analysis was one of several noteworthy studies reported at the EBCC. Primary source: European Breast Cancer Conference Source reference: Dowsett M, et al "Estrogen module of 21-gene recurrence score predicts increased late recurrence for ER+ HER2- breast cancer" EBCC 2014; Abstract O-216.