HER2 Support Group Forums - View Single Post - Any one else a Stage 1 AND Grade 1 Her2++++?

Debbie L. · 01-31-2009, 09:34 AM

Hi all,

I went looking for confirmation of my sense that HER2+ tumors are not any bigger at diagnosis than HER2- ones. It was hard to find much, but I did find (below) a small study that addressed both that, and grade.

I thought that HER2+ grade I would be extremely rare but I found this reference that it's not all THAT rare (10% of HER2+'s, if I read this correctly). Very small study, though.

Also, just from observation, it didn't seem to me that HER2+ tumors were bigger than any others, and this study confirmed that. Again just anecdotally - the women that I talk to with the largest tumors seem more often to be triple negative (and even with those large tumors, they are often node negative - so weird) or ER+.

This study did not look at HER2+ and correlation to lymph node status but my guess is that it would be a positive correlation.

So the next question is what does grade I/HER2+ MEAN? Can someone with this pathology be reassured (seems logical)? Does Herceptin have a role in treating this subtype? (no answers to these questions yet, alas, but we can guess that the answer is "yes", because Herceptin's action is totally different from chemo's, right?)

What about chemo? So far all hints point to chemo's lack of effect on low grade tumors. For awhile, it seemed like it was that chemo was less effective on ER+ tumors but I think that was because they tended to be lower grade.

So it's not simply that low grade tumors are at less risk of recurrence and don't NEED chemo, right? It's that chemo offers little advantage to these cancers, even if (somehow) they had a worse prognosis than the do.

This is mostly speculation on my part. (except the 10% grade I/HER2+ and the lack of correlation between HER2 and tumor size - see copy/paste below). What do you think?

Abstract: The purpose of this study was to determine if any relationship exists between Her-2/neu gene amplification and estrogen receptor (ER), progesterone receptor (PR), MIB-1, grade, size and age in female breast cancer. Five hundred and eighteen female patients with invasive breast carcinoma, 390 ductal and 128 lobular, in which assessment of Her-2/neu amplification by fluorescence in-situ hybridization (FISH) has been performed, were reviewed retrospectively. Each patient was further assessed for ER, PR, MIB-1, grade, size and age at diagnosis. Chi-square analysis was then used to correlate the above observations. Overall gene amplification was seen in 76 (15%) of the cases, 68 (17%) were ductal and 8 (6%) were lobular. Her-2/neu gene was amplified in 37 (10%) out of 379 ER positive cases and in 39 (28%) out of 139 ER negative cases. Her-2/neu was amplified in 22 (7%) out of 301 PR positive cases and in 54 (25%) out of 217 PR negative cases. Amplification occurred in 18 (8%) out of 222 negative MIB-1 cases and amplified in 58 (20%) out of 296 positive cases. Amplification was seen in 5 (10%) out of 49 grade I tumors, 17 (12%) out of 143 grade II tumors and 54 (27%) out of 198 grade III tumors. Lobular carcinomas were not graded. Amplification was present in 52 (15%) out of 346 T1 lesions, in 17 (13%) out of 130 T2 lesions, in 5 (17%) out of 30 T3 lesions and in 2 (17%) out of 12 T4 lesions. Her-2/neu was amplified in 67 (14%) out of 467 woman 41 years and older, and in 9 (18%) out of 51 women 40 years and younger. Comparison of these frequencies using chi-square test revealed statistically significant correlation between Her-2/neu amplification and ductal versus lobular carcinoma (p < 0.0003), ER (p = 0.0001) and PR (p < 0.0001) negative tumors, over-expression of MIB-1 (p < 0.0005) and high tumor grade (p = 0.0009), while size of the tumor (p = 0.08) and age of the patients (p = 0.67) were not statistically significant. Correlation was found between Her-2/neu amplification and tumor type, high histological grade, ER and PR negative tumors, and high proliferative MIB-1 index. No correlation was found between size of the tumor and age of the patient with Her-2/neu amplification.

01-31-2009, 09:34 AM	#7
Debbie L. Senior Member Join Date: Jul 2006 Posts: 463	here's one small reference Hi all, I went looking for confirmation of my sense that HER2+ tumors are not any bigger at diagnosis than HER2- ones. It was hard to find much, but I did find (below) a small study that addressed both that, and grade. I thought that HER2+ grade I would be extremely rare but I found this reference that it's not all THAT rare (10% of HER2+'s, if I read this correctly). Very small study, though. Also, just from observation, it didn't seem to me that HER2+ tumors were bigger than any others, and this study confirmed that. Again just anecdotally - the women that I talk to with the largest tumors seem more often to be triple negative (and even with those large tumors, they are often node negative - so weird) or ER+. This study did not look at HER2+ and correlation to lymph node status but my guess is that it would be a positive correlation. So the next question is what does grade I/HER2+ MEAN? Can someone with this pathology be reassured (seems logical)? Does Herceptin have a role in treating this subtype? (no answers to these questions yet, alas, but we can guess that the answer is "yes", because Herceptin's action is totally different from chemo's, right?) What about chemo? So far all hints point to chemo's lack of effect on low grade tumors. For awhile, it seemed like it was that chemo was less effective on ER+ tumors but I think that was because they tended to be lower grade. So it's not simply that low grade tumors are at less risk of recurrence and don't NEED chemo, right? It's that chemo offers little advantage to these cancers, even if (somehow) they had a worse prognosis than the do. This is mostly speculation on my part. (except the 10% grade I/HER2+ and the lack of correlation between HER2 and tumor size - see copy/paste below). What do you think? Abstract: The purpose of this study was to determine if any relationship exists between Her-2/neu gene amplification and estrogen receptor (ER), progesterone receptor (PR), MIB-1, grade, size and age in female breast cancer. Five hundred and eighteen female patients with invasive breast carcinoma, 390 ductal and 128 lobular, in which assessment of Her-2/neu amplification by fluorescence in-situ hybridization (FISH) has been performed, were reviewed retrospectively. Each patient was further assessed for ER, PR, MIB-1, grade, size and age at diagnosis. Chi-square analysis was then used to correlate the above observations. Overall gene amplification was seen in 76 (15%) of the cases, 68 (17%) were ductal and 8 (6%) were lobular. Her-2/neu gene was amplified in 37 (10%) out of 379 ER positive cases and in 39 (28%) out of 139 ER negative cases. Her-2/neu was amplified in 22 (7%) out of 301 PR positive cases and in 54 (25%) out of 217 PR negative cases. Amplification occurred in 18 (8%) out of 222 negative MIB-1 cases and amplified in 58 (20%) out of 296 positive cases. Amplification was seen in 5 (10%) out of 49 grade I tumors, 17 (12%) out of 143 grade II tumors and 54 (27%) out of 198 grade III tumors. Lobular carcinomas were not graded. Amplification was present in 52 (15%) out of 346 T1 lesions, in 17 (13%) out of 130 T2 lesions, in 5 (17%) out of 30 T3 lesions and in 2 (17%) out of 12 T4 lesions. Her-2/neu was amplified in 67 (14%) out of 467 woman 41 years and older, and in 9 (18%) out of 51 women 40 years and younger. Comparison of these frequencies using chi-square test revealed statistically significant correlation between Her-2/neu amplification and ductal versus lobular carcinoma (p < 0.0003), ER (p = 0.0001) and PR (p < 0.0001) negative tumors, over-expression of MIB-1 (p < 0.0005) and high tumor grade (p = 0.0009), while size of the tumor (p = 0.08) and age of the patients (p = 0.67) were not statistically significant. Correlation was found between Her-2/neu amplification and tumor type, high histological grade, ER and PR negative tumors, and high proliferative MIB-1 index. No correlation was found between size of the tumor and age of the patient with Her-2/neu amplification.