approximately 85% of women with this disease receive adjuvant chemotherapy unnecessar

The future?

RB

algorithm.http://professional.cancerconsultant....aspx?id=35747


Oncotype DX™ Predicts Loco-Regional Recurrences in Breast Cancer Patients

ABSTRACT

Researchers affiliated with the National Surgical Adjuvant Breast and Bowel Project (NSABP) reported that Oncotype DX Recurrence Score has demonstrated the ability to predict the risk of loco-regional recurrences in node-negative, hormone-positive women with breast cancer. These findings may expand the use of Oncotype DX to predict failure or success of adjuvant therapy. These results were recently presented at the 28th Annual San Antonio Breast Cancer Symposium (SABCS).

Adjuvant chemotherapy and/or endocrine have resulted in an improvement in survival in women with early-stage breast cancer. However, the benefit from adjuvant chemotherapy in this group of patients is not uniform, as it is estimated that approximately 85% of women with this disease receive adjuvant chemotherapy unnecessarily. Therefore, it is crucial to determine which patients with early breast cancer are at a high risk of developing a recurrence so that individualized adjuvant treatment can reduce the risk of death in appropriately selected patients, while sparing low-risk patients from unnecessary toxicities and medical expenses. While tumor markers have provided some advances in predicting prognosis, it appears that the most promising predictive results may be generated from gene expression profiles.

Oncotype DX is an CLIA-approved reverse-transcription polymerase chain reaction (RT-PCR) test indicated for patients with newly diagnosed, stage I or II, node-negative, estrogen-receptor positive breast cancer who will be treated with tamoxifen. Oncotype DX predicts the risk of a patient experiencing a recurrence 10 years following diagnosis, utilizing formalin-fixed paraffin-embedded tumor tissue. Oncotype DX utilizes a panel of 21 genes (16 cancer-related genes and 5 control genes), derived from 3 studies, to accomplish a recurrence-score

[Christine MH-UK]

I am not so sure that this applies to most HER2+ve patients, since this test is "indicated for patients with newly diagnosed, stage I or II, node-negative, estrogen-receptor positive breast cancer." Still, anything that matches patients to treatments better is welcome.

[AlaskaAngel]

As one of the patients in the applicable subgroup who is currently apparently NED, and who did "active duty" (chemotherapy and rads) in 2002, my question is now "Well then, can't I have that test to tell whether the chemo I had did me any good, and whether I am at high or low risk for recurrence -- which would therefore tell me whether I should seek to have a different therapy (like Herceptin, or other treatment) to continue to avoid recurrence?

I have asked this question of more than one oncologist, and the answer has been "no" with zero explanation as to why not. I am aware that this subgroup benefits significantly from the use of a SERM or an AI, but I am also aware that often the SERM or the AI (and even serial application of various AI's) stops working even for those who are hormone-receptor-positive.

Christine MH-UK, do you know? And why is it such a big secret?

There are at least two gene tests on the market, and I have seen reference to a lot more under construction.

I am not sure as to their exact applicability.

Here is a link on the subject generally. I think I have saved some more and will post it if I refind it!

I have not seen anything that directly answers your question.

I saved the link with the extract, but could not immediately see the item below, but it should be there somewhere - it is in any case a great link with lots of fascinating insights - but may take some time to look at - I have only very briefly skimmed it.

RB



http://www.bcrfcure.org/rese_summaries04_page3.html

ABSTRACT


“Using gene chip technology, the investigators are focusing on profiling known genetic markers such as p53, HER2/neu, ER/PR, bcl2, and MAP4. During the first year of this project, significant progress was made, including the establishment of a sophisticated gene expression profiling system (micro-chip gene array) for analysing patients’ tumor samples.”

“Dr. Smith reported in late January that his team has extended their neoadjuvant work to include the analysis of differences in the gene profile of tumors before and during treatment, to detect which genes are amplified or deleted. They have also collaborated with Dr. Jenny Chang and colleagues at Baylor College of Medicine in the RNA profiling in these tumors, to determine which genes are switched on or off. The researchers have also initiated RNA extraction from their tissue bank of approximately 2,800 frozen breast carcinomas with a median 10-year full clinical follow-up, with a view to linking the molecular profiles of these treatments with clinical outcome. Core-cut biopsies and/or fine needle aspirates have been obtained from 63 primary breast cancer patients before chemo-therapy and from 19 of these 21 days after starting treatment. C-DNA microarray analysis has demon-strated that significantly more genes change in patients who subsequently respond to therapy, validating this approach for the discovery of genes associated with response/resistance to chemotherapy.”

[panicked911]

I was one of those women who had the oncotype test done as I am stage 1 node negative - it was recommended by my surgeon - the cost is over $3,000 of which an overwhemling majority of insurance companies refuse to pay.

When I went to see my onc for the first time and told her I was still waiting for the test results, she said " waste of time and money to do it - Her2+++ weighs to heavily in the equation and will almost always put you in the high risk group - which it did -

If I would have known how heavily her+++ weighes in the equation, I never would have done it.

Interestingly, even with the oncotype test results she still put me in the gray category for chemo and agreed that ovary ablation, arimidex and herceptain was a more than reasonable approach and would give me the same odds of reoccurance as chemo -

Hope this helps.

[barbaralea]

I was given the oncotype dx. I am stage 1 node negative and HER-2 positive. It has been recommended that I begin Herceptin. Does anyone know much about the side effects. I am a little worried about doing this. I have already done chemo and radiation and am on Arimidex. I hopt it is not overkill.

A seasonal story?

I attach a story from the UK press and some counter opinions.

As usual it is important to be cautious and impossible to draw conclusions without the full facts - it may not have been the mistletoe but the hormone treatment or someting else, or the mistletoe helped.

I attach some balancing abstract by way of background.

RB


http://www.mirror.co.uk/news/tm_obje...name_page.html

24 December 2005
MY BREAST CANCER WAS CURED BY MISTLETOE
Mum's joy as Xmas plant kills tumour
By Jan Disley and Victoria Bone

JOYFUL Nicola Wicksteed celebrated a Christmas miracle yesterday - after beating breast cancer with MISTLETOE.

Three months after taking extract of the Christmas "kissing plant" combined with herbs, her 7cm-wide tumour has vanished.

She said: "I put it down to natural drugs supporting my immune system." Amazed doctors said her recovery was "remarkable". Property developer and mum Nicola, 50, learned, she had a tumour two years ago. Snubbing surgery and chemotherapy she injected herself with mistletoe, took Carctol - a remedy of eight Ayurvedic herbs - and had hormone therapy.

A month after starting the treatment, the tumour had halved. Two months later, her cells were back to normal. Nicola, of Windermere, Cumbria, said: "I discovered cancer patients in Germany have mistletoe treatment and wanted to give it a chance.

"I know chemotherapy can destroy cancer cells but it also attacks the immune system."

Nicola was helped by the Park Attwood Clinic, at Bewdley, Worcs. Dr Maurice Orange said: "Mistletoe and hormone therapy worked better than anyone hoped. The result was extraordinary.

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"There is nothing there at all now. It does not mean the cancer has completely gone, but Nicola is in full remission."

Mistletoe was first used in cancer therapy more than 80 years ago. It appears to stimulate the immune system while destroying cancer cells.

j.disley@mirror.co.uk

http://www.mayoclinic.com/health/mistletoe/AN01247


Mistletoe: A possible cancer treatment?
Q.
I've heard that mistletoe may help fight cancer. Is this true?
No name / No state
A.

The liquid extract from European mistletoe — which is different from American mistletoe — has long been used as an alternative cancer treatment in Europe. Proponents believe that certain substances in mistletoe may help boost the immune system and slow or stop cancer growth. However, published studies have had conflicting results.

In Europe, mistletoe extracts are prescription drugs that are given by injection. Mistletoe injections have not yet received approval in the United States. However, this may change. The National Institutes of Health is currently conducting a study to examine the safety and effectiveness of mistletoe injections, given in combination with the chemotherapy drug gemcitabine, as a cancer treatment.

It is important to note that you should never eat any part of a mistletoe plant or drink mistletoe extract because mistletoe is a poisonous plant. Ingesting mistletoe may cause vomiting, convulsions, seizures and even death. Keep mistletoe plants out of reach of children and pets.
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AN01247


http://www.bccancer.bc.ca/PPI/Unconv...xorIscucin.htm

ABSTRACT

Unconventional Therapies - Iscador / Mistletoe / Viscumalbum / Plenosol / Helixor / Iscucin

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The role of your cancer health professional is to create an environment of openness and trust, and to help in making informed decisions about alternative/complementary therapies. Collaboration will improve the safe integration of all therapies during your experience with cancer. The "Summary" and "Professional Evaluation / Critique" sections of this Unconventional manual are cited directly from the medical literature, and are intended to help in the objective evaluation of alternative/complementary therapies.

Summary
"Although there is laboratory evidence of biological activity that may be beneficial to cancer patients, the evidence of clinical benefit from human studies remains weak and inconclusive. Because of the absence of serious side effects and the limited evidence that mistletoe products may offer some therapeutic advantages, further research is warranted." (Kaegi)

There have been recent studies published that show that mistletoe extracts can inhibit metastasis, reduce size, and cause necrosis of induced tumours in rodents. These studies suggest that by stimulating the cells of the immune system the mistletoe extracts have this prophylactic effect. No evidence has been published to date showing that mistletoe extracts are effective in treating cancer in humans. (Yoon) (Weber) (Zarkovic) (Antony) (Kutton)

"Because the extract has relatively weak antineoplastic activity, it may be useful as an adjuvant therapy with surgery or radiotherapy. ... Some components have shown antineoplastic activity. However, additional clinical investigation is required to assess the plant's efficacy and long-term safety profile. Because I.V. mistletoe preparations are not standardized in the United States, it is unlikely that mistletoe will be considered for use as an antineoplastic agent in the near future." (Fetrow)

My sincere appologies if you are wondering waht this is doing here. I meant it to be a new post.

RB