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Triple positives (ER+,PR+,HER2+++)
I wonder if the group of ER+, PR+, and HER2+++ (being a mixed combination) just has a tendency to recur later, whereas those who are ER-/PR- and HER2+++ tend to recur earlier? Do we have any ER+, PR+, HER2+++'s on board here who have recurred? If so, how far out?
This recent study doesn't answer my question but is interesting:
"Estrogen-receptor-positive breast cancer and the drug tamoxifen used to go hand in hand, but as researchers continue their quest to understand the behavior of breast tumors, they're learning that not all ER-positive tumors are created equal. Some respond better to tamoxifen than others do. The question is why.
A new study published in the Journal of the National Cancer Institute (September 7) may shed some light. The study analyzed ER-positive tumors from nearly 45,000 breast cancer patients to determine the characteristics associated with a poor response to tamoxifen. Researchers found that patients whose tumors contained both estrogen and progesterone receptors (PRs) were most likely to benefit from the drug. In contrast, tumors that lacked PRs were more likely to express higher levels of the growth-factor receptors HER1 and HER2. This combination (lacking PRs and expressing HER1 or HER2) makes for a more aggressive tumor that is less likely to respond to tamoxifen, and therefore is more likely to recur. Other studies have also discovered that unlike tamoxifen, the effectiveness of aromatase inhibitors (AIs) doesn't seem to depend on the PR status of a tumor.
What does this mean for patients? It's a controversial issue and the jury is not in, says Richard Elledge, M.D., medical director of the Breast Care Center at Baylor College of Medicine in Houston and the study's senior author. "But I and others feel that this can be used to decide when to initiate what kind of treatment." Those with an ER-positive tumor that also has progesterone receptors may be better off starting with tamoxifen and then switching to an AI later on, while those with an ER-positive tumor that is PR-negative may want to start with an AI from the beginning."
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