Thoughts on serum her 2 mets in lung/liver

[Rich66]

Current onc wonders what can be done with info from Serum her2 in context of 1.7 her2(liver biop) mets to liver and lungs. I figure, get any available info, then look at what it adds up to. After all, with various mets, what does a single biopsy tell? Worth pursuing?

[Jackie07]

Found this signature in another Breast cancer support board:

6/9/06 - biopsy positive for cancer
6/23/06 - DIAGNOSIS: stage IV (T4d N2 M1) invasive ductile carcinoma NOS with bone and liver mets; 17 cm mass (primary tumors), inflammatory breast cancer(IBC); HER2/neu+, HR-
6/26/06-12/11/06 - Chemo FEC/Taxol w/Herceptin & Aredia
12/?/06 - pre-op x-ray show two tumors in the upper right lungs 1.2 and 1.8 cm in diameter.
12/20/06 - right modified radical mastectomy, 7 of 13 removed nodes showed evidence of prior disease
12/21/06 - No Evidence of Disease (stage IV/NED); complete remission
2/6/07-3/22/07-Radiation 28+5 boost, 6040cGy.
CURRENT: Still NED, taking Herceptin and Zometa without end. Heart and kidney function remains normal.

[chrisy]

Rich,

I think the value of the her2 serum test is in using it as a surrogate for other types of tests - to measure if a treatment is working.

My understanding of how people on this board are using it is, at the beginning of or during treatment, seeing this number drop is an indicator that the treatment is working. The theory being, there are fewer her2 cells shedding into the bloodstream.

Once in the normal range, and if in remission or stable - and continuing on a her2 based maintenance therapy like herceptin, it could be used to monitor this state and if the number started going up, this would be a signal to look for recurrence.

Sort of like a tumor marker, except you are measuring the amount of her2 in the blood.

So in your mom's case, if she started a new her2 based therapy and the serum number did not increase, MIGHT indicate a need to change. If/when she is in remission, but continues to hold this with herceptin, the test MIGHT indicate recurrence.

Others who are actually using this will probably respond better!

[Rich66]

I guess I'm wondering if it woudl be useful to indicate Her2 status of tumor sites not biopsied. i.e., if there is enough her2 in serum, enough of the tumor is her2 pos to suggest addition of Herceptin etc...which my mom never had. My concern is whether one isolated (liver) biopsy might be missing the larger picture and limiting treatment.

But it also seems like if there is any serum her2 at all, monitoring it in addition to tumor markers and CTC could add to the picture.

Again..I keep thinking they should gather all possible info and see what it points to. But oncs seem to be wary and lean on the phrase "but would we do with that?"

[Debbie L.]

Rich, this is a big question right now. I think that I saw at least one abstract about it on the St. Gallen website (not the one that said serum HER2 correlates with prognosis). I will go back and look for it later when I have time. As near as I can understand it, they see +serum HER2 values sometimes on people whose tumors cells were HER2 negative. There is speculation that treating these people with Herceptin, if they are ERPR positive, would make the cells more responsive (less resistant) to hormone therapy. It seems like for some cancers, it's a continuum where as ERPR decreases (or resistance develops), HER2 increases. But that doesn't happen with everyone, of course. But speculation is the key word right now. Very much a puzzle and one that is not yet solved although they keep getting more clues.

So that's no answer at all to your question. Sorry. We're not ignoring the question, we just don't have an answer.

And I do agree with your mom's providers - if you don't know what you're going to do with a result, you do not order a test. Another way to phrase that is to say that if the result of a test would not change treatment, then you do not order it.

So if you found a provider (and an insurer) who said "if the serum HER2 is positive, we'll give her Herceptin" - that would be a reason to do the test.

Debbie Laxague

[Debbie L.]

Sorry Rich. I hope you didn't go searching already. I did, and couldn't find it. I think maybe I got my sources scrambled - try listening to Mark Pegram in this interview - his is the last of the four on the page, and he begins with ERPR+ MBC and lapatinib/Herceptin.

http://www.breastcancerupdate.com/do.../1/default.asp

tinyurl: http://tinyurl.com/cx5gzn

And then this link has an extensive discussion of serum HER2, in part in HER2 negative tumors.

http://breast-cancer-research.com/content/9/5/R74

I hope I didn't lead you on a wild goose chase.

Debbie

[Rich66]

Update on this issue. I gave the onc the article that Debbie sent me:

http://theoncologist.alphamedpress.o...61?maxtoshow=&
HITS=10&hits=10&RESULTFORMAT=&fulltext=her-2+negative&searchid=1&FIRSTINDEX=
0&resourcetype=HWCIT

It, along with borderline liver biopsy and apparent progression(1 growing lung met) on Xeloda, was enough to get him to order the test.
regarding not doing tests if they don't know how to interpret them, consider this: Many tests have usefulness as a baseline record as ability to interpret evolves over time. Unless prohibitively expensive, I think it might be useful to get info from all available tests now so that results may be used in the future.
Thanks again for the link.

[Rich66]

Anyone know how long it takes to go from blood draw to results?

[Joe]

Rich,

One to two weeks.

Regards
Joe

[StephN]

Hi Rich -
Time for results for that HER2 serum test are two weeks or a bit more for me.

I am waiting for my last one now. Should have it any day.

Hope your Mom can get Herceptin, which may get her to NED since BC usually is more slow growing in elderly.