Borderline FISHy

Rich66 · 11-21-2009, 12:17 PM

http://www.news-medical.net/news/200...st-tumors.aspx

"Evaluation of HER-2 status should consider the costs of treatment as well as the potential benefits of therapy," Press said. "And the cost of the diagnostic test is minimal compared with the cost of the medications. More accurate assignment of patients to treatment more than offsets the costs of erroneously treating women whose breast cancers lack HER-2 amplification.
In addition, there is the human cost of failing to treat women whose breast cancers have HER-2 amplification."
"An issue with FISH for HER-2 testing is that up to 2 percent of breast cancers have FISH ratios at or near the cutoff level. However, we are aware of no published data demonstrating that patients with borderline HER-2 amplification respond less favorably to trastuzumab and lapatinib," he said.

Any idea if he's saying borderline positive or borderline negative?

Ruth · 11-21-2009, 12:25 PM

Hi Rich ~ Wouldn't this be the same? Borderline positive is borderline negative too? I'm not sure...but I'm thinking borderline is just that...can go either way? I could see an argument for either way to look at it. But maybe I'm reading all these posts on here today seeing lots of arguments going either way. LOL
Hugs ~ Ruth

Rich66 · 11-21-2009, 12:32 PM

Dunno. Up until this published statement, the party line has been the cutoff is the cutoff. I had mom's path sent to his lab for 2nd opinion and it was negative but near the cutoff. It categorically excludes her from TDM-1 and other Her2+ trials, despite showing some stability for a bit on herceptin monotherapy. Now there's this ambiguous FISHy-washy statement.

mcgle · 11-22-2009, 12:08 AM

FYI

I am borderline Fishy (2.71), am four years down the line, having had surgery, rads and tamoxifen - no chemo or herceptin.

This was the right decision for me, though I was sceptical at the time.

Mcgle (UK)

Rich66 · 11-22-2009, 12:11 AM

Interesting. What made it right for you?

mcgle · 11-22-2009, 12:14 AM

The fact I am still clear! But there was no node involvement or vascular invasion, which is why my medics were reluctant to put me through aggressive therapy.

Mcgle (UK)

Rich66 · 11-22-2009, 12:55 AM

Was this in the era of adjuvant Herceptin? Consider posting a cancer history in your signature.

Rich66 · 11-22-2009, 12:56 AM

Was this in the era of adjuvant Herceptin? Consider posting a cancer history in your signature. I don't know what "still clear" means in your context.

mcgle · 11-22-2009, 07:13 AM

Rich

Since this is a public board, I do not want to reveal too much info about myself, hence the lack of signature.

'Still clear' means there has been no evidence of disease since I finished my treatment (apart from ongoing tamoxifen).

My cancer was discovered in late 2005, and the consensus was I should not do chemo or herceptin.

Hope this helps answer your questions.

Mcgle (UK)

Lien · 11-22-2009, 08:48 AM

Same here. I was diagnosed in Jan. of 2004. Treated with lumpectomy, rads, zoladex and arimidex. Still clear. Vit H was not approved in the adjuvant setting and when I had my checkup last Oct. my doc told me he probably wouldn't give me Herceptin now if I were newly diagnosed. He thinks the side effects are potentially worse than the improvement I could obtain, riskwise.

Jacqueline

Joan M · 11-23-2009, 11:15 AM

Rich,

Got it. Or as I say, what's the difference between partly sunny and partly cloudy?

I'm considered borderline positive. And, according to the oncologist, it's better to err on that side.

Joan

Cal-Gal · 11-23-2009, 04:58 PM

Hi Rich,

I am HER2 equivocal--and receiving Herceptin--
2 of my tumors were negative and 2 equivocal--

I feel fortunate that I am taking Herceptin--
especially in light of the fact that I am ER/PR negative--

webmum · 11-24-2009, 06:16 AM

I remember my oncologist sayin I was exactly borderline, 2.25 as 2.3 would have been overexpression and 2.2 underexpression.
Eventually they said they "manipulated" the sample in some way or other and finally got a positive result. At the time I thought they were being very keen to enrol me on this trial (with lapatinib) just so they had more patients.....but then realised they were only keen to save my life as I would have been triple neg otherwise.

grade 3 stage 3a, 5cm KI67 of 90%, a 2cm lump in lymphnodes....I needed all the help I could get!!

(After surgery I was told it had been a complete response, I could never thank my oncologists enough!)

chiara

Cal-Gal · 11-24-2009, 10:13 AM

Rich-thanks for this conversation--it is important---I did alter my dx history to reflect the 2tumors negative Her2---2tumors equivocal Her2---any way you look at it---all my tumors overexpressed--it is to the degree that they overexpressed--which gives us the further detail---I am thankful for Herceptin--as I am ER/PR negative and besides chemo there are no other options at this point in time---

Rich66 · 11-24-2009, 11:00 AM

Given the relatively low side effect profile, Herceptin seems a pretty manageable way to get some edge on the beast. Herceptin gave my mom less side effects than Arimidex. And she appears to be quite the sensitive one.

Joan,The other way is the classic half empty, half full. Of course, the "cloudy" imagery might be very appropriate.

Manipulated the sample, webmum? Sounds err FISHy. I have visions of the onco version of swapping urine samples for a drug test

The thing about these results, if I can resume beating the dead horse, is that the limited sampling, time to fixation and varying quality of interpretation is a bit unnerving. I 've heard everything from "1.8 is as negative as can be" to the statement at the top of this thread. The fact that Cal-Gal mentions varying status between tumors at time of surgery is a prime example. A mets patient is lucky to get 1 biopsy and they extrapolate from there. Hardly an adequate approach as we embrace "targeted" treatment decisions. Just like screening, we don't need less testing..just better testing.

Mcgle, are you talking about IHC because 2 is positive by FISH test? BTW, the only reason for the treatment signatures is to help put people's situation in context. I was uncomfortable with the idea until I realized how helpful it was to learn from and make useful comments. If I came across a treatment issue, I could remember "Ah..so and so had that, wonder what she thinks about it" With a profile name like mcgle(how to prnounce it?), your anonymity is assured. I actually found it very helpful to force things into a one page format. Most oncs don't have anything as concise as what patients here put together.

Cal-Gal · 11-24-2009, 11:09 AM

Hi Rich--also noted that the FISH test has a variance range of .2 or 2 points--whatever that is? I know you will correct that---(don't want to dig out my pathology-)

so that variance factor could make a difference to someone like me who has all 4 tumors overexpressing HER2-but 2 'officially' negative and 2 'officially' equivocal--the 2 that are equivocal would be positive if you added in the variance--

why can't this be simpler?

mcgle · 11-24-2009, 11:32 AM

Rich

My rather unusual case (good prognostic indicators in spite of the HER2 element) was referred to a professor of oncology here in the UK.

My IHC test came back at 2+ which is why they went ahead with the FISH test. There are obviously differing opinions here because said prof stated 2 was definitely negative and 3 was definitely positive, which is why I am borderline positive.

Hope this explains things.

BTW, Mcgle is an acronym of family members' names.

Mcgle (UK)