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Old 03-21-2010, 09:00 PM   #21
Barbara2
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Re: Risk of Recurrent Disease in HER2-Positive Patients

Here is the capsule summary of the data from this study:

Capsule Summary

CCO Independent Conference Coverage of the 2009 Annual Meeting of the AACR-CTRC San Antonio Breast Cancer Symposium*

*CCO is an independent medical education company that provides state-of-the-art medical information to healthcare professionals through conference coverage and other educational programs.


HER2 Positivity a Risk Factor for Recurrence in ER-Positive Early-Stage Breast Cancer

Posting Date: December 15, 2009
  • Analysis of prognostic factors in retrospective cohort dataset
Summary of Key Conclusions
  • HER2, estrogen receptor (ER)–positive patients with early-stage breast cancer at significantly increased risk of recurrent disease within 2.5 years after diagnosis
    • Peak in annual recurrence rate at 2 years in HER2-positive group
  • AIs reduce the risk of recurrence in HER2-positive patients
    • Trastuzumab should be considered for ER-positive, HER2-positive patients given that inhibition of growth factor signaling may increase response to endocrine therapy
Background
  • AIs provide survival benefit in ER-positive early-stage breast cancer and reduce risk of recurrence
    • Optimal timing for initiation of AI therapy in relation to tamoxifen therapy not well defined
    • Identification of prognostic markers would be helpful in selection of patients for treatment with AIs
  • Current study sought to determine whether progesterone receptor (PgR) status or HER2 status predictive for recurrence in ER-positive early breast cancer
Summary of Study Design
  • Analysis of ER, PgR, and HER2 expression in retrospective cohort of women with symptomatic early-stage breast cancer diagnosed between 1980 and 2002 and treated with adjuvant tamoxifen
  • Definition of recurrence
    • Invasive malignancy on histopathology at any site or
    • High index of suspicion upon radiologic investigation
  • Primary study endpoint
    • Kaplan-Meier analysis of DFS: 2.5 years and 5.0 years
    • Time-dependent Cox regression analysis assessed using term ≤ 2.5 years
  • HR for recurrence rate per year by panechnikov smoothing function; bandwidth of 6 months
  • Multivariate time-dependent analysis
    • Adjusted for HER2 status, tumor size, grade, nodal status, PgR status, and HER2 status associated with DFS at time from diagnosis
Baseline Characteristics
  • Patient and disease characteristics at baseline
Characteristic, %
Patients
Age at diagnosis, yrs
  • Younger than 50
16.2
  • 50-59
20.6
  • 60-69
33.6
  • 70 or older
29.4
  • Unknown
0.2
Tumor size, cm
  • < 2
38.3
  • 2-5
50.7
  • > 5
5.5
  • Unknown
5.5
Grade
  • I
24.6
  • II
48.0
  • III
24.6
  • Unknown
2.7
Number of lymph nodes
  • 0
48.0
  • 1-3
26.6
  • > 3
17,2
  • Unknown
8,2
PgR status
  • Positive
60.0
  • Negative
36.6
  • Unknown
3.5
HER2 status
  • Positive
12.7
  • Negative
86.1
  • Unknown
1.2
Radiotherapy
28.1
Chemotherapy
25.4

Main Findings
  • Tumors confirmed as ER positive (n = 402)
    • Median follow-up: 6.1 years
    • Median age of cohort: 63 years
    • PgR positive, 60%
    • HER2 positive, 12.7%
  • HER2-positive status associated with lower DFS rates at 2.5 and 5.0 years
Characteristic, %
DFS at 2.5 Yrs
DFS at 5.0 Yrs
Overall
87.7 (86.1-89.3)
80.7 (78.7-82.7)
  • PgR status
    • Positive
91.7 (89.9-93.5)
86.0 (83.7-88.3)
    • Negative
80.7 (77.4-84.0)
71.8 (68.0-75.6)
  • HER2 status
    • Positive
74.5 (68.4-80.6)
70.5 (64.1-76.9)
    • Negative
90.1 (88.5-91.7)
82.6 (80.5-84.7)
  • Univariate analysis of factors significantly associated with DFS
    • Tumor size: P < .001
    • Grade: P < .001
    • Nodal status: P < .001
    • PgR status: P = .002
  • Multivariate time-dependent analysis between HER2 status and time dependant term
    • ≤ 2.5 years, HR: 2.54 (95% CI: 1.21-5.32)
    • > 2.5 years, HR: 0.33 (95% CI: 0.10-1.11; P = .004)
  • Peak in annual recurrence rate at 2 years in HER2-positive group
Reference

Mansell J, Tovey S, Angerson WJ, Wilson CR, Doughty JC. The tnfluence of HER2 status on the recurrence pattern in oestrogen receptor positive (ER+) early breast cancer (EBC). Program and abstracts of the 32nd Annual San Antonio Breast Cancer Symposium; December 9-13, 2009; San Antonio, Texas. Abstract 4045.
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Blessings and Peace,
Barbara

DX Oct 02 @ age 52 Stage 2B Grade 3 Mastectomy
"at least" 4.5 cm IDC 1+node ER+61% /PR-
Assiciated Intraductual component with Comedo Necrosis
Her2+ FISH8.6 IHC 2+
5 1/2 CEF Arimidex
Celebrex 400mg daily for 13 months
Prophylactic mastectomy
Estradiol #: 13
PTEN positive, "late" Herceptin (26 months after chemo)
Oct 05: Actonel for osteopenia from Arimidex.
May 08: Replaced Actonel with Zometa . Taking every 6
months.

Accepting the gift of life, I give thanks for it and live it in fullness.
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Old 02-16-2012, 01:08 PM   #22
tricia keegan
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Re: Risk of Recurrent Disease in HER2-Positive Patients

Jean I was curious to know if you ever got a comment/opinion from Dr Slamon on whether to remain on an A1 past five years or whether he felt a Herceptin boost was needed after this time??
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Tricia
Dx July '05 IDC 1.9cm Triple positive 3/9 nodes positive
A/C X 4 ..Taxol/Herceptin x 12 wks then herceptin 1 yr
Rads x 36 ..oophorectomy August '06
Currently taking Arimidex..
June 2011 osteopenia/ zometa x1 yearly- stopped Zometa 2015 as Dexa show normal bone density.
Stopped Arimidex July 2014- Restarted Arimidex 2015 for a further two years on the advice of my Onc.
2014 Normal Dexa scan
2018 Mammo all clear, still NED!
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Old 02-16-2012, 07:30 PM   #23
Jean
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Re: Risk of Recurrent Disease in HER2-Positive Patients

Hi Tricia,
I will reach out to him and ask him.
My onc. here on the East coast has advised strongly to stay on the AI. I have thought for a while that an
herceptin boost would be ideal...even if off label.
Let's see what he says.

Sending best wishes to all.
jean
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Stage 1, Grade 1, 3/30/05
Lumpectomy 4/15/05 - 6MM IDC
Node Neg. (Sentinel node)
ER+ 90% / PR-, Her2+++ by FISH
Ki-67 40%
Arimidex 5/05
Radiation 32 trt, 5/30/05
Oncotype DX test 4/17/06, 31% high risk
TOPO 11 neg. 4/06
Stopped Arimidex 5/06
TCH 5/06, 6 treatments
Herceptin 5/06 - for 1 yr.
9/06 Completed chemo
Started Femara Sept. 2006
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