FISH test

[michele u]

Ok, i had to have a FISH test on my tumor to get qualified for the vaccine trial. I hadn't had one before. My number was 10 !!!!!!!! I think most people's are 5 for a high number. What is everyone else's?

My FISH score is 9.4, started Herceptin off-label 2 months ago for a year .

Julie

Also Michele, which vaccine trial are you participating Seattle or PA. Seattle requires you to be menopausal, are you menopausal?

thanks

[michele u]

Julie,
I'm looking at Seattle. I had my ovaries out when i found out i had cancer.

Michele:

I was 6.9 and I started Herceptin off label last June for Stage !!B.

Mine was 3.16 signals per cell which probably explains why my doctor isn't pushing herceptin at this point.

Any correlation between how above 2 the FISH score is and aggressiveness/recurrence likelihood?

Rich and Michele,
No one knows for sure. What I have found, in a paper by Schwartz in Breast Cancer Research
2005, volume 7, claims that in his research tumors with FISH scores of 5 or 6( which I think they called moderately high) had no worse prognosis than those of 7 (which I think they called very high) and above when he looked at those which were treated with surgery and radiation alone WITHOUT ADJUVANT THERAPY. He went back and ran FISH studies on the preserved specimens of tumors removed from patients from many years ago.

But Rich I have found no papers analyzing the behavior/prognosis and best treatment of the few hormone-sensitive her2neu tumors compared with the vast majority of hormone-insensitive her2neu tumors in any great numbers and none comparing their FISH scores.

On MD Anderson's website is a proposal by Dr. Pusztai to divide all breast cancer into four categories which allow prediction of outcome and particularly efficacy of therapy:
1. basal-like(estrogen-negative)
2. luminal-like (estroge-positive)
3. normal
4. her2neu (mostly amplified, ie mostly positive by FISH)

What we all would like to know is where hormone sensitive, her2neu postive tumors fit into this scheme. Do they have the good prognosis and sensitivity to ai treatment of nonher2neu tumors or do they have the aggressive behavior necessitating herceptin treatment and does chemotherapy really do anything for them besides inducing menopause.

We all hope the ASCO meetings , especially the herceptin papers, will present some data differentiating how the hormone-sensitive her2neu patients did in comparison to the her2neu hormone insensitive patients.

Hopefully Genentech, having grabbed the biggest marketshare of patients (the 90% of her2neu patients who should receive herceptin) will now focus on some other groups in
to widen their sales slightly without much additional research expenditure. How about some trials of herceptin with ais in the non-metastatic setting? or with some less toxic chemo combinations for the frail/elderly population?

Hope this helps!

Lani


PS Michele, Is the Seattle trial only for node positive or metastatic her2neu breast cancer?

http://tinyurl.com/cg3ju

I was unable to access more than the abstract. How many her2neu hormone receptor postive patients did they follow?. How did they determine who was her2neu (ihc vs fish) and what were their fish scores? Thanks, Lani

for Rich and anyone else looking into this for yourself or someone you love:

another set of "results":

http://www.asco.org/ac/1,1003,_12-002636-0...19-00749,00.asp

How about a roll-call to see how many of www.her2support's members and guests are
hormone positive (and how positive)? My guess is that it is more than 10%!

Hope this helps,
Lani

[michele u]

Lani,
There are at least different protocol's. They are on the news section that tells about the clinical trials. then get on the washington vaccine website. or you can go to www.tumorvaccinegroup.org I know that there is a metatstatic study and the one that i'm trying to get inot if for stage2 and 3(i think) If you want more infro Lani, email me and i have the numbers directly to the Dr. there, Dr. Disis. She is very good about emailing right back with any question. My email is mulmer@mainstaycomm.net

Thanks Michele. Yes, I emailed Dr. Disis back in January. I was wondering if she had any new
trials since then. And yes, I did see the excellent summary of the trials on this website!

Just to confuse everyone even more there is a discussion of how different oncologists treat hormone positive her2neu positive breast cancer at http://www.patternsofcare.com/2004/2/adjuv...nal_therapy.htm

They comment that anecdotally it is especially the perimenopausal patients who get AIs who get the bothersome joint complaints. Anyone care to comment on how they have done with LHRHs
(gosrelin, lupron) and/or oophorectomy and ais (arimidex, femara or exemestane)?


Thanks again,

Lani

What does an "amplified 2.2" fish score mean? From what I've gathered it means positive but I'm not sure how much. I'm post menopausal (59), Stage 1, ER/PR+, small tumor (1 cm) and this is a recurrence. My oncologist is recommending Herceptin, Taxotere, and Cytoxin and is currently seeking insurance company approval prior to beginning administration. This is a new occurance of BC, my first occuring in '01 in the opposite breast. I got A/C for it and developed some heart weakening, as a result.

Can anyone comment on what my score means or whether these chemo drugs make sense in my case? I'd just like to be as informed as possible.

Thanks!

[michele u]

I think the FISH test starts at 2.2 and above being "amplified" or positive. So anything above 2.2 would be positive.The IHC test scores like 1+ 2+ 3+. So 3+ would be like a score of above 2.2 on FISH. That's how i take, i could be wrong