Her2 and mets

[embur102]

Hi all!
One year ago today was my diagnosis, and I am a bit contemplative today.

One burning question....is the degree of positivity of HER2 related to the rate of metastasis? i.e. I am HER2 +++, is my chance of mets higher?

I have googled this, also, but I always find personal feedback from people-who-know most helpful.

Blessings to each and every one of you courageous and beautiful HER2 women!!

Happy Spring

[Midwest Alice]

Hi, I'm interested in seeing if my answer is correct. The +++ means how well the cancer may respond to targeted treatment. So the more + the better? There are many who know a lot more than I do . They will tell us. Good question. Make it a great day.

[carlatte7]

I was +++ also and certainly responded well...wondering the same thing last week on my anniversary date

[Mtngrl]

Happy cancerversary! Congratulations. You made it through a hellish year.

I think it's natural to think about what you're thinking about. Humans have an innate need for order, predictability, understanding.

Having said that, though, you're not going to get it in this case.

My advice is to live your life as fully, gratefully, and joyfully as you can, so that whatever happens, and whenever, you don't have too many regrets. This is good advice for anyone, of course. People who've had cancer are just much more likely to take it.

[Mtngrl]

Well, Karen, then happy cancerversary to you as well.

I'm thinking of going to Ireland for mine.

[Jackie07]

Happy cancerversary!

My diagnosis in 2007 was also a 2B. I wasn't able to complete the one year Herceptin due to heart issues. But so far so good.

I think the H+++ (Grade 3) means the cancer cells divides faster than Grade 2 (more copies of Her2 genes are found), thus mor aggressive. But it could also mean that it responds better to Herceptin.

Went through genetic testing, but did not take preventive measures until another cancer incident happened to my family. Though all three of us have different cancers, they are sort of related (HNPCC). So I did a prophylactic hysterectomy/oophorectomy. The surgeon said there was hyperplesia on the lining of the uterus already. So the preventive measure was the right move.

[Debbie L.]

Good morning. Happy anniversary to all.

I remember asking the same question (what does level of HER2 mean) and not getting any answers. I thought I remembered a good explanation of this on this website but I can't find it this morning. Maybe someone else knows the way?

First of all, HER2 +++ (3+) is the report from one way of testing for HER2. Cancers that test 1 or 2+ (+, ++) by this method (IHC) are not considered to be HER2 positive, although the 2+ ones are usually double-checked by another method (see below). So almost, if not all of us on this list have or had HER2+++ (3+) cancer. Reporting it as HER2 +++ simply means "HER2 positive". That doesn't really say anything about how much HER2 there was, compared to other HER2 positive cancers.

But as with everything else, it's not quite that simple. The newer (but not necessarily better) test for HER2 is called FISH, and it reports out a number (a ratio but it's written as just a number). For that test, above 2 is usually considered HER2 positive. As I said above, if the IHC test is done first and comes back 2+ or 3+, typically it's double-checked with a FISH assay. The FISH report does quantify the amplification of HER2. So you'll see HER2+ that has a FISH of 2.5 and those that have FISHes well above 10 -- a wide range and all are "HER2 positive". Most of the research that has tried to link the level of FISH to either outcome (prognosis) or response to Herceptin has not been able to see any correlation.

To further muddy the waters, it's interesting that they are actually doing studies now of HER2 targeted treatments (Herceptin and/or vaccine) for those who are technically considered HER2 negative but are now being called "HER2 low expressing" because the cancer has some HER2 (1 or 2+) but not enough to be called positive by current standards (less than 2 on the FISH assay).

Here's a pretty good explanation of the tests, if you want to know more, but it doesn't answer your question either (smile). http://www.nccn.com/about-nccn-com/6...-category.html

There have been a few small studies that seemed to find some correlation between HER2 level and outcome (or response) but most have not. I did see something very recently about response to TDM-1 being better in higher levels of positivity. Okay, here's one write-up of that (it was at AACR), and it's not FISH they used. They tested for HER2 in yet another way (mRNA). They only report differences in response for the T-DM1 arm, not for the xeloda/tykerb arm. Or at least, if that was different, it's not mentioned in this article. One subgroup analysis is not enough to give us an answer but I'm sure they will keep looking. http://www.oncologynurseadvisor.com/...ticle/288201/#

So the answer to your question is sort of "no". First of all, 3+ is not necessarily "high", it's just positive. And if it were high, we don't know what that means but probably it doesn't mean anything, or someone would have figured it out by now.

Debbie Laxague

[AlaskaAngel]

To that I'll add that the assumption has been that the chemo works better on faster-dividing (aggressive) cancers, whether or not the trastuzumab does -- and breast cancer that is determined to be HER2 positive (HER2+++) is more often judged to be made up of faster-dividing cells.

Yet chemotherapy may not be as useful as combo monoclonal antibodies for some of these faster-dividing cells, if the information from the lapatinib-trastuzumab combo but no-chemo trial is accurate as more time goes by.

And there also may be some hormonal effect upon the fast-dividing cancer cells for those who are hormone-receptor positive, in that those patients tend to recur later than HR- patients, if they do recur, whereas if a HR- patient can get past the first few years they tend NOT to recur later on.

Mixed in with that is that we do not have information telling us how many patients may recur due to the chemotherapy itself or perhaps its support drugs or both.

A.A.

[Lien]

The bottom line is: we really don't know. What we do know is that for Her2 positive cancer we have an extra set of treatments that can be very effective. You could see it like this: all cancers are different and some are immune to some kinds of treatment. Yours is vulnerable to both Her2 targeted therapies and those that attack the Estrogen receptor. Meaning that you have more arrows to shoot at the cancer with.

I've heard people say that nowadays Her2 positive cancers are easier to treat than some of the other types. I'm not sure this is true, but until we know for sure, I hang on to that theory.

Jacqueline