Triple positives (ER+,PR+,HER2+++)

[AlaskaAngel]

I wonder if the group of ER+, PR+, and HER2+++ (being a mixed combination) just has a tendency to recur later, whereas those who are ER-/PR- and HER2+++ tend to recur earlier? Do we have any ER+, PR+, HER2+++'s on board here who have recurred? If so, how far out?

This recent study doesn't answer my question but is interesting:

"Estrogen-receptor-positive breast cancer and the drug tamoxifen used to go hand in hand, but as researchers continue their quest to understand the behavior of breast tumors, they're learning that not all ER-positive tumors are created equal. Some respond better to tamoxifen than others do. The question is why.

A new study published in the Journal of the National Cancer Institute (September 7) may shed some light. The study analyzed ER-positive tumors from nearly 45,000 breast cancer patients to determine the characteristics associated with a poor response to tamoxifen. Researchers found that patients whose tumors contained both estrogen and progesterone receptors (PRs) were most likely to benefit from the drug. In contrast, tumors that lacked PRs were more likely to express higher levels of the growth-factor receptors HER1 and HER2. This combination (lacking PRs and expressing HER1 or HER2) makes for a more aggressive tumor that is less likely to respond to tamoxifen, and therefore is more likely to recur. Other studies have also discovered that unlike tamoxifen, the effectiveness of aromatase inhibitors (AIs) doesn't seem to depend on the PR status of a tumor.

What does this mean for patients? It's a controversial issue and the jury is not in, says Richard Elledge, M.D., medical director of the Breast Care Center at Baylor College of Medicine in Houston and the study's senior author. "But I and others feel that this can be used to decide when to initiate what kind of treatment." Those with an ER-positive tumor that also has progesterone receptors may be better off starting with tamoxifen and then switching to an AI later on, while those with an ER-positive tumor that is PR-negative may want to start with an AI from the beginning."

I am triple +, although ER/PR are actually at low %'s & my her2 at +3.

I remember one time when my onc nurse once mentioned to me that my cancer was somewhere between a good kind & a bad type. The good one would be hormone positive, so this cancer could be kept at better control w/ hormonal blockers. The bad type is the cancer w/ her2 overexpression.

Apparently, my cancer doesn't respond to Herceptin alone; in order for this to be much more effective, I would need to add a chemo drug to it.

I'm all out of hormonals options, in order for 6 months each which had kept me stable: Femara (brain met), Faslodex, and then Aromasin. They didn't bother to try me with Arimidex, cuz it works very similarly to Femara. They said MAYBE I could try Tamoxifen in the near future.

Currently, I am on Xeloda (3,300mg) & weekly Herceptin.

[Becky]

I am a pseudo triple positive. What I mean by that is that I am Her 2 (3+), 50% ER+ and less than 5% PR+ (which in some Dr.'s interpretation is negative but some say it is alittle positive).


Currently, I am taking adjuvant Herceptin (my year is up in mid June) and I had my ovaries removed so I could take Arimidex as I felt with my own research and that of this group, was a great adjuvant combo to try to prevent recurrence. I was lucky to be able to get Herceptin. I was almost 4 months out of chemo when the ASCO conference recommended anyone 6 mos or less out of chemo to get the Herceptin (so I am taking it like in the HERA study).

I have had no recurrence yet and hope not to. I was dx 8/04 with a 1.9cm tumor and one positive node (Stage IIA). Sept scans clear. Next month I am getting my first precautionary brain MRI.

Best regards

Becky

[jsattaw]

I'm 95% ER+, 5% PR+ and HER2+ --

I was first diagnosed in '98 (at 37 years old) but didn't know my Her2 status at that time. I did radiation, no chemo and no hormone treatment (had a baby in 2000). Recurred in May '05 -- and after adjuvant chemo am doing 1-year of Herceptin. I also had a complete hysterectomy and started Arimedex about 1 month ago.

Keeping my fingers crossed the combo of Herceptin and hormone treatment will keep any recurrences away.

My onc has not done any scans -- I was node negative both times. I will probably push for something in the new future for a baseline.

So...it was 7 years between the two cancers. I recurred in the same spot as the original -- right along the scar line and in the scar tissue from my lumpectomy.