Relapse HISTORY for her2+S

RobinP · 09-15-2006, 08:20 AM

I see that many are interested in the relapse history for her2+s. If you look at the 2006 ASCO, there is a virtual presentation, I believe by Winer, that charts some of the relapse natural history to date. From that data it is clear that her2+ bc can and do relapse after the 18-24 peak, albeit less frequently. I would ONLY presume that the relapse time MAY be delayed in cases of hormonal positive and in very early stage disease where it takes longer to seed and spread cancer.

SusanV · 09-15-2006, 09:32 AM

Hello Robin,

Could you direct me as to how I could find the ASCO information that your referenced ?

Many thanks !!!

Lolly · 09-15-2006, 12:52 PM

Susan, if you scroll to the bottom of this page, you'll find the "forum jump", which contains the ASCO 2006 forum where you should be able to find the link Robin mentions.

CLTann · 09-15-2006, 01:28 PM

I looked under forum jump on Asco highlights, but can't find the subject on relapse. Would appreciate it if you would be a little more specific, like pointing out the article in the number sequencing. Thanks.

Ann

Lolly · 09-15-2006, 04:52 PM

I can't find it, hoping Robin posts with some help.

dawbs · 09-15-2006, 04:57 PM

Try this link:

http://content.nejm.org/cgi/data/353/16/1673/DC1/1

Vicki

Yorkiegirl · 09-15-2006, 05:27 PM

YOu wrote<<<<From that data it is clear that her2+ bc can and do relapse after the 18-24 peak, albeit less frequently.<<<<

I have been freaked ever since I read this, this morning. Now I just have to go and find the article you mentioned.

Susan Rankin · 09-15-2006, 06:53 PM

This also freaked me out!!!! I want to read this article and then talk to my oncologist soon!

Susan

Becky · 09-15-2006, 07:22 PM

Don't let this freak you out. There is a natural relapse period for all breast cancer. All pathologies. For Her2+ and triple negative, the highest period of recurrence occurs within the first two years. This is also true for "run of the mill" bc that is only hormone positive. However, the "only hormone" positive bc also has a "blip" in relapse in the 7-9 year period (but this blip is smaller than in the first 2 years from diagnosis.

Now the article chronicals relapse after the first year of Herceptin. It is natural that this period would be the same period that is the most common for recurrences for Her2+ cancer. Who relapses? Well - the women who would - what I mean by this is that Herceptin does not work for everyone (about half) so half of those who would relapse do. But remember, even without Herceptin, not everybody relapses. More DO NOT relapse.

So, is it logical that if you received Herceptin through this vulnerable period that it would prevent relapse? The only way to start to really evaluate this question is when the Hera trial is completed so one can see if 2 years of Herceptin is better than one year (because 2 years will cover this "relapse" period).

Preliminary evidence is pointing to the fact that more does not improve the odds (it may "save" 1-3 women per thousand more - not statistically significant).

As good as Herceptin as an adjuvant is, it will not prevent the relapse for some. This will be more relevent and reliable when better tumor testing is available AND when clinical oncologists separate out these pathologies to analyze where the failure rates occur and address them with newer and better drugs (ie: do Her2+ and ER+ (and/or PR+) recur less when on Herceptin and an antihormonal or do ER/PR negatives do better on Herceptin. Do the failures come from women who are also Her1+ or some other tumor marker we don't even know anything about?)

So, I would not freak out over this. This vulnerable period exists regardless of drug therapy (be it Herceptin, Tamoxifen, AIs etc). It is a period that every woman with breast cancer has to live through and live beyond. With these drug therapies available and new technologies on the horizon, we have a very bright future in which to go out and live our lives fully.

Have a nice weekend

Kindest regards

Becky

Susan Rankin · 09-15-2006, 09:28 PM

Becky,

Thank you. I feel much better after reading your message.

After being off of Herceptin for three months now I feel as if I lost my security blanket.

Susan

Hopeful · 09-16-2006, 07:16 AM

This is a guess on my part, because I went searching for the article RobinP cited also. Go to http://www.asco.org/portal/site/ASCO...y&abstractID=3 and click on "slides" under Associated Presentations 1. Pre-operative therapy for women with Her2 positive breast cancer. Based on RobinP's description of what she read, this was as close as I could find.

Hopeful

RobinP · 09-16-2006, 08:19 AM

Boy, I didn't mean to stir the pot. I thought everyone knew that her2 bc could relapse after the peak period, again less frequently. My point of posting was to inform, rather than frighten as I notice lately some questions about late her2 reoccurences. Specifically, I wanted to let others know that there is a growing natural history for her2+ bc that is accumulating via the NCI and HERA trials concerning her2+ relapse. Part of that history was presented in the virtual 2006 ASCO presentation. It's been a while, I viewed this last spring, but I believe it was by Dr. Winer on HERA's data.

PS The above abstract is not what I was referring to. It is actually a line graph with observation and study group relapse mapped out from 0-36 months.

Lani · 09-16-2006, 08:24 AM

They have found (when looking at all breast cancers, not just her2neu+ breast cancers) that the peak of recurrence occurs x number of months (around 24 for her2+ and triple negative as Becky said,with another later "blip" peak of recurrence for those ER+her2-) after surgery NOT x number of months after the lump was discovered. In those who delayed after finding their lump or who were unable to get access to health care right away (this is a global disease) they found the peak occurred x number of months after the surgery even if the tumor had been there quite a long time before.

The thinking is that the surgery starts an inflammatory process and that the gene signature of breast cancer looks a lot like the gene signature of inflammation and that some of those growth factors etc let loose or stimulated by the act of surgery "start the clock ticking"

This is one reason why they are moving toward needle and core biopsies,
hoping to mimimize the inflammatory reaction by minimizing the surgery.
It is another reason why increased usage of preop MRIs to better define the extent of disease and minimize repeat operations to obtain better margins may improve cancer care in the future.

Noone it seems has studied whether the 1-5 day course of various types of accelerated partial breast irradiation produce more or less inflammatory cytokines but if/when the long term results of APBI come out, if they are better than conventional radiation this should be one avenue of research as to why.

It may be that breast cancer is indeed a stem cell disease and that the "tumors in waiting" are those slowly dividing cells in the bone marrow which get activated by inflammatory cytokines etc just like the mold in bathroom grout gets activated by moisture no matter how much you use Tilex or other bleach-containing compounds.

The group in Germany that has been advocating getting preop and post treatment bone marrow biopsies is starting a clinical trial to see how this would influence treatment and the course of disease. They need to test the bone marrow cells not only for cytokeratin but also double stain them for her2 neu as those with her2neu positive isolated tumor cells in the bone marrow have been shown to be associated with a much higher rate of recurrence than those in the graphs Robin P has pointed out. If this, or a more specific and accurate way of isolating circulating tumor cells can become more widespread and found indicative of residual disease there will be a way in those treated adjuvantly rather than neoadjuvantly ie, when there is no longer a tumor present to judge whether there is or is not a response to therapy, to assess whether the best treatment is being utilized.

Sorry to be so serious on a Saturday...Have a great weekend!

RobinP · 09-16-2006, 08:30 AM

Amen Lani, let's ALL lighten up, RELAX and enjoy the weekend. Take care everyone.

RobinP · 09-16-2006, 10:54 AM

A copy from another post of mine applies here too as a positive note:

These are quotes from the esteemed E. Perez, MD:

''Unlike ER-positive breast cancer, in which events are strung out over the course of 10 to 15 years, in HER2-positive breast cancer most of the events occur in the first five years and a lot of them occur in the first couple of years. That is part of the reason why, in each of these studies, we saw a dramatic benefit early on, even in the first year (Perez 2005b; Piccart-Gebhart 2005; Romond 2005)"

I guess Perez is basing her comments on retrospective studies which go back after the event and analyze data. According to Perez, survival after five years for her2+, er-, pr- is a milestone, not a guaranteed cure, but a certainly a positive milestone.

Of course, we'll get the full story , and perhaps a more accurate picture, of natural history from prospective studies like the HERA where data is analyzed as it is made.

__________________

Barbara H. · 09-16-2006, 11:21 AM

I don't mean to scare others, but my recurrence came 6 years later. I was having headaches for awhile and waited way too long to have them checked out. The mets were everywhere except the bones. After I started Herceptin in July, 04 my tumor markers were normal by the second or third treatment. My pet scan in March indicated no cancer except in the bones. I've been on Navelbine. I had at PET-CT scan yesterday. If all is well I will drop the Navelbine. If not, I will have to consider other options. I really wonder if my outcome would have been different had I been able to have Herceptin early on.

After six years I was feeling too safe, and the lesson for others is that we must question issues in our body that do not feel right and not wait to have them checked out.

Best wishes,
Barbara H.

lu ann · 09-16-2006, 08:16 PM

Hi Barbara,

I have been on xeloda for the last 2 months with very little side effects. It has been by far the easiest treatment I have been on. It is supposed to work well with herceptin and the new trial, tykerb. I havn't been on herceptin since Dec. 05.

I had a 5 1/2 month break from all but zometa for the bone mets. I started xeloda in August. I was on 4000mg dailly for 2 weeks, then 1 week off. Doc dropped me back to 3000mg daily, as my feet were swelling. I'm also on lasix.

If I don't qualify for the tykerb, I might ask Doc if I can go back on herceptin with xeloda.

Blessings from Lu Ann

RobinP · 09-17-2006, 06:45 AM

HERA is not the only adjuvant Herceptin study with history data. The NCI studies even have more data, as they have been going on longer.For those intereseted, you can see the NCI adjuvant Herceptin trials' natural history her2 data for zero to five years in the NEJM 8/20/05 issue.I subscribed to the online NEJM last year and saw this in their online supplement from the article about NCI studies in the methodology section of the article. I can't cut and paste it here, it doesn't allow that, you got to subscribe.

saleboat · 09-17-2006, 07:21 AM

Robin,

Is this the link that you're looking for? Vicki posted it above as well.

http://content.nejm.org/cgi/data/353/16/1673/DC1/1

I was under the impression that the data was from 'time of radomization' which I take to mean the time for first chemo.

In my particular case, I read the data as saying that after three years, I can breathe more easily.

Jen

RobinP · 09-17-2006, 07:33 AM

Yes, that is the link, funny I couldn't cut and paste it when I tried months ago, perhaps the NEJM has publically released it now. I concurr with you about time to randomization Saleboat, thanks for the clarification, it helped. Also, congratulations the graphs look good for your particulars, being three years out stage 3.