Her2+ early bc patients and local recurrence

Hopeful · 10-31-2006, 03:47 PM

The authors are affiliated with the Abramson Cancer Center at the Univeristy of Pennsylvania, Philadelphia, PA

The Breast Journal
Volume 12 Page 431 - September 2006
doi:10.1111/j.1075-122X.2006.00297.x
Volume 12 Issue 5 ORIGINAL ARTICLEThe Impact of HER-2 Status on Local Recurrence in Women with Stage I–II Breast Cancer Treated with Breast-Conserving TherapyEleanor E. R. Harris, MD, Wei-Ting Hwang, PhD Eric A. Lee, Keith A. Cengel, MD, PhD, Michael D. Feldman, MD, PhD, Angela DeMichele, MD, Gary Kao, MD, PhD, and Lawrence J. Solin, MD
Abstract: This study was undertaken to determine whether overexpression of the oncogene HER-2 is associated with an increase in local recurrence in women with early stage breast cancer treated with breast-conserving therapy (BCT). A retrospective review of the medical records of all women treated with stage I–II invasive breast cancer from 1991 through 2001 was performed. Of 596 eligible patients treated in that time period, immunohistochemical testing for HER-2 expression was performed in 352 patients (59%): 266 patients (76%) were HER-2 negative and 86 patients (24%) were HER-2 positive. Median follow-up was 5.4 years. The patient characteristics for the two groups were compared for age, pathologic T and N stage, number of positive nodes, estrogen receptor (ER) and progesterone receptor (PR) status, radiation treatment, and use of hormonal therapy or chemotherapy. There were no significant differences in any of these parameters between the two groups (all p ≥ 0.10). Local recurrence at 5 years was 2% in the HER-2-negative group and 0% in the HER-2-positive group (p = 0.15). There was no difference in local recurrence after BCT between HER-2-positive and negative breast cancers at 5 years. Therefore HER-2 overexpression does not appear to be a contraindication to BCT.

Hopeful

Lani · 10-31-2006, 05:01 PM

it looks like being her2+ does not make local recurrence more likely (than if tumor was her2-) when treated with lumpectomy with radiation therapy.

If only the rates of distal metastasis were equally low!

As part of my review regarding whether the risks outweighed the benefits of radiating an 84 year old patient with a her2+ breast cancer I came upon the only article discussing the rate of local recurrence (and distal metastasis/overall survival)in elderly her2+ patients treated with BCT with radiation therapy.

I thought others might benefit from it--including Tom:

Lani · 10-31-2006, 05:03 PM

Am J Clin Oncol. 2006 Feb;29(1):71-9.
Impact of Her-2 Neu overexpression on outcome of elderly women treated with wide local excision and breast irradiation for early stage breast cancer: an exploratory analysis.

Poltinnikov IM, et al

Department of Radiation Oncology, Kimmel Cancer Center of Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, PA 19103, USA. igor.poltinnikov@mail.tju.edu
OBJECTIVE: The purpose of this study was to investigate the prognostic significance of Her-2 neu status in elderly patients managed with breast conservation strategy for stage I-II breast cancer. METHODS: We conducted an IRB approved retrospective review of 153 women age 70 and older with stage I-II breast cancer, managed with wide local excision and breast radiation between January 1997 and December 2002. The subset of 106 patients had a known Her-2 neu status and was analyzed for primary patient and tumor characteristics. These characteristics were correlated with cause specific survival (CSS), overall survival (OS), and combined nodal and distant failure (NDF). Her-2 neu positivity was confirmed with FISH HercepTestTM. Statistical tests included Cox regression, contingency table and Kaplan-Meier analysis. RESULTS: Median follow-up was 55 months and patient's median age was 76. Twenty two percent of patients were Her-2 neu positive and 78% were Her-2 neu negative. Her-2 neu positivity was significantly associated with high histologic grade (P = 0.008), T2 stage (P = 0.001) and positive axillary lymph nodes (P = 0.02) among 73 patients who had surgical assessment of axilla. Overall, only 15 patients (14%) received chemotherapy. There were no recurrences in the breast. Her-2 neu positivity predicted for NDF and CSS on multivariate analysis. Projected 5-year freedom from NDF was 70% for Her-2 neu positive and 97% for Her-2 neu negative patients (P < 0.01, log-rank). CSS was 86% for Her-2 neu positive and 98% for Her-2 neu negative patients (P < 0.01, log-rank). OS was no different between Her-2 neu positive and Her-2 neu negative patients (80% versus 85%, P = 0.25). CONCLUSIONS: Her-2 neu amplification predicts development of NDF and negatively influences CSS, but not local control or OS in elderly patients treated with breast conservation. Similar to the trend in younger patients, Her-2 neu positivity may be used in the future to consider more aggressive treatment strategies in elderly patients.

Hopeful · 10-31-2006, 06:16 PM

Lani, it seems that Her2+ cells like to wander; not many stay-at-homes in the bunch. I have read articles discussing distant vs. local recurrence, which have concluded that the two are driven by entirely different mechanisms. That would certainly explain the difference in Her2+ results. At least we have found one area where we are not worse off than Her2- !

I look continue to look forward to your articles. Thanks for posting.

Hopeful