stats on breast cancer prognosis by subtype--large 20 year study by Kaiser

[Lani]

I read the article itself and Luminal Bs were ER or PR+ her2+ (Luminal B is not always defined that way)

Some patients were lost to followup when their insurance coverage changed from Kaiser to something else



Study Finds Least Aggressive Form of Breast Cancer Still Poses Risk for Death Years Later
[Kaiser Permanente]

PASADENA, Calif. — Women with the most common and least aggressive subtype of breast cancer were still at risk of death from the disease more than 10 years after diagnosis, according to a Kaiser Permanente study published in the journal Cancer Epidemiology, Biomarkers & Prevention. Kaiser Permanente Department of Research and Evaluation

The 21-year study included nearly 1,000 women from Kaiser Permanente Southern California and found that molecular subtypes of breast cancer were important independent predictors of breast cancer mortality. In particular, women with luminal A tumors — a subtype of breast cancer that is generally thought to have the best prognosis — were still at risk for death from the cancer more than 10 years after diagnosis.

Researchers also found that women with HER2-enriched and luminal B tumors had roughly a two-fold increased risk of death from breast cancer compared to women who are diagnosed with luminal A tumors, a finding that is consistent with previous studies.

"The findings of this study indicate that it is important to consider breast cancer molecular subtypes in determining the optimal treatment for women with breast cancer," said study lead author Reina Haque, PhD, MPH, from Kaiser Permanente Southern California's Department of Research & Evaluation. "Women with luminal A tumors — the least aggressive but most common cancerous breast tumor — could benefit from extended treatment to improve their chances for long-term survival."

Breast cancer tumors are often divided into four molecular subtypes:

luminal A, which tends to have the best prognosis with fairly high survival rates;
luminal B, which typically occurs in younger women and has a poor prognosis;
the basal-like subtype, which also tends to occur in younger women, as well as African American women, and has a poor prognosis;
and the HER2-enriched subtype, which has a fairly poor prognosis and is prone to early and frequent recurrence and metastases.
Of the four subtypes, luminal A is the most common and is responsible for 42 percent to 59 percent of all breast cancer cases.

Breast cancer is the second-leading cause of cancer death in women and will be responsible for nearly 40,000 deaths among U.S. women this year, according to the American Cancer Society. The risks for developing breast cancer increase as a woman ages, while other factors include genetics, personal health history and diet.

"These and earlier findings strongly support molecular subtypes as important independent predictors of breast cancer mortality," said Haque. "It is important for women with breast cancer, even those diagnosed with the least aggressive form of the disease, to be an advocate for their own health and speak to their doctors about treatment options."

Researchers suggest that future breast cancer studies should focus on identifying factors that are associated with longer survival in women with luminal A tumors as well as how the association between breast cancer molecular subtypes and survival varies by race and ethnicity, particularly in minority women who are more likely to have aggressive tumor subtypes.

This study is the latest Kaiser Permanente research effort to understand the effects of breast cancer. In January, Kaiser Permanente Colorado Institute for Health Research contributed to new research that reveals substantial differences — by both surgeon and institution — in the rates of follow-up surgeries for women who underwent a partial mastectomy for treatment of breast cancer. The differences, which cannot be explained by a patient's medical or treatment history, could affect both cancer recurrence and overall survival rates, according to the study.

And last year, research scientists at the Kaiser Permanente Northern California Division of Research found that breast cancer survivors who experience significant weight gain have an increased risk of death after diagnosis and were 14 percent more likely to experience a cancer recurrence compared to women whose weight remained stable following diagnosis.

The original study was funded through the California Breast Cancer Research Program. Additional work was supported by the National Institutes of Health/National Cancer Institute (R01CA136743-01) and the Breast Cancer Research Foundation.

Other study authors included Syed A. Ahmed, MD, Galina Inzhakova, MPH, Jiaxiao Shi, PhD, Chantal Avila, MA, Shelley M. Enger, PhD, and Jonathan Polikoff, MD — all from the Kaiser Permanente Southern California Department of Research & Evaluation; Leslie Bernstein, PhD, of the City of Hope Department of Population Sciences; and Michael F. Press, MD, PhD, of the University of Southern California Norris Comprehensive Cancer Center.

ABSTRACT: Impact of Breast Cancer Subtypes and Treatment on Survival: An Analysis Spanning Two Decades
[Cancer Epidemiology, Biomarkers and Prevention]

Background: We investigated the impact of breast cancer molecular subtypes and treatment on survival in a cohort of medically insured women followed for more than 20 years.

Methods: We examined 934 female members of an integrated health care delivery system newly diagnosed with invasive breast cancer between 1988 and 1995 and followed them through 2008. Tumors were classified into four molecular subtypes on the basis of their expression profile: luminal A; luminal B; basal-like; and HER2-enriched. We followed women from the surgery date to death, health plan disenrollment, or study's end. HR and 95% confidence intervals (CI) were fit using Cox proportional hazards models adjusting for cancer treatments and tumor characteristics.

Results: A total of 223 (23.9%) women died because of breast cancer during the 21-year study period. Compared with women with luminal A tumors, women with HER2-enriched (HR 2.56, 95% CI 1.53-4.29) and luminal B tumors (HR 1.96, 95% CI: 1.08-3.54) had roughly a two-fold increased adjusted risk of breast cancer mortality. In addition, the survival curves suggest that risk of late mortality persists in women with luminal A tumors.

Conclusion: Among women with health care coverage, molecular subtypes were important predictors of breast cancer mortality. Women with HER2-enriched tumors and luminal B subtypes had the poorest survival despite adjusting for important covariates.

Impact: In a cohort followed for more than 20 years, women with HER2-enriched tumors had worse survival, but interestingly, the survival curve for women with luminal A tumors continued to steadily decline after 10 years of follow-up.

[bejuce]

Ouch. This is depressing. So HER-2+/ER+/PR- is luminal-B and has a 2-fold increase risk of death? Any data on whether the risk drops after a few years of remission?

I think I'm going to bed now and cry.

[JennyB]

Bejuice dont cry this study is over 20 years so for the larger part Herceptin wasnt' around.
My Onc just collated his first 5 year stats for Herceptin receivers and out of 127 Her2 positive, adjuvant Herceptin receivers only 3 have relapsed!! Now I know that is a small group but even he admits its pretty impressive data and when I pushed him he even admited that that was better than the non Her2's for that time period!!

So don't be sad be happy that we have Herceptin and other drugs in our arsenal!

Jenny

PS These results were from Perth, WA Australia and covered, I believe, the whole state

[Jackie07]

And we've got newer weapons to combat recurrence:

Ann Oncol. 2012 Aug 29. [Epub ahead of print]
Pertuzumab: new hope for patients with HER2-positive breast cancer.

Capelan M, Pugliano L, De Azambuja E, Bozovic I, Saini KS, Sotiriou C, Loi S, Piccart-Gebhart MJ.
Source

Department of Medicine, Institute Jules Bordet, L'Université Libre de Bruxelles, Brussels.

Abstract

BackgroundHuman epidermal growth factor receptor 2 (HER2) overexpression is detected in approximately 15% to 20% of all breast cancers (BCs). A revolutionary change in the prognosis of this subgroup of patients has occurred since trastuzumab therapy was introduced into daily clinical practice. However, because trastuzumab resistance is common, new molecules with complementary and/or synergistic mechanisms of action have been developed. Pertuzumab is a new anti-HER2 humanized monoclonal antibody that prevents the formation of HER2 dimers.Material and methodsA computer-based literature search was carried out using PubMed (keywords: breast neoplasm, dimerization, HER-2, pertuzumab); data reported at international meetings are included.ResultsThis paper describes pertuzumab's mechanism of action, safety, and role in HER2-positive BCs. It also explores the role of pertuzumab as a single agent or combined with trastuzumab by reviewing data from preclinical research to ongoing clinical trials. Recently published trials, particularly the CLEOPATRA study, highlight the efficacy, tolerability, and increase in disease-free survival associated with this novel agent when combined with trastuzumab.ConclusionThe pertuzumab and trastuzumab anti-HER2 dual blockade is likely to represent a substantial advance for patients with HER2-positive BCs and a new milestone on the way to personalized medicine.

[caya]

I'm a Luminal B as well (triple +), so at first glance I was upset to see this. But as Jenny pointed out - this is a 21 year old study. Herceptin was not routinely given to early stagers until 2005-2007, and we all know how the stats changed dramatically after that.

I wish they would add a little "p.s." at the end of these depressing, outdated studies to reflect this.

all the best
caya

[Jean]

Bejuice you are in good company ...Becky and I are the same as you....

remember what Bob Dylan said...
"times are a changin"

this study is like our laptops and desk computers....
within a year or two they are outdated.
Herceptin has changed the picture.

jean

[Laurel]

Hear, Hear, Jean! I am with you and Caya, a triple positive "Lumi-B" gal myself! When I read stats like these I just so wish I had a penis so I could go p*ss in the wind! Guess I'll just have to stick out my tongue and make rude noises or thumb my nose! HA!

PS. Lani, please know I would not be peeing or making rude noises in your general direction because I really am appreciative of the post and information. I just get feisty and determined to defy the odds.

Ya know, as I look at Jean's eloquent post and think about this one following it....well, let's hope this gets a laugh because eloquent it ain't!