Know HER2 status w/out test?

[mts]

Hi all-
A friend of mine was recently Dx'd with BC and her onc told her she did not need a FISH. She said he was "very confident" that she was HER2 negative because of her ER/PR + and who knows what else...

She had the IHC (I think thats the acronym) and perhaps he is basing his conclusion off that. I had that test too and results were barely positive. Only after I had the FISH test did I find out just how aggressive it was.

I wonder if his advice is good... She really likes him and trusts him... and I am not sure if his telling her she does need FISH is good advice!

Maria

[Christine]

Maria,

Although both the IHC test and the FISH test both measure HER2 status, there is no correlation between the scores as they both assess a different part of the gene.

Refer to our Tests and Treatments page for more detailed info:

Tests and Treatments (http://www.her2support.org/a/newher2_004.htm)

The results of the IHC test would determine if a FISH test would be warranted. Generally if the IHC results are HER2 3+ , a follow up FISH test would be unnecessary. If on the other hand the results were HER2 2+ or
HER2 3, her onc should consider a FISH test.

As she has been recently diagnosed, she may want to consider talking to her onc about the Bayer ELISSA serum test. This will monitor the HER2 levels in her blood and may indicate if the current treatment is effective.


Hugs
Christine

[Lisa]

The HER2 level has no relationship to the estrogen or progesterine factors. Follow Christine's information and discuss it with the onc. Get the answers you need!

Love and light,

Lisa

[Gina]

Dear Maria,

First off, I think your friend is VERY LUCKY to have a knowledgeable friend like YOU!!! As I have posted before, in this day and age of an over-abundance of testing and empirical data...., there is NO NEED TO GUESS where being Her-2 positive or negative is concerned. Insist that your friend at least get the serum Her-2 test per Christine's post, if she hasn't already as she may have according to your note. I, personally, like to follow both the CA 27/29 and the serial serum Her-2 on a regular basis as the CA 27/29 is a bit further downstream and produces interesting graphs when charted together with the serum her-2. Plus, if your friend does turn out to BE ABSOLUTELY her-2 positive, the regular bloodwork will help monitor how much Herceptin she should have, how she is doing, if there are more lesions, etc. HOWEVER, and those of you who "know" me realize that it is RARE that I come out IN DEFENSE OF THE ONCOLOGISTS, BUT "in your friend's onc's defense...smile", let me just add this tidbit. I have been struggling with her-2 and herceptin for a LONG time (BC since '97/Herceptin alone since '99) and it has been my experience that Her-2 mediated cancers do LEAVE what I would call a DISTINCT IMPRINT, a signature, if you will (remember the Cloaked ships from Startrek??? smile); therefore, I do actually believe that it is possible that her ONC, if experienced with her-2 mediated cancers can practically "smell it" There are many clues besides agressive tumor growth. For instance, if one sees a consistently HIGH flag on the PROTEIN section of the Blood Chemistries, this is at least suspicious of Her-2, as her-2 mediated cancers over-express the her-2 protein, raising over all protein levels in the blood. There are other "hints". Consistently HIGH GRANS, low LYMPHS, LOW bile, HIGH liver enzymes (esp. GGT) , and HIGH ALP, in the case of bone mets. A truly good Hemotologist/oncologist has been trained to see various patterns in the bloodwork and when he or she compares them to the scans and the actual physical exam of the patient, many times they most likely "can intuit" the presence or absence of HER-2, but STILL FOLKS...REMEMBER NOTHING BEATS SEEING THE EMPIRICAL DATA FOR YOURSELF..BE SURE YOUR FRIEND GETS THE BLOOD TESTS REGULARLY...sign me...Doubting Thomas in DC..hee hee --GINA P.S. for those interested here is another really good LAYMAN's article on the Serum Her-2 blood test (Gee, I swear, I should get kick backs hee hee hee for promoting the serum test so, but SERIOUSLY, it has been REALLY, REALLY helpful to me and other friends I know.

Her-2/neu Testing
Also known as: c-erbB-2
Formally known as: Human epidermal growth factor receptor

How is it used?
When is it requested?
What does the test result mean?
Is there anything else I should know?


How is it used?
Her-2/neu testing is used to help determine how aggressive a breast cancer tumour is likely to be.

It is also used as a predictor of response to therapy, such as hormone therapy and chemotherapy.

The serum Her2/neu test is sometimes used to monitor cancer therapy. If the level is initially elevated then falls, it is likely that treatment is working; if it stays elevated, treatment is not working; and if the level falls then rises, the cancer may be recurring. [This has been my experience, when the serum numbers were high, the cancer was progressing, when the seurm numbers were 12 or less, the cancer was being controlled by the Herceptin alone (plus diet).]

When is it requested?
Her-2/neu testing is recommended as part of an initial workup of invasive breast cancer and is sometimes done with recurrent breast cancer. It is not diagnostic but helps the doctor determine treatment options and understand more about the tumour’s characteristics.

Serum Her-2/neu is sometimes requested initially to establish a baseline and then, if elevated, used to monitor cancer treatment. However, this method is not widely used because levels are only elevated when a large amount of cancer is present so early cancers are likely to be negative for serum Her-2/neu. [This has NOT been my experience in actual practice. I have found that the serum Her-2 is often the first signaler that there is a problem...often going out of range WEEKS before the CA 27/29 does (which is further downstream) and MONTHS before new lesions can be spotted on CT scans...FYI.-GP]


What does the test result mean?
If an IHC Her-2/neu test is positive, it means that the Her-2/neu gene is over-expressing (producing more than a normal amount of) the Her-2/neu protein. If a FISH test is done, then amplification (production of too many copies) of the Her-2/neu gene can be detected. If either of these is positive, then the patient is likely to have a tumour that is aggressive, that will respond poorly to hormone treatment, and that will be resistant to chemotherapy. These patients may be considered candidates for Herceptin therapy.

If the IHC is negative but the FISH is positive, the patient still may benefit from Herceptin, but if both are negative, the treatment will not be useful [In my experience with others using these markers, this has been the case..., rarely, but still on occasion, you will find someone who does not show Her-2 on the tumor with the FISH but it will later be found in the blood thanks to the Serum Her-2 testing and these folks indeed do respond well to Herceptin. Conversely, though, one must be careful as timing is EVERYTHING. A person who had a tumor test positive for Her-2 with the FISH, can have a "NORMAL" serum her-2 following treatment, if the treatment has been successful, whether Herceptin was included or not. Sometimes CAF or Taxotere can bring the markers within normal range, for a time. So, one must take the serum marker over time and WITH the CA 27/29 for more assured results. BUT, if NO her-2 can be proven to be involved, it is usually TRUE in practice, that the HERCEPTIN will be of no value..., but because of the innate trickiness and variable qualities of the Serum Her-2 which moves up and down with an amazing velocity, if the patient had NO OTHER HOPE and as the Herceptin is relatively non-toxic compared to other strategies..., in certain cases, I might still consider a couple of cycles just to BE ABSOLUTELY CERTAIN, especially if the cancer was exhibiting other properties similar to the Her-2 mediated cancers like being very agressive, perhaps inflammatory, and otherwise demostrating a blood signature. I think it would still be worth a shot, but that is just my opinion. I have no practice or studies to support it being used in these cases]

Is there anything else I should know?
Her-2/neu-positive tumours are susceptible to Herceptin (trastuzumab), a therapy that was created to target Her-2/neu protein. Herceptin, an antibody made in the laboratory, attaches itself to the excess protein molecules and inhibits the growth of the cancer. The development of this specialized therapy has increased the use of Her-2/neu testing. Herceptin may be used alone or with some chemotherapy agents but is only useful in those who have Her-2/neu amplification and protein over-expression.

Her-2/neu testing is not available in every laboratory. Both IHC and FISH require experience and special training to perform and interpret. Your doctor will probably send your sample to a reference laboratory and the results may take several weeks to return. [This has not necessarily been the case in my experience. Back in 2003, it was difficult to get and I had to go through Specialty Labs on the West Coast, but since late 2003, it has been readily availalbe from both Labcorps and Quest and MANY other labs around the country and is no more difficult to draw than a CBC and the results come back in as little as 2 to 4 business days, at least that has been my experience here on the EAST coast in the DC area.]

It takes a small amount of cancer tissue to perform the Her-2/neu test. If a sufficient sample is not available, your doctor may try running a serum Her-2/neu test and/or make an assumption that you are Her-2/neu-positive in order to broaden your treatment options.

This page was last modified on May 20, 2004.

[Kristin]

FISH is the gold standard for HER 2 testing, I use to do this at my last job. IHC can be on the border line positive but FISH can be definetively positive. I would urge your friend to get her doctor to perform FISH on her biopsy. They can use the same block for testing as they did for IHC. Better safe then sorry.
Kristin