Question about FISH test

[Erin]

Hello Everyone,
I have been lurking for a few weeks reading posts and learning a lot. I am 50 years old and was dx 1/4/07 with RB DCIS and IDC, intermediate grade, stage 2. Er/Pr + HER2 +++

Had lumpectomy with sentinel node biopsy on 1/12/07. 3 of 3 nodes clean, one focally positive margin on the tumor due to its location against the chest wall. My HER2 status was confirmed using the FISH test, which came back 6.8. Will start 6 rounds of Taxotere/Carboplatin/Herceptin on 2/13, Herceptin to continue for 1 year. Rads and some kind of hormone therapy somewhere down the road.

Here is my question: Does the level of the FISH test have any relation to the relative agressiveness of the cancer? In other words, if your FISH comes back at 4.1 is that less agressive than 6.8? I know I need to ask my onc about it, but I will not see him again until next week. I was hoping one of you might have some info on it.

Thanks in advance for your help :-)

[Melinda]

Erin,
I asked about the same thing just today to my radiologist. She told me that FISH comes back either positive or negative. The 6.9 or 4.1 has nothing to determine how aggressive the HER2 is. THe test they are using for that is the ONCO. An expensive test that some insurance companies do not recognize. My does not BUT... the lab that does the test goes out of their way to assist. Just today they called me! Based on income they will defray a large portion of this test. They will appeal to your insurance company 3 times and keep fighting. They have a true sense that this test which DOES come back in a scoring mode is a valuable asset to oncs. I am currently waiting on mine to come back sometime in the next 2 weeks or so. It is not a test that you have to "study" for... they already have the tissue sample... all they do is to send it to their lab. THeir number is1-877-235-4349. They even assign you a case worker for any questions.
Hugs and prayers
Melinda

[mcgle]

My understanding is the more FISH+/IHC3+ you are, the more likelihood there is of herceptin being effective.

In my own case with a weakly positive FISH score (2.71) and an IHC score of 2+, there was no question of me having herceptin, given that I did not receive chemo either.

I am a year out, and so far, so good...

Mcgle (UK)

[janet11]

Hi Erin,
I was also on 6 3-week cycles of Taxotere, Carboplatin, and weekly Herceptin. Now that chemo is done, I'm doing Radiation with Herceptin every 3 weeks.

And I'm finally over the Taxotere -- my taste buds are almost totally back! That was the worst side effect -- each cycle more and more favorite foods tasted horrible (*smile*). But it was very doable. My first cycle was the worst because of the anticipation AND because I didn't know what to expect and so wasn't prepared. Then I found that Immodium countered diarrhea, Senekot nightly for the first 4 nights of treatment countered the constipation, and Biotene mouthwash countered "sewer mouth" (*grin*). Once I had those, the rest of chemo was quite doable.

So good luck with your treatment. FYI: My FISH test was 7.0 I wasn't told that that meant anything except "highly positive for HER2, so Herceptin is likely to help".

Janet

[CPA]

Erin,

Maybe this will help (and if I am wrong, I am sure that somebody will correct what I am posting).

As I understand, FISH measures the number of a specific gene on a certain chromosome. If you have too many (more than 2) then you are positive. It does not matter if you have 4, 5 or 12... Anything over the normal is too many.

The IHC test is essentially a stain done on specially prepared slides of b/c cells. The darker the stain, the more receptors present. If the slide is "clear" or lightly stained, you are a 0 or 1, while darker slides are 2 or 3. Becasue there is some interpretation involved in matching the color to the score, there is some room for error in this test, especially between 1 (negative) and 2 (positive).

So, the FISH actually checks for the genetic abnormality, while the IHC checks for the results of the genetic abnormality (too many receptors).

[tousled1]

From Breastcancer.org

There are two tests for HER-2:


IHC test (IHC stands for ImmunoHistoChemistry)

The IHC test shows if there is too much HER-2 receptor protein in the cancer cells.
The results of the IHC test can be 0 (negative), 1+ (negative), 2+ (borderline), or 3+ (positive).


FISH test (FISH stands for Fluorescence In Situ Hybridization)

The FISH test shows if there are too many copies of the HER-2 gene in the cancer cells.
The results of the FISH test can be "positive" (extra copies) or "negative" (normal number of copies).

Find out which test for HER-2 you had. This is important. Only cancers that test IHC "3+" or FISH "positive" will respond well to therapy that works against HER-2. An IHC 2+ test result is called borderline. If you have a 2+ result, you can and should ask to have the tissue tested with the FISH test.

[Erin]

Thank you all for the responses about the FISH testing. It was very helpful and put my mind a little more at ease (as much as possible right now!). I really appreciate your help on this.

Chemo starts next Tuesday and I am trying to stay busy and not think too much about it...and at the same time prepare...you know, a wig, some hats and scarves, lab tests, etc. It feels like such a count-down! Like walking the plank! I am more nervous about this than I was about the surgury :-(

I'll keep lurking and reading, and post again after the big event. Thanks again to all of you.

[CPA]

Erin,

In addition to the chemo drugs, you will probably be pre-medicated with a steroid (decadron), benadryl, tylenol and an anti nausea (zofran or compazine). You will probably also be given decadron to take for a few days after chemo and also a prescription for an anti-nausea medication as-needed. If your insurance will pay, you might want to ask specifically for zofran if your onc gives you compazine. It worked better for Jill than compazine, but it is $$$.

[caya]

Hi Erin,

I'm a newbie too, had my first chemo on January 25th. It wasn't bad at all. They gave me fluids and the anti-nauseant medication in the IV drip before the actual chemo drugs. It went very well, the entire experience for me ( and my husband who accompanied me) was pretty good - the nurses were very kind, the oncology pharmacist talked to us and gave me an information sheet on the 3 chemo drugs with all the possible side effects etc. An orderly came around handing out snacks, then sandwiches at lunch time as well as drinks - My oncologist came by a few times to check on me.

I started to feel a bit nauseous about 4 hours after I came home, so I took one of the anti-nausea pills, it did the trick. The onc. nurse told me to take these pills at the FIRST sign of the queazy feeling - "Don't be a hero" were her exact words. So I was a bit nauseous the first 3 days, lived on vegetable soups, soda crackers and ginger ale, but then I was okay. Over the past 2 weeks I have had the odd queazy day, so I took regular anti-nausea medication (here in Canada it is called Gravol) once in a while.

The onc. nurse told me that for my chemo cocktail (FEC) it would be about 2 weeks before my hair falls out - and here it is nearly 2 weeks later, and today as I put my fingers through my hair, it is coming out. So I am getting it buzzed off on Friday - I already have my 2 wigs and assorted hats ready.

Good luck Erin - you will be okay.

Best regards
Caya