to those who complain there is no good way to tell if the treatment worked/followup

[Lani]

seems minimal (come back if you break a bone, start seeing double with a terrible headache or turn yellow), would you participate if they had a trial like the one proposed below?:

ABSTRACT: HER2 status of bone marrow micrometastasis and their corresponding primary tumours in a pilot study of 27 cases: a possible tool for anti-HER2 therapy management? [British Journal of Cancer; Subscribe; Sample]
Discrepancies have been reported between HER2 status in primary breast cancer and micrometastatic cells in bone marrow. The aim of this study was to assess HER2 gene status in micrometastatic cells in bone marrow and corresponding primary tumour. Micrometastatic cells were detected in bone marrow aspirations in a prospective series of 27 breast cancer patients by immunocytochemistry (pancytokeratin antibody). HER2 status of micrometastatic cells was assessed by fluorescence in situ hybridisation (FISH), respectively in 24 out of 27. Primary tumour HER2 status was assessed by immunohistochemistry (CB11 antibody) and by FISH in 20 out of 27 of the cases. HER2 was amplified or overexpressed in five out of 27 (18.5%) primary tumours and in four out of 27 (15%) micrometastatic cells. In two cases, HER2 was overexpressed and amplified in primary tumour, but not in micrometastatic cells, whereas, in one case, HER2 presented a low amplification rate (six copies) in micrometastatic cells not found in the primary tumour. We demonstrated that negative and positive HER2 status remained, in the majority of the cases, stable between the bone marrow micrometastasis and the primary tumour. Therefore, the efficiency of anti-HER2 adjuvant therapy could be evaluated, in a clinical trial, by sequential detection of HER2-positive micrometastatic cells within the bone marrow, before and after treatment.

[Belinda]

Lani - thanks-you - you are brilliant at fossicking out these studies. I have read a lot of your posts and appreciated them enormously. I'd participate in a trial like this if they could take the bone marrow without too many complications. Any extra and more specific indicators would be useful. And this sort of study could generate new and more targeted research on HER2 targeted treatments.

Thanks again - B

[Lani]

J Exp Clin Cancer Res. 2006 Dec;25(4):487-93.
Bone marrow and sentinel lymph node biopsy in patients with breast cancer: from staging to ultrastaging?

Fortunato L,
Baldi A,
Farina M,
Campioni M,
Amini M,
Piro FR,
Costarelli L,
Pompili P,
Vitelli CE.
Departments of Surgery and Pathology San Giovanni-Addolorata Hospital, Rome, Italy. lfortunato@tiscali.it
Bone marrow (BM) biopsy has been suggested as an independent prognostic tool to improve staging in patients with breast cancer. Two hundred and ten consecutive patients operated for breast cancer from June 2000 to June 2005 who signed an informed consent were enrolled in this protocol. Patients underwent SLN biopsy, and lymph nodes were analysed with serial sections and stained with hematossilin-eosin and immunohistochemistry. At the end of the procedure a BM aspirate from the iliac crest was obtained and 5-10 cc of blood collected. A CEA specific nested reverse transcriptase (RT) polymerase chain reaction (PCR) assay was used to examine BM samples. Results were blinded to both patients and clinicians. The median age of the patients was 56 years (range 34-80), and the median tumor diameter 1,5 cm (range 0.2-4.5). BM aspirates were unsuccessful in ten patients, and RT-PCR was not technically feasible in seventeen women, leaving 183 patients available for analysis of results and follow up. SLN biopsy allowed diagnoses of occult metastases (micrometastases and isolated tumor cells) in 16% of patients (29/183). 25% of T1N0 patients (23/92), 35% of T2N0 patients (6/17), and 44% of N1-2 patients (32/72) were BM+ (p = 0.03). At a median follow up of 35 months 5/122 in the BM- group and 6/61 in the BM+ group have relapsed (p = 0.2), while 1/122 and 4/61 have died of disease (p = 0.04) In conclusion, ultrastaging of breast cancer patients may identify a substantial subgroup of patients N-/BM- who may not require adjuvant chemotherapy, as well as a subgroup N-/BM+ with a decreased survival who may need more aggressive therapies. Further follow-up is needed to confirm this hypothesis, and several studies are under way.
PMID: 17310838 [PubMed - in process]

[MJo]

Wow. 25% of T1N0 patients were BM+ in the Italian study. I sure am glad I took adjuvant therapy! I wonder if a Bone Marrow test will be routine in the future.