BC friend recurred need links to articles...

[Soccermom]

need some info for friend that has been told that she may be able to be treated for recurrence to chest nodes (?) and wall with Herceptin. She is BRCA+, and was NOT her2 with her original diagnosis. Can anyone cite any studies regarding use of Herceptin in this case.

Thanks loads!
Marcia

[Bev]

I saw it yesterday but could not find. Herceptin seems to have similiar results for Her -. I'll go look in trash again. BB

[Bev]

The study was in Clinicalcareoptions.com this week. It's a continuing education credit site for docs. If you need log in or password data, let me know. Bev

[Soccermom]

Dear Bev, Thank you!
I Looked for the article but here are so many! Was the author Perez or Slamon? I do need a password and log in to access. Thanks again,Marcia

[dilly]

Are they saying that Herceptin is effective for Her2 negative cancers??? I do want to see that study!

[Bev]

Adjuvant Trastuzumab Benefit Seen in Both HER2-Positive and HER2-Negative Breast Cancers

Posting Date: June 08, 2007

Retrospective laboratory analysis^[1]
National Surgical Adjuvant Breast and Bowel Project (NSABP) study B-31 Summary of Key Conclusions


Clinical benefit of adjuvant trastuzumab seen consistently across all patient subsets defined by fluorescence in situ hybridization (FISH) or immunohistochemistry (IHC)
Benefit from adjuvant trastuzumab possibly not limited to tumors defined as HER2 positive by current definitions
Potential issues with HER2 status determination in adjuvant setting
HER2 expression may be a continuous variable; difficult to determine cutoff
Tumors with HER2/CEP17 ratio < 2 defined as HER2 negative, but can have HER2 expression
Confirmatory studies needed Background


Treatment with trastuzumab indicated for patients with HER2-positive breast cancer
HER2 positive defined as
HER2 protein overexpression
3+ staining by IHC
HER 2 gene amplification
HER2/CEP17 ratio > 2 by FISH
Criteria for HER2 amplification/overexpression determined from advanced breast cancer patient population treated with trastuzumab
Criteria not formally evaluated in breast cancer patients treated with trastuzumab in adjuvant setting
Current study evaluated benefit of adjuvant trastuzumab on DFS according to HER2 status assessed by FISH and IHC in women enrolled on NSABP B-31
NSABP study B-31 interim report: May 2005^[2] Summary of Study Design

[Bev]

Summary of Study Design

http://clinicaloptions.com/upload/oncology/conferences/clin%20onc%20june%202007/511_paikschematic_4.gif
Central laboratory analysis of HER2 amplification/overexpression
Samples with results by FISH: n = 1795
Samples with results by IHC: n = 1787
HER2 status by FISH and IHC correlated with DFS events by treatment arm Main Findings


HER2 assessments showed high HER2 false-positive rate
207 of 1795 cases (11.5%) HER2 negative by FISH
299 of 1787 cases (16.7%) HER2 negative by IHC
174 of 1795 cases (9.7%) HER2 negative by both FISH and IHC
Trastuzumab associated with consistent benefit in DFS across all subsets defined by either FISH or IHC

[Bev]

<table class="ccotable" cellpadding="0" cellspacing="0" width="500"> <thead align="left"><tr><th>HER2 Assessment
</th> <th> Patients, n
</th> <th colspan="2"> AC → P
</th> <th colspan="2"> AC → PT
</th> <th> Risk Ratio
(95% CI)
</th> <th> P Value
</th> </tr> <tr> <th>
</th> <th>
</th> <th> n
</th> <th> Events
</th> <th> n
</th> <th> Events
</th> <th>
</th> <th>
</th> </tr> </thead> <tbody> <tr> <td> FISH positive
</td> <td> 1588
</td> <td> 789
</td> <td> 160
</td> <td> 799
</td> <td> 85
</td> <td> 0.47
(0.36-0.61)
</td> <td> < .0001
</td> </tr> <tr class="alternate"> <td> FISH negative
</td> <td> 207
</td> <td> 114
</td> <td> 23
</td> <td> 93
</td> <td> 8
</td> <td> 0.40
(0.18-0.89)
</td> <td> .026
</td> </tr> <tr> <td> IHC positive (3+)
</td> <td> 1488
</td> <td> 740
</td> <td> 151
</td> <td> 748
</td> <td> 82
</td> <td> 0.48
(0.37-0.63)
</td> <td> < .0001
</td> </tr> <tr class="alternate"> <td> IHC negative
(0, 1+, 2+)
</td> <td> 299
</td> <td> 161
</td> <td> 32
</td> <td> 138
</td> <td> 10
</td> <td> 0.32
(0.16-0.65)
</td> <td> .0017
</td> </tr> <tr> <td> FISH and IHC negative
</td> <td> 174
</td> <td> 92
</td> <td> 20
</td> <td> 82
</td> <td> 7
</td> <td> 0.34
(0.14-0.80)
</td> <td> .014
</td> </tr> </tbody> </table> AC → P; doxorubicin, cyclophosphamide followed by paclitaxel; AC → PT; doxorubicin, cyclophosphamide followed by trastuzumab and paclitaxel.

No significant interaction between DFS benefit from trastuzumab and
HER2 protein level
HER2 gene copy number References

1. Paik S, Kim C, Jeong J, et al. Benefit from adjuvant trastuzumab may not be confined to patients with IHC 3+ and/or FISH-positive tumors: central testing results from NSABP B-31. Program and abstracts of the 43rd American Society of Clinical Oncology Annual Meeting; June 1-5, 2007; Chicago, Illinois. Abstract 511.
2. Romond E, Perez EA, Bryant J, et al. Docetaxel and cyclophosphamide followed by paclitaxel with or without trastuzumab as adjuvant therapy for patients with HER2-positive operative breast cancer: combined analysis of NSABP-B-31 and NCCTG-N9831. Program and abstracts of the 41st Annual Meeting of the American Society of Clinical Oncology; May 13-17, 2005; Orlando, Florida.

[Soccermom]

Thanks so much ,Bev!

[Adriana Mangus]

Just a question. Why did you get retested ror BRCA1,2. ?

I tested negative about 2 mos. Just wanted to know the need to get retested again. Thanks.

[Becky]

http://clinicaloptions.com/Oncology/Conference%20Coverage/Clin%20Onc%20June%202007/Tracks/Breast%20Cancer/Capsules/511.aspx