HER2 amplification predicts breast cancer recurrence but not overall survival

[Hopeful]

http://www.abstracts2view.com/sabcs/view.php?nu=SABCS08L_1378

Hopeful

[gdpawel]

All the gene amplification studies can tell us is whether or not the cells are potentially susceptible to this mechanism of attack. They don’t tell you if one drug or combination is better or worse than some other drug or combination which may target this. There are differences.

The cell is a system, an integrated, interacting network of genes, proteins and other cellular constituents that produce functions. You need to analyze the systems’ response to drug treatments, not just one target or pathway.

Over the past few years, researchers have put enormous efforts into genetic profiling as a way of predicting patient response to targeted therapies. However, no gene-based test can discriminate differing levels of anti-tumor activity occurring among different targeted therapy drugs. Nor can an available gene-based test identify situations in which it is advantageous to combine a targeted drug with other types of conventional cancer drugs. So far, only a functional profiling has demonstrated this critical ability.

[Jackie07]

We need to be careful about reading statistics. The study covered from 2001, many years before Herceptin became a standard treatment.

Several members on this board have survived way past the predicted years with Herceptin and other drugs. Gene profiling adds about 3 months to our life at some monetary cost. I'm just not sure I would want to do that.

Can someone get the Insurance Companies to accept it as part of the standard procedure?

[gdpawel]

All I'm saying is there's no single gene whose expression accurately predicts therapy outcome.

I wouldn't see a problem trying to get private insurance companies to reimburse for functional profiling tests (Medicare already does). When you get to the new genetic/molecular profiling tests, the validation standard that private insurance companies is accepting for reimbursement is "accuracy" and not "efficacy." The essential "proof" is that all they have to do for these tests is that the test has a useful degree of "accuracy," not that the use of the diagnostic test improves clinical outcomes.

That's the exact same existing validation for every single test used in cancer medicine, from estrogen receptors to panels of immunohistochemical stains (IHC) to diagnosing and classifying tumor to Her2/neu and CA-125 to functional profiling tests (oncologic in vitro chemoresponse assays) to MRI's, CT Scans, Pet Scans and so on. All diagnostic tests have the same entitlement to be judged by the same validation standard as genetic/molecular profiling tests.