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Anyone know the significance of having her2, 3+++ ?
Any articles I can look at?
Do the pluses indicate that herceptin will work for me?
How do I know the Herceptin is working? Is there a measurable test to determine that?

Questions & more questions,
Diannes

There's a lot of information on this site ( try: http://www.her2support.org/her2.html ) and others (breastcancer.org is also a good place) about what it means to be HER2 positive. You'll get a better explanation reading that information than from our replies.

Or did you mean the specifics of three pluses rather than two pluses? The test that gives the result in pluses is the IHC test for HER2. A "FISH" test is considered more accurate and it gives the result as one number (although technically it's a ratio). Some labs and/or oncs will not retest a 3+ IHC using FISH. You can ask your onc to double check with FISH but most IHC 3+ are truly positive.

It does not seem that the degree of HER2 positivity has any relation to response to Herceptin. There was a small study posted here recently that said that they did see a relationship but there have been many larger studies that did not, and the experts say that they have no accurate way (yet) to predict who will be in the roughly 50% of those who respond to Herceptin.

I've wondered if the degree of HER2 positivity has any relation to prognosis (in the absence of Herceptin). Anyone know?

Debbie Laxague

Good questions. I will ask when I see my onco on December 5th. I wonder if I will go up to 52 weeks of treatment-which means another infusion the day after Christmas.
My Her2 + number was 3.8. The surgeon told me anything above 2 meant positive now that I know more I wished I would have asked more questions.

In the October issue of Reader's Digest, they tell of the new vaccine that is in the making. (Don't get excited--it's 5 years away...) But they say that Herceptin is most effective in women with high Her 2 levels. The big hope of this vaccine is to help women with lower levels of Her 2.

The one thing I can tell you (from my experience) is that I am still here after 9 years and I am Her2+++. I am ER/PR+ and fought stage IV Inflammatory (the worst of the worst when it comes to breast cancer). It's been in my liver once and lungs twice (presently). Both times, I responded/am responding rather well to Herceptin.

Everyone's cancer is different, so do NOT listen to anyone of your well meaning friends/acquaintances that tell you about someone they know and how easy it was, how hard it was or how they died a gruesome death. That is not what you need to hear right now. what you do need is to ask the right questions of the right people in the right place (which you are doing)...And do NOT listen to statistics. They are usually five years old based on treatments that are five years old.

Since your on Herceptin, you probably had a MUGA (aka gated pool) scan of your heart. That should be repeated every 3 months. Herceptin (like some chemo's) can damage your heart. If your rating goes down, your onc may give you some time off from the Herceptin, recheck your heart with another MUGA and then start the Herceptin again. Many of us have had this experience. I had to take a break the first time I took Herceptin. After 3 months, my heart was stronger than ever, and I started the Herceptin again. If you haven't had a MUGA scan prior to starting Herceptin you need to get one immediately and question your onc as to why you didn't get this important test.

After 3 months on the Herceptin, your onc should order either a PET, CAT or a PET/CAT (one test that does both at the same time). This will be compared to prior tests (again, if you haven't had one done prior to starting chemo/Herceptin you need to question the onc and maybe consider getting a new onc). Ask for a copy - actually you should be getting copies of ALL your reports, including pathology from the original biopsy. I don't know your history (surgery), but if the bc is/was anywhere outside of the breast, the scan should answer your question whether the Herceptin is working. Tumor marker tests are not always accurate (never worked for me), but your onc should be running that test too. If there has been an increase or decrease, that could also determine whether the Herceptin is working too. Talk to your onc and ask which tests he/she is/will be using.

Keep asking all the questions you have...

Hi -
Regarding your question of whether a high HER2 number will result in better response to Herceptin, I have heard from the top researchers at the cancer meetings (most in private conversations) that they DO think that if you have a high HER2 factor, the chances are very good for good response.

One thing you should be aware of is that there are FOUR known HER pathways. The HER 2 happens to be the target for Herceptin. Perhaps there is a way that a very strong HER2 signaling overshadows the other HER pathways allowing a better response with Herceptin therapy.

I spoke to more than one researcher at the AACR meeting last April who is working on this very question. It would be great to get some results of their studies!

Our kind of cancer can be very "smart" and figure ways to utilize the other HER pathways and circumvent the number TWO route, thereby rendering Herceptin useless against the cancer in its new incarnation.