Often this question arises especially with new members
How Risky Are Small HER-2-Positive Tumors?
The major adjuvant trials of trastuzumab have centered on high-risk, node-negative or node-positive breast cancer. The benefit of trastuzumab in patients with small, node-negative but HER-2-positive cancers is not well established because the natural history of these lesions is not well known. Investigators from the M.D. Anderson Cancer Center reported on outcomes of tumors 1 cm or smaller as a function of HER-2 status.[4] This observational cohort did not receive either chemotherapy or trastuzumab, and thus the study does not permit one to know how each of these interventions might be of benefit. What was observed, however, was that prognosis clearly depended on HER-2 status. For HER-2-negative tumors, the 10-year risk for recurrence-free survival with T1abN0 breast cancer was 88% if the tumor was ER positive and was 80% if "triple negative." However, if the tumor was HER-2 positive, 10-year recurrence-free survival was only 62%. This observation suggests that even small tumors that are HER-2 positive carry a substantial risk for recurrence and might benefit from adjuvant treatment with chemotherapy and trastuzumab. This is consistent with current guidelines from the National Comprehensive Cancer Network, which suggest consideration of chemotherapy and trastuzumab for HER-2-positive tumors that measure between 6 and 10 mm. A prospective study conducted at the Dana-Farber Cancer Institute and affiliated sites is testing the effectiveness of paclitaxel plus trastuzumab for stage 1, HER-2-positive tumors. Summary Anti-HER-2 therapy remains a field of vital clinical investigation. New agents from both the antibody-based and small molecular/tyrosine kinase inhibitor-based domains are in development. Emerging data raise fascinating questions about the interplay of ER and HER-2 signaling pathways that are being explored in ongoing clinical trials. Meanwhile, the risk for HER-2-positive lesions continues to be marked in the absence of trastuzumab, underscoring the value of that agent in treating early-stage breast cancer. This activity is supported by an independent educational grant from Susan G. Komen for the Cure. References [ CLOSE WINDOW ] References
[ CLOSE WINDOW ] [CLOSE WINDOW] Authors and Disclosures As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content. Author(s) Harold J Burstein, MD, PhD http://img.medscape.com/person/burstein.harold.gif%0AAssociate Professor of Medicine, Harvard Medical School, Boston, Massachusetts Disclosure: Harold J. Burstein, MD, PhD, has disclosed no relevant financial relationships. Editor(s) Margie Miller Group Editorial Director, Medscape Hematology-Oncology Disclosure: Margie Miller has disclosed no relevant financial relationships. Emma Hitt, PhD Freelance editor and writer, Marietta, Georgia Disclosure: Emma Hitt, PhD, has disclosed no relevant financial relationships. Jill W. Chamberlain Editorial Director, Medscape Hematology-Oncology Disclosure: Jill W. Chamberlain has disclosed no relevant financial relationships. [ CLOSE WINDOW ] CME Information CME Released: 01/20/2009; Valid for credit through 01/20/2010 Target Audience This activity is intended for oncologists and other healthcare providers who treat patients with breast cancer. Goal The goal of this activity is to report and appraise new and emerging treatment regimens and clinical strategies for breast cancer; to enhance the care and outcomes of persons with breast cancer; and to support quality clinical practice of healthcare professionals involved in the management of patients with breast cancer. Learning Objectives Upon completion of this activity, participants will be able to:
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Great post, Jean. It only proves what we have been preaching. Her2 untreated is deadly no matter how small the invasion. Good to know we have chosen the proper course, huh?
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Hi Laurel,
I believe it is very important for all new members who come on the board to have all the updated facts. The protocol for early stage has changed. While no one wants to expose themselves to these drugs, often times because a tumor is small many newly dx. feel that offers some added protection. I just thought they should be armed to know that size is not the issue anymore. We hope that the day will soon arrive when we understand the complex biochemical signaling pathways involved and that tumors will be reviewed and treated based on their own genes. We still do not know why some have resistance to herceptin or a test to determine that. Knowledge is power...and at the very least women need to know everything they can so they can make the best treatment choices for themselves. All Good Wishes, Jean |
I think the proper way to say it is that it could be deadly.
Jean's stats say that the 10 yr survival rate of untreated Her2 disease is 67%. That means that 1/3 of the women in the category will recur (but it was not an overall survival rate) so the number includes those that will only have a local recurrence. The trick is to find those who will have a distant recurrence and treat those women. The goal is the right treatment to the right women. Not all those with Her2 recur, even with the least treatment. |
Lack of good information
As long as they have not and do not demonstrate what the rates would be with trastuzumab alone for these patients, these studies are biased in favor of adding chemotherapy when it may not be necessary. There also is no way to tell whether the addition of chemotherapy could increase the risk for some patients.
AlaskaAngel |
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