[Lani]

It is a molecular subtype --one of the four/five described by Charles Perou et al. Various other researchers have bickered about whether some her2+s fall within the basal phenotype, whether there should be just 3 or 4 or 5 or 6 subtypes, where her2+ER+s fit in etc. Excellent papers have been written by Charles Perous as well as Laszlo Pusztai, whom I have heard speak at at least 3 and 6 conferences, respectively.

I looked up your Phenopath and it is a private company not owned by Wall Street, but still owned by Doctor's (for profit). This is the first time I have heard of them (doesn't mean much), however you may want to seek out the publications of a woman who has a similar company but works extensively with MDAnderson researchers and clinicians and has published (jointly with them) many important articles on her2+ breast cancer including those looking for IHC markers of response to tykerb, etc. Her name is Sarah Bacus and her company is Targeted Molecular Diagnostics.

I am not recommending them (although RobinP did, which is how I learned about their services) as I am not in a position to, but remember that RobinP, also a nurse, was able to talk to them and decide which IHC tests would be most helpful in deciding whether to take late herceptin (PTEN was one, as if she was PTEN negative, there would probably be herceptin resisitance de novo) They, reasonably, prefer to test you for things for which there are established treatments available (hence c-kit which is quite rare in breast cancer). I can only hope they will see your dilemna as you do and help out your oncologist despite the fact that you have already received treatment and are currently NED (thank goodness)

These for profit organizations normally do their work for clinical trial projects and other researchers as I understand it. Because they are for profit and interface with the public, they offer tests not usually available at university/cancer center pathology departments.

I once helped a friend in Denmark send his wife's speciment slides to MD Anderson for a second pathologic opinion. I learned the address and phone number from the website (this was 3.5 years ago) She had triple negative bc and they did report out her EGFR IHC RESULT. I have no idea what they are offering now, but your oncologist could look into it I suppose.

I went to a recent lecture at Stanford on the topic as well as the three day AACR meeting on advances in breast cancer research in October as well as (trying to keep up on) my reading of the literature (I read on many other things as well!)

I would ask your onc if he would agree to a a serum her2ECD as many papers have shown her2- tumors metastasizing as her2+ making herceptin theoretically helpful in a subgroup of those who are her2- (her2ECD IS PRESENT EVEN IN THOSE WHO ARE NOT METASTATIC, but shouldn't be positive in any but the tiniest amounts if you are her2-, according to my reading). Several papers by Allan Lipton and Walter Carney among others discuss this.

I will also try to check with Dr. Deng, whose company offers a different technology for checking for circulating tumor cells and characterizing them by IHC to see if they have anything to offer, but again, this is a company aiming to be for profit.

If you oncologist could be in touch with Laszlo Pusztai at MDAnderson(who has developed a method to use multigene arrays to predict chemo and antihormonal responsiveness as well as prognosis--not yet commercially available or FDA approved) or someone in the pathology department there (try to google phone number for MDAnderson second pathologic opinions) tell him the dilemna and ask, who in the pathology department might inform you of your options for further testing

According to the two latest conferences I have attended there are several new and much more effective treatments for triple negative bc (including carboplatin and PARP inhibitors).
Hope this has helped!