HER2 Support Group Forums - View Single Post - The 411 on me... not much too new, but a new wrinkle or two.

Lani · 10-23-2009, 10:37 AM

After going to the AACR advances in breast cancer research meeting in San Diego a week ago I was terribly impressed by Dr. Christoph Klein's work on metastasis.

He is among many who feel bone marrow information can be EXTREMELY important to guide treatment.

Since you have tumor cells in your iliac crest which are big enough to see on scan/xray, wouldn't it make sense to biopsy/aspirate these and discovery their phenotype (pattern of markers) to be certain your next treatments are the very best they can be and most likely to take care of your problem since you won't be biopsying your pituitary. Not everyone has the capabilities to phenotype DTCs, but since your tumor is visible on scans/XR perhaps discussing a small bone biopsy would be reasonable.

I hear over and over again at the conferences that breast cancer patients die of their metastases, not their primary tumor and if you direct the treatment against the pathways active/markers on their primary tumors you may be three/four/five steps/mutations/clones behind where you need to be to attack what is driving the met.

Circulating tumor cells are heterogeneous--Dr. Stephanie Jeffrey of Stanford has even shown triple negative CTCs circulating in her2+ metastatic breast cancer patients on herceptin, but according to the literature and talks at conferences I have attended DTCs seem to represent more patients' prognoses(see works of Klaus Pantel) and which pathways need to be blocked to save them.

Once you irradiate the pelvis it won't be possible to know what your DTCs
(disseminated tumor cells--ie tumor cells in your bone marrow) were like
they might be ER+ when the primary was ER- or vice versa

A true bone biopsy vs a bone marrow aspiration might tell even more as they could possibly freeze it and do a microarray--they are finding out how to predict based on microarrays which treatments will be effective. Again, the microarray for the met may be different from the microarray for the primary tumor and it is not the primary tumor that threatens lives.

I have written the above based on my readings and attendance at conferences--I have no expertise but I hear these themes over and over again at conferences...if only we had been able to biopsy the metastasis to direct treatment!

10-23-2009, 10:37 AM	#6
Lani Senior Member Join Date: Mar 2006 Posts: 4,778	Re: The 411 on me... not much too new, but a new wrinkle or two. After going to the AACR advances in breast cancer research meeting in San Diego a week ago I was terribly impressed by Dr. Christoph Klein's work on metastasis. He is among many who feel bone marrow information can be EXTREMELY important to guide treatment. Since you have tumor cells in your iliac crest which are big enough to see on scan/xray, wouldn't it make sense to biopsy/aspirate these and discovery their phenotype (pattern of markers) to be certain your next treatments are the very best they can be and most likely to take care of your problem since you won't be biopsying your pituitary. Not everyone has the capabilities to phenotype DTCs, but since your tumor is visible on scans/XR perhaps discussing a small bone biopsy would be reasonable. I hear over and over again at the conferences that breast cancer patients die of their metastases, not their primary tumor and if you direct the treatment against the pathways active/markers on their primary tumors you may be three/four/five steps/mutations/clones behind where you need to be to attack what is driving the met. Circulating tumor cells are heterogeneous--Dr. Stephanie Jeffrey of Stanford has even shown triple negative CTCs circulating in her2+ metastatic breast cancer patients on herceptin, but according to the literature and talks at conferences I have attended DTCs seem to represent more patients' prognoses(see works of Klaus Pantel) and which pathways need to be blocked to save them. Once you irradiate the pelvis it won't be possible to know what your DTCs (disseminated tumor cells--ie tumor cells in your bone marrow) were like they might be ER+ when the primary was ER- or vice versa A true bone biopsy vs a bone marrow aspiration might tell even more as they could possibly freeze it and do a microarray--they are finding out how to predict based on microarrays which treatments will be effective. Again, the microarray for the met may be different from the microarray for the primary tumor and it is not the primary tumor that threatens lives. I have written the above based on my readings and attendance at conferences--I have no expertise but I hear these themes over and over again at conferences...if only we had been able to biopsy the metastasis to direct treatment!