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12-29-2005, 04:37 PM

I put "arimidex working better for er+ pgr - than er+ pgr+" into google and heres the first four that came which all relate to the search term.

The medscape link also includes a section on herceptin. It is free you just have to register. I have included an abstract on ER and Tamoxifen, and the use of oncogene testing.

RB

http://www.susanlovemd.org/community...usa_mayer.html

http://www.annieappleseedproject.org/notfromadper.html

http://www.jco.org/cgi/content/full/22/9/1605

http://www.medscape.com/viewprogram/4205_pnt

Abstract

Molecular Predictors of Tamoxifen Benefit

One of the most exciting diagnostic tools to emerge in recent years has been the OncotypeDX recurrence score assay from Genomic Health. This assay quantifies the expression of 21 genes in breast tumors based on RNA retrieved from paraffin-embedded, formalin-fixed tissue. The recurrence score has been translated into an absolute risk of tumor recurrence through 10 years of follow-up among women with ER+, node-negative breast cancer. Investigators[9] from the National Surgical Adjuvant Breast and Bowel Project (NSABP) have sought to determine whether this recurrence score, which appears to risk-stratify patients very successfully, can also predict which tumors benefit from tamoxifen. They characterized the recurrence score for tumors of patients in NSABP B-14, a randomized trial of placebo vs tamoxifen. Patients in B-14 had node-negative, ER+ tumors. Previous studies had shown that the lower the recurrence score, the lower the risk of recurrence. New data have used the recurrence score to determine which patients may benefit from tamoxifen (Table 2).
Table 2. Recurrence Score and Tamoxifen Benefit in NSABP B-14
Recurrence Score 10-Year Distant
Disease Free Survival Gains With Tamoxifen
Placebo Tamoxifen Absolute
Benefit Relative
Risk Reduction
Low (< 18) 85.9% 93.1% 7.2% 51%
Intermediate (18-30) 62.5% 79.5% 17.3% 46%
High (> 30) 68.7% 70.3% 1.6% 5%

These data suggest the following: First, tamoxifen dramatically reduces the risk of recurrence in some, but not all breast cancers. Tumors with low or intermediate recurrence scores, which tend to have higher levels of ER expression, grade 1-2 features, and be HER-2-negative, derive tremendous benefit from tamoxifen treatment, with nearly 50% reduction in risk. By contrast, tumors with high recurrence scores, which tend to be lower ER expressors and to have poorly differentiated features and sometimes HER-2 expression, derive minimal benefit from tamoxifen. Previous research by the same group has shown that patients with these high-recurrence-score tumors derive substantial benefit from chemotherapy. It is important to note that these data refer only to patients treated with tamoxifen; whether the recurrence score is valid among patients treated with an AI is not known.

A key clinical point is that we can now refine our understanding of which patients have a more favorable prognosis due to tumor sensitivity to tamoxifen, and conversely, which patients may yet derive substantial benefit from chemotherapy because they are relatively insensitive to endocrine manipulation. Thus, this type of testing has the potential to dramatically refine patient selection for important adjuvant clinical treatments.

12-29-2005, 04:37 PM	#26
Unregistered Guest Posts: n/a	I put "arimidex working better for er+ pgr - than er+ pgr+" into google and heres the first four that came which all relate to the search term. The medscape link also includes a section on herceptin. It is free you just have to register. I have included an abstract on ER and Tamoxifen, and the use of oncogene testing. RB http://www.susanlovemd.org/community...usa_mayer.html http://www.annieappleseedproject.org/notfromadper.html http://www.jco.org/cgi/content/full/22/9/1605 http://www.medscape.com/viewprogram/4205_pnt Abstract Molecular Predictors of Tamoxifen Benefit One of the most exciting diagnostic tools to emerge in recent years has been the OncotypeDX recurrence score assay from Genomic Health. This assay quantifies the expression of 21 genes in breast tumors based on RNA retrieved from paraffin-embedded, formalin-fixed tissue. The recurrence score has been translated into an absolute risk of tumor recurrence through 10 years of follow-up among women with ER+, node-negative breast cancer. Investigators[9] from the National Surgical Adjuvant Breast and Bowel Project (NSABP) have sought to determine whether this recurrence score, which appears to risk-stratify patients very successfully, can also predict which tumors benefit from tamoxifen. They characterized the recurrence score for tumors of patients in NSABP B-14, a randomized trial of placebo vs tamoxifen. Patients in B-14 had node-negative, ER+ tumors. Previous studies had shown that the lower the recurrence score, the lower the risk of recurrence. New data have used the recurrence score to determine which patients may benefit from tamoxifen (Table 2). Table 2. Recurrence Score and Tamoxifen Benefit in NSABP B-14 Recurrence Score 10-Year Distant Disease Free Survival Gains With Tamoxifen Placebo Tamoxifen Absolute Benefit Relative Risk Reduction Low (< 18) 85.9% 93.1% 7.2% 51% Intermediate (18-30) 62.5% 79.5% 17.3% 46% High (> 30) 68.7% 70.3% 1.6% 5% These data suggest the following: First, tamoxifen dramatically reduces the risk of recurrence in some, but not all breast cancers. Tumors with low or intermediate recurrence scores, which tend to have higher levels of ER expression, grade 1-2 features, and be HER-2-negative, derive tremendous benefit from tamoxifen treatment, with nearly 50% reduction in risk. By contrast, tumors with high recurrence scores, which tend to be lower ER expressors and to have poorly differentiated features and sometimes HER-2 expression, derive minimal benefit from tamoxifen. Previous research by the same group has shown that patients with these high-recurrence-score tumors derive substantial benefit from chemotherapy. It is important to note that these data refer only to patients treated with tamoxifen; whether the recurrence score is valid among patients treated with an AI is not known. A key clinical point is that we can now refine our understanding of which patients have a more favorable prognosis due to tumor sensitivity to tamoxifen, and conversely, which patients may yet derive substantial benefit from chemotherapy because they are relatively insensitive to endocrine manipulation. Thus, this type of testing has the potential to dramatically refine patient selection for important adjuvant clinical treatments.