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Hopeful · 08-01-2008, 07:20 AM

Geez, take a day off from the internet, miss all the excitement.

For Debbie L, here is the link to the thread with my post in it that discussed chemotherapy's relationship to late recurrences: http://her2support.org/vbulletin/sho...eferrerid=1173

Here are some quotes from a recent CME from Clincal Care Options for oncology, derived from information presented at the most recent (2007) San Antonio Breast Cancer Symposium:

Matthew Ellis, MD, PhD:
I will also add that good prognosis needs to be defined—and not just by a 5‑year event rate. In reality, a 15‑year event rate is needed, even for hormone receptor–negative disease. While it is true that late events continue to occur mostly in the ER‑positive population, patients who are ER‑negative still experience late relapses. Therefore, we need to be very conservative. . . . It is important to point out where the gray areas still lie. Even in the group of patients with low recurrence risk currently defined at 10 years, there could be events in that group at 15 or 20 years because they have slower growing tumors. Therefore, the idea that the RS (recurrence score measured by Oncotype Dx) could be used to determine length of endocrine therapy is not yet valid. However, chemotherapy benefits occur in the first 5 years, after which time, the curves become parallel. Therefore, chemotherapy exerts its effect on relapse early on because it induces tumor cell apoptosis. In contrast the effect of adjuvant endocrine therapy increases with time. In general, I believe that developing these genetic signatures as a tool to define chemotherapy decision making is promising, but they are not yet suited for making decisions about endocrine therapy, such as duration or choice between agents.

FWIW, I believe a lot of late relapses are not recorded simply because they are so late - maybe the patient has moved, the original doc has retired, whatever the case may be. There just has not been long term follow-up (and I mean 20+) to be able to give stats on the matter. The closest thing I have seen is the meta analysis performed by the Early Breast Cancer Trialists Collaborative Group, which meets every five years to review their data. In their most recent meeting in 2005, the phenomenon of late recurrence for ER+ patients vs ER- was discussed, and it was noted that at 10 years, the lines crossed, with ER- having fewer relapses and ER+ more. I think the greater focus of research has been on the more aggresive, early recurring bc, which is predominantly ER-, and the fact that ER+'s recur so late has taken attention away from the fact that we need additional research in this area. Remarks like those from Dr. Ellis above are encouraging to me, in that it appears there will be more research into this issue, and, hopefully, more options for treatment.

Hopeful

08-01-2008, 07:20 AM	#41
Hopeful Senior Member Join Date: Aug 2006 Posts: 3,380	Geez, take a day off from the internet, miss all the excitement. For Debbie L, here is the link to the thread with my post in it that discussed chemotherapy's relationship to late recurrences: http://her2support.org/vbulletin/sho...eferrerid=1173 Here are some quotes from a recent CME from Clincal Care Options for oncology, derived from information presented at the most recent (2007) San Antonio Breast Cancer Symposium: Matthew Ellis, MD, PhD: I will also add that good prognosis needs to be defined—and not just by a 5‑year event rate. In reality, a 15‑year event rate is needed, even for hormone receptor–negative disease. While it is true that late events continue to occur mostly in the ER‑positive population, patients who are ER‑negative still experience late relapses. Therefore, we need to be very conservative. . . . It is important to point out where the gray areas still lie. Even in the group of patients with low recurrence risk currently defined at 10 years, there could be events in that group at 15 or 20 years because they have slower growing tumors. Therefore, the idea that the RS (recurrence score measured by Oncotype Dx) could be used to determine length of endocrine therapy is not yet valid. However, chemotherapy benefits occur in the first 5 years, after which time, the curves become parallel. Therefore, chemotherapy exerts its effect on relapse early on because it induces tumor cell apoptosis. In contrast the effect of adjuvant endocrine therapy increases with time. In general, I believe that developing these genetic signatures as a tool to define chemotherapy decision making is promising, but they are not yet suited for making decisions about endocrine therapy, such as duration or choice between agents. FWIW, I believe a lot of late relapses are not recorded simply because they are so late - maybe the patient has moved, the original doc has retired, whatever the case may be. There just has not been long term follow-up (and I mean 20+) to be able to give stats on the matter. The closest thing I have seen is the meta analysis performed by the Early Breast Cancer Trialists Collaborative Group, which meets every five years to review their data. In their most recent meeting in 2005, the phenomenon of late recurrence for ER+ patients vs ER- was discussed, and it was noted that at 10 years, the lines crossed, with ER- having fewer relapses and ER+ more. I think the greater focus of research has been on the more aggresive, early recurring bc, which is predominantly ER-, and the fact that ER+'s recur so late has taken attention away from the fact that we need additional research in this area. Remarks like those from Dr. Ellis above are encouraging to me, in that it appears there will be more research into this issue, and, hopefully, more options for treatment. Hopeful