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Hopeful said: Being Her2+ and marginally ER+ (10% or less of cells staining) is not unusual. Being Her2+ and highly ER+ (80% or better) is. It is the highly triple positives that comprise that 5% of all bc stat Sassy quotes.
That brings up issues. What IS negative ERPR? Lots of different answers to that question depending upon lab or provider. Research abstracts usually don't say what cut-off they used in assigning their subsets, although if you can get your hands on full text it's usually mentioned. Plus, there's the issue of unreliable assays, which I think is a larger issue than is thought, in non-central labs. (the EBCTCG overview that you posted, for example, used a cut-off of 10fmol of protein/mg of cytosol protein, or any evidence of immunohistochemical evidence of receptor protein" - how does that correlate with an Allred score, or a community lab report of "10%"? Lots of apples and oranges).
What about the research that seemed to suggest that Herceptin may make HER2+/ERPR+ disease more susceptible to hormone treatment?
Also, they were testing routinely for HER2 in 2001, even in my podunk community hospital. That was well before the release of the adjuvant trials data.
Sassy said: Also, prior to the release of the trial, most people were not tested for HER2 until metastisized, so would it not be most likely that those who were triple positive that did not recurr would not have known they were HER2+?
Does this make sense?
Yes, perfect sense. But I was not asking for those who have not recurred. I wanted to hear from ERPR/HER2+'s who did recur, more than 7 years out from diagnosis. Even if they didn't know their HER2 status at diagnosis, if they biopsied the mets, the HER2 status would be known (although a few do change from HER2- to +).
I have so many questions and thoughts on this topic that it's making my brain hurt.
Hopeful said: So, while ER+ bc is seen as "more favorable" by diagnosticians than ER- bc, that seems to be a short-term way of looking at it - the risks of relapse from ER+ bc remains higher than that for ER- bc many years after dx.
But even over the long term, there will be more recurrences in ER- cancers. Overall. Or there were, before Herceptin (there's that pesky issue again, of stats by definition being at least partly irrelevant to someone diagnosed at the time that the stats are released). When we start to try and break into smaller subsets, it gets hazier, especially, as you say, for the ERPR+/HER2+. But there should be some good subset data coming out of the adjuvant Herceptin trials on these details that we want.
Nothing's black and white, to put it mildly. I listened to more podcasts on my drive to/from work today, and several times it was mentioned that a fair amount of breast cancer overlaps categories, even in the huge gene array categories, like the other article that you noted, hopeful.
It's encouraging how much more we understand each year, but on the other hand, the incredible complexity becomes more apparent with each new understanding.
And OT to this - do people on this forum look at Adjuvant!? In one of the podcasts, they said that it will soon include HER2. This was in a discussion of whether Adjuvant! is as good as OncotypeDX, and the point made (Slamon, I think) was that when Peter Ravdin adds HER2 to the mix, it will be (as good). (and then he said "and it's free").
Great discussion,
Debbie Laxague
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