Don't understand

chekmark · 10-17-2011, 04:40 PM

OK ladies need your help. I have never understood my fish test path report and I always forget to ask my oncologist since we get on to other topics. I was just looking at it and it says " Given the average Her 2 Signal is roughly double to the number of CEP 17 signals, this MAY represent Her2/neu gene duplication without amplification. Gene duplication is uncertain with respect to gene amplication." Which number do I look at? Cep ration or average Cep 17 signal? It indicates that I am positive amplied. Results 2.2 with an average HER 2 signal cout of 4 copies/cell and preferably 7 copies. I kind of avoided this for the last year since this whole her2 thing is so scary. I can't figure it out. Call me an idiot. I guess now that I am almost finished with treatment I am feeling braver about knowing these numbers. I don't see my oncologist for a couple of months so I thought I would ask the experts here. It is the May represent Her2/neu gene that caught my eye today. Does that mean that it is not full proof? Can't blame me for hoping and wishing.

chekmark · 10-19-2011, 04:13 AM

Wow, really no one? Someone has to know? Come on ladies!

PinkGirl · 10-19-2011, 06:51 AM

Well, I don't understand all of those numbers but doesn't the
fact that you're getting a year of Herceptin sort of answer your
questions????

tricia keegan · 10-19-2011, 06:56 AM

Sorry I can't help either!

Debbie L. · 10-19-2011, 07:24 AM

Pink is right, checkmark. They do not know a lot about what the "level" of HER2 positivity means. Last time I looked, most studies had not been able to link it to either prognosis nor to Herceptin response. The HER2 gene is on the 17th chromosome and the way FISH reports the results is in a ratio. The 2.2 number is the relevant one for you. Some cancer's FISH results are much higher than 2.2, apparently without significance.

The current thinking is that anything over 2 is positive. There is at least one trial enrolling now I believe, using Herceptin for those tumors that are 1-3+ for HER2 on IHC but FISH "negative" (below 2), as one researcher found apparent response to Herceptin in that group.

To muddy the waters further: I just listened to Neil Love's Research to Practice podcasts. I don't remember who he was talking to, but it was in the update for surgeons one. They were talking about HER2 in gastric cancer and how confusing it is with no answer yet there -- because they suspect the HER2 overexpression may wax and wane and be independent of amplification of the gene itself so they're not sure how to test nor when Herceptin (or other anti-HER2 meds) might be most effective. I am explaining this simplistically because my understanding is marginal (smile).

Debbie Laxague (who tried to figure out the significance of the numbers early-on, too, without much success)

Debbie L. · 10-19-2011, 07:47 AM

Mildly interesting -- this small retrospective look found that FISH ratio correlated with ER negativity (higher ratios as ER decreased, or perhaps vice-versa): "Methods: Of the 80 HER2-positive (IHC3+/FISH+) BC, quantitative HER2 FISH ratio (widely spread over 1-18.3) and ER correlation was noted (r=0.34, p=0.002). Moreover, HER2 ratio (>4) correlated with higher Ki-67 (r= 0.5, p=0.01) and grade (p trend=0.05) in ER-positive subtype, inferring a biologic cut-point." Full abstract here: http://www.asco.org/ascov2/Meetings/...stractID=35388 . "

If you search the archives, there will be discussions of ratio numbers. I think there have been a few small studies that thought they'd found significance (to prognosis, if I remember correctly) of ascending HER2 FISH levels, but most studies have not been able to find any correlations. It seems that most of the current questions in this arena center around that in-between area (some name it as being 1.8-2.2, other just say IHC+ but FISH negative). If anyone has looked recently at significance of high vs. low ratio numbers, I don't find it in a quick googling.

Debbie Laxague

chekmark · 10-19-2011, 09:33 AM

It is so confusing. I will try to remember to ask my oncologist. Pinkgirl, no not really. I still want to have an idea of highly positive I am for her2 but I am very grateful for the herceptin. Thanks Debbie. I appreciate your response. God Bless.