Good news though. Stats were almost entirely pre-herceptin. Remember that before getting in a panic...
http://breast-cancer-research.com/co...df/bcr1844.pdf (now better formatted w less typos)
Found prognosis (5 year survival)depends on combination of her2/ER status AND Akt status, with worst prognosis in those with
triple negative + high Akt(suprisingly triple negative w low Akt patients fared much better)
her2+ ER- w high Akt patients, could be separated out into two groups, 20% 5 yrs DFS vs 60% 5yrs survival w her2_er- with low Akt
Her2+ ER+ --among these patients, 5 yrs survival was poor with our without elevated Akt , but those patients w elevated pAkt 5 yr DFS was worse:
high her2 neu combined w high Akt had the worst outcome--10-15% 5 yr DFS
her2 +patients had an average DFS of 2.8 years whether er+ or er- vs 3.9 year DFS in her2 negative patients.
More than 70% of patients with HER2/neu positive tumors had overexpression of pAkt, and the high pAkt tumors were associated with positive lymph nodes
luminal B patients (her2+ ER+) had pAkt levels of 42.3 compared to her2+er- patient's Akt levels of 56.3, and triple negative Akt levels averaged 35
her2+er- had 20% dfs w hi akt 60% w low Akt
The above stats were a bit hard to summarize as the provisional pdf does not include any charts , tables or graphs yet
all patients in this study got surgery and chemo a few got herceptin (toward the end of the study period)
They were primarily black and Hispanic as the study took place in an East LA County Hospital (Martin Luther King-Drew)
These tests could be done simply on normal paraffin embedded original breast biopsy specimens using only IHC (or FISH).
This is the kind of information one can get from a set of tumor specimens combined with patients medical histories ...hint , hint! WHEN I LAST LOOKED ONLY ABOUT 46 OF OVER 946 VIEWERS HAD OFFERED ACCESS TO THEIR SPECIMENS. We sure aren't going to be able to get researchers, cancer centers, etc excited about that, I am afraid. That's about one out of 22 persons offering. I originally made the suggestion in a thread started by, I believe, Alaska Angel who was grieving her friend as a way to both honor those lost and try to speed up research to prevent us from losing more. I will stop proselytizing here and let you know where I think this paper may lead...
If this pans out with larger numbers of patients of all ethnic groups, races
a newly diagnosed patient could be put into one of 8 different risk categories , the lowest being ER+her2-Akt- ...and, for example, the her2+er- person could know they were in the group with 20% 5 year survival or the group with 60% 5 year survival if no herceptin is given. With additional tumors and prognoses to analyze they may find that if they separate those with respect to, say her3+ status, as well, or PTEN high/ low status as well-- these patients may need, let's say the triple combo of Dr. Osbourne (herceptin, pertuzumab, iressa) or to herceptin+ avastin or other combined targetted therapy on an adjuvant bases to see if starting with "the big guns" ie combination targetted treatments can make the difference.
If separating these patients out by tissue microarray is necessary, that will take much more time to do clinical trials as they are much more expensive and require fresh frozen specimens. Luckily of the two trials I outlined above one drug company makes both drugs in one case (herceptin+ avastin) and two of the 3 drugs in the other (herceptin, pertuzumab) in the other. That company is Genentech and they also make a drug similar to Iressa called Tarceva, although I don't know if the Osbourne team tried it to see if it works the same, worse or better than Iressa. I would expect that years would get added on if one has to wait until drug companies agree to combine their efforts and funds in a clinical trial together rather than funding one of their own.
This type of study, where patients already were treated similarly, where one only has to retrieve specimens and do relatively inexpensive and simple tests
has a lot of merits (as well as pitfalls). But this one was done so well (under the guidance and supervision and with critiquing by Dr Slamon) that it is already the highlighted article on the website and one of the most highly accessed articles on the Breast cancer research site.
important new article by Dr. Slamon et al
Hybrid Mode
