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01-11-2014, 09:37 PM
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#1
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Senior Member
Join Date: Mar 2006
Posts: 4,778
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all her2+ ER+s take note (especially Jean)
Jean has waited many years for validation that it was her2 positivity and NOT size that mattered when it came to deciding how to treat her her2+ER+ breast cancer. She sought several opinions as I recall. For years, many if not most oncologists told patients that if they were ER+ and their tumor was only T1aor b, node negative and without distant mets they were going to do well no matter what and certainly with just antihormonals.
Statistically they were right in that the majority of patients did well, but there was an almost four fold increased risk of DEATH even in these supposedly low-risk patients. 10 year survival rates were 74% for her2+ er+s and 89% for her2-ER+s
From this study it seems that it turns out that size doesn't matter, but biology (subtype, what is driving the tumor) does.
How best to treat Her2+ER+ remains somewhat of a mystery (as well as how many subtypes of the subtype there are)--- but the fact that one can make an enormous (percentage-wise) difference in not just recurrence rates, but mortality, with antiher2 therapy even in the smallest group of them does not seem to be.
Cancer Med. 2014 Jan 10. doi: 10.1002/cam4.167. [Epub ahead of print]
HER2 overexpression a major risk factor for recurrence in pT1a-bN0M0 breast cancer: results from a French regional cohort.
Rouanet P, Roger P, Rousseau E, Thibault S, Romieu G, Mathieu A, Cretin J, Barneon G, Granier M, Maran-Gonzalez A, Daures JP, Boissiere F, Bibeau F.
Author information
Abstract
The management of pT1a-bN0M0 breast cancer remains an area of controversy. Data from 714 patients classified as having pT1a-bN0M0 breast cancer and treated, from 1999 to 2004 in the Languedoc-Roussillon France, were analyzed. The human epidermal growth factor receptor 2 (HER2) status analyses were centralized. The objective of this study was to describe the prognosis of pT1a-bN0M0 breast cancer according to HER2 distribution and hormonal status. The median follow-up was 6.4 years. Ten-year overall survival was 94%. HER2 overexpression was observed in 6.1% of the patients. The 10-year prognosis of patients with HER2-positive tumors was worse than that of those with HER2-negative (disease-free survival 73% vs. 89%, P < 0.0001). Tumor size (T1a/T1b) was not a relevant prognostic factor. The co-expression of HER2 with hormonal receptors (HR) was associated with high recurrence at 10 years. In both univariate and multivariate analyses, the most relevant prognostic factor for this population was HER2 amplification. In multivariate analysis, patients with HER2-positive tumors had higher risk of mortality (HR, 3.89; 95% CI, 1.58-9.56). In pT1a-bN0M0 breast cancers, HER2 amplification or overexpression is a risk factor for recurrence. In HER2-positive breast cancers, HR expression is associated with a poor prognosis despite the hormone therapy. For this population, a personalized management may be required.
© 2014 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
KEYWORDS:
HER-2 positive tumors, small breast carcinoma
PMID: 24407937
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01-11-2014, 10:46 PM
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#2
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Senior Member
Join Date: Sep 2005
Location: Alaska
Posts: 2,018
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Re: all her2+ ER+s take note (especially Jean)
Thanks, Lani. What were the treatments that were used? Were any treated with trastuzumab without chemo, or were they all treated with chemo regardless of size, or what?
__________________
Dx 2002 age 51
bc for granny, aunt, cousin, sister, mother.
ER+/PR+/HER2+++, grade 3
IDC 1.9 cm, some DCIS, Stage 1, Grade 3
Lumpectomy, CAFx6 (no blood boosters), IMRT rads, 1 3/4 yr tamoxifen
Rads necrosis
BRCA 1 & 2 negative
Trials: Early detection OVCA; 2004 low-dose testosterone for bc survivors
Diet: Primarily vegetarian organic; metformin (no diabetes), vitamin D3
Exercise: 7 days a week, 1 hr/day
No trastuzumab, no taxane, no AI
NED
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01-11-2014, 11:02 PM
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#3
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Senior Member
Join Date: Sep 2005
Location: Naples FL
Posts: 1,744
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Re: all her2+ ER+s take note (especially Jean)
I was in this same dilemma... however my oncologist in Seattle was involved in the trials and KNEW that herceptin was critical for early stages...even though chemo was a prerequisite, she prescribed herceptin off label for me. 5 months into my treatment, the FDA approved it for early stage.
__________________
Suzan W.
age 54 at diagnosis
5/05 suspicious mammogram-left breast
5/05 biopsy-invasive lobular carcinoma with LCIS,8mm tumor,stage 1 grade 2, ER+ PR+ Her2+++
6/14/05 bilateral mastectomy, node neg. all scans neg.
Oncotype DX-high risk
8/05-10/05 4 rounds A/C
10/05 -10/06 1 yr. herceptin
arimidex-5 years
2/14/08 started daily self administered injections..FORTEO for severe osteoporosis
7/28/09 BRCA 1 negative BRCA2 POSITIVE
8/17/09 prophylactic salpingo-oophorectomy
10/15/10 last FORTEOinjection
RECLAST infusion(ostoeporosis)
6/14/10 5 year cancerversary!
8/2010-18%increase in bone density!
no further treatments
Oncologist says, "Go do the Happy Dance"
I say,"What a long strange trip its been"
'One day at a time'
6-14-2015. 10 YEAR CANCERVERSARY!
7-16 to 9-16. Extensive (and expensive) dental work done to save teeth. Damage from osteoporosis and chemo and long term bisphosphonate use
6-14-16. 11 YEAR CANCERVERSARY!!
7-20-16 Prolia injection for severe osteoporosis
2 days later, massive hive outbreak. This led to an eventual dx of Chronic Ideopathic Urticaria, an auto-immune disease from HELL.
6-14-17 12 YEAR CANCERVERSARY!!
still suffering from CIU. 4 hospitilizations in the past year
as of today, 10-31-17 in remission from CIU and still, CANCER FREE!!!
6-14-18 13 YEAR CANCERVERSARY!! NED!!
Last edited by suzan w; 01-11-2014 at 11:07 PM..
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01-11-2014, 11:51 PM
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#4
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Senior Member
Join Date: Apr 2012
Location: Melbourne, Australia
Posts: 494
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Re: all her2+ ER+s take note (especially Jean)
Thanks Lani - as a Her2+, ER+ person who has moved to stage 4 after nearly 8 years, WITHOUT chemo or Herceptin. Oh well!
Pam.
__________________
Diagnosed 2004: Lumpectomy - 2 tumours, both grade 1 infiltrating duct carcinoma, about 12mm. ER+,
C-erbB-2 status 3+.
Clear margins, no nodal involvement.
Radiotherapy, i year Tamoxifen, 4 years Arimidex.
Rediagnosed 2012: Multiple bone metastases.
3/12: began on Marianne trial - T-DM1 + Pertuzamab/Placebo.
5/12:Unexpected development of numerous bilateral liver mets. Came off trial.
Started Docetaxol/ Herceptin + Zometa.
8/12:Bones stable +major regression in liver (!)
9/12:Can't take any more Docetaxol! Start on Herceptin and Tamoxifen. Cross fingers!
Changed to Denosumab.
11/12: Scan shows stable - yay!
11/13: Still stable :-) !!!
1/16: All stable, but lowered calcium, so switched to Zometa 3 monthly.
2/19: Happily still stable on Herceptin, Letrozole and 3 monthly Zometa.
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01-12-2014, 09:52 AM
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#5
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Senior Member
Join Date: Jan 2007
Location: Thornhill, Ontario
Canada
Posts: 2,320
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Re: all her2+ ER+s take note (especially Jean)
Thanks Lani.
I was diagnosed in Oct. 2006, and Herceptin had already been approved in Canada for early stagers. I was stage 1 triple+, node negative and there was no question that I was getting Herceptin, as well as chemo (FEC) with Taxotere. At the time, my oncologist said that was the best treatment for me.
I am over 7 years out now.
all the best
caya
__________________
ER90%+/PR 50%+/HER 2+
1.7 cm and 1.0 cm.
Stage 1, grade 2, Node Negative (16 nodes tested)
MRM Dec.18/06
3 x FEC, 3 x Taxotere
Herceptin - every 3 weeks for a year, finished May 8/08
Tamoxifen - 2 1/2 years
Femara - Jan. 1, 2010 - July 18, 2012
BRCA1/BRCA2 Negative
Dignosed 10/16/06, age 48 , premenopausal
Mild lymphedema diagnosed June 2009 - breast surgeon and lymph. therapist think it's completely reversible - hope so.
Reclast infusion January 2012
Oopherectomy October 2013
15 Years NED!!
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