Relapse HISTORY for her2+S

Susan Rankin · 09-15-2006, 06:53 PM

This also freaked me out!!!! I want to read this article and then talk to my oncologist soon!

Susan

Becky · 09-15-2006, 07:22 PM

Don't let this freak you out. There is a natural relapse period for all breast cancer. All pathologies. For Her2+ and triple negative, the highest period of recurrence occurs within the first two years. This is also true for "run of the mill" bc that is only hormone positive. However, the "only hormone" positive bc also has a "blip" in relapse in the 7-9 year period (but this blip is smaller than in the first 2 years from diagnosis.

Now the article chronicals relapse after the first year of Herceptin. It is natural that this period would be the same period that is the most common for recurrences for Her2+ cancer. Who relapses? Well - the women who would - what I mean by this is that Herceptin does not work for everyone (about half) so half of those who would relapse do. But remember, even without Herceptin, not everybody relapses. More DO NOT relapse.

So, is it logical that if you received Herceptin through this vulnerable period that it would prevent relapse? The only way to start to really evaluate this question is when the Hera trial is completed so one can see if 2 years of Herceptin is better than one year (because 2 years will cover this "relapse" period).

Preliminary evidence is pointing to the fact that more does not improve the odds (it may "save" 1-3 women per thousand more - not statistically significant).

As good as Herceptin as an adjuvant is, it will not prevent the relapse for some. This will be more relevent and reliable when better tumor testing is available AND when clinical oncologists separate out these pathologies to analyze where the failure rates occur and address them with newer and better drugs (ie: do Her2+ and ER+ (and/or PR+) recur less when on Herceptin and an antihormonal or do ER/PR negatives do better on Herceptin. Do the failures come from women who are also Her1+ or some other tumor marker we don't even know anything about?)

So, I would not freak out over this. This vulnerable period exists regardless of drug therapy (be it Herceptin, Tamoxifen, AIs etc). It is a period that every woman with breast cancer has to live through and live beyond. With these drug therapies available and new technologies on the horizon, we have a very bright future in which to go out and live our lives fully.

Have a nice weekend

Kindest regards

Becky

Susan Rankin · 09-15-2006, 09:28 PM

Becky,

Thank you. I feel much better after reading your message.

After being off of Herceptin for three months now I feel as if I lost my security blanket.

Susan

Hopeful · 09-16-2006, 07:16 AM

This is a guess on my part, because I went searching for the article RobinP cited also. Go to http://www.asco.org/portal/site/ASCO...y&abstractID=3 and click on "slides" under Associated Presentations 1. Pre-operative therapy for women with Her2 positive breast cancer. Based on RobinP's description of what she read, this was as close as I could find.

Hopeful

RobinP · 09-16-2006, 08:19 AM

Boy, I didn't mean to stir the pot. I thought everyone knew that her2 bc could relapse after the peak period, again less frequently. My point of posting was to inform, rather than frighten as I notice lately some questions about late her2 reoccurences. Specifically, I wanted to let others know that there is a growing natural history for her2+ bc that is accumulating via the NCI and HERA trials concerning her2+ relapse. Part of that history was presented in the virtual 2006 ASCO presentation. It's been a while, I viewed this last spring, but I believe it was by Dr. Winer on HERA's data.

PS The above abstract is not what I was referring to. It is actually a line graph with observation and study group relapse mapped out from 0-36 months.

Lani · 09-16-2006, 08:24 AM

They have found (when looking at all breast cancers, not just her2neu+ breast cancers) that the peak of recurrence occurs x number of months (around 24 for her2+ and triple negative as Becky said,with another later "blip" peak of recurrence for those ER+her2-) after surgery NOT x number of months after the lump was discovered. In those who delayed after finding their lump or who were unable to get access to health care right away (this is a global disease) they found the peak occurred x number of months after the surgery even if the tumor had been there quite a long time before.

The thinking is that the surgery starts an inflammatory process and that the gene signature of breast cancer looks a lot like the gene signature of inflammation and that some of those growth factors etc let loose or stimulated by the act of surgery "start the clock ticking"

This is one reason why they are moving toward needle and core biopsies,
hoping to mimimize the inflammatory reaction by minimizing the surgery.
It is another reason why increased usage of preop MRIs to better define the extent of disease and minimize repeat operations to obtain better margins may improve cancer care in the future.

Noone it seems has studied whether the 1-5 day course of various types of accelerated partial breast irradiation produce more or less inflammatory cytokines but if/when the long term results of APBI come out, if they are better than conventional radiation this should be one avenue of research as to why.

It may be that breast cancer is indeed a stem cell disease and that the "tumors in waiting" are those slowly dividing cells in the bone marrow which get activated by inflammatory cytokines etc just like the mold in bathroom grout gets activated by moisture no matter how much you use Tilex or other bleach-containing compounds.

The group in Germany that has been advocating getting preop and post treatment bone marrow biopsies is starting a clinical trial to see how this would influence treatment and the course of disease. They need to test the bone marrow cells not only for cytokeratin but also double stain them for her2 neu as those with her2neu positive isolated tumor cells in the bone marrow have been shown to be associated with a much higher rate of recurrence than those in the graphs Robin P has pointed out. If this, or a more specific and accurate way of isolating circulating tumor cells can become more widespread and found indicative of residual disease there will be a way in those treated adjuvantly rather than neoadjuvantly ie, when there is no longer a tumor present to judge whether there is or is not a response to therapy, to assess whether the best treatment is being utilized.

Sorry to be so serious on a Saturday...Have a great weekend!

RobinP · 09-16-2006, 08:30 AM

Amen Lani, let's ALL lighten up, RELAX and enjoy the weekend. Take care everyone.

RobinP · 09-16-2006, 10:54 AM

A copy from another post of mine applies here too as a positive note:

These are quotes from the esteemed E. Perez, MD:

''Unlike ER-positive breast cancer, in which events are strung out over the course of 10 to 15 years, in HER2-positive breast cancer most of the events occur in the first five years and a lot of them occur in the first couple of years. That is part of the reason why, in each of these studies, we saw a dramatic benefit early on, even in the first year (Perez 2005b; Piccart-Gebhart 2005; Romond 2005)"

I guess Perez is basing her comments on retrospective studies which go back after the event and analyze data. According to Perez, survival after five years for her2+, er-, pr- is a milestone, not a guaranteed cure, but a certainly a positive milestone.

Of course, we'll get the full story , and perhaps a more accurate picture, of natural history from prospective studies like the HERA where data is analyzed as it is made.

__________________

kat in the delta · 09-25-2006, 01:54 PM

Just looked at this--Thanks for the info.I like the Facts and the Details and no cover-ups, and am glad someone had some statistics.!!! ..I have been trying to find something. I have finished my 1 yr of Herceptin after getting the A/C, rads and taxol with 1/2 of my taxols with herceptin right after my Onc. came from a meeting about using it for early stagers, then the other half alone + 1 yr of herceptin.
I have felt like a sitting duck after stopping herceptin eventho' it may not have worked for me. Also, for the past few weeks my upper right chestwall has been really hurting me at the site of my masc.& lymph node removal. I have even taken pain meds for it. Sometimes I feel like my chest is on FIRE !!! My Onc. says that this is normal..--???-(I don't think so)
Has anyone here experienced a burning pain at the site of surgery and nearby regions ? rsvp kat in the delta

julierene · 09-25-2006, 02:36 PM

If you look at my history below, you will see that there will always be those women... I got BC very young at 28 (as well as my mother at 28) because we have a genetic mutation in the p53 gene. There is new info out about a drug called advexin (i think) and they are hoping that will help with the p53 pathway. For a woman who fell in the 11% category, I have often wondered how many other pathways there are. So much for node negative and small tumor size!