Relapse HISTORY for her2+S

[Susan Rankin]

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]

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]

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]

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]

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

[RobinP]

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.

__________________

[Barbara H.]

I don't mean to scare others, but my recurrence came 6 years later. I was having headaches for awhile and waited way too long to have them checked out. The mets were everywhere except the bones. After I started Herceptin in July, 04 my tumor markers were normal by the second or third treatment. My pet scan in March indicated no cancer except in the bones. I've been on Navelbine. I had at PET-CT scan yesterday. If all is well I will drop the Navelbine. If not, I will have to consider other options. I really wonder if my outcome would have been different had I been able to have Herceptin early on.

After six years I was feeling too safe, and the lesson for others is that we must question issues in our body that do not feel right and not wait to have them checked out.

Best wishes,
Barbara H.

[lu ann]

Hi Barbara,

I have been on xeloda for the last 2 months with very little side effects. It has been by far the easiest treatment I have been on. It is supposed to work well with herceptin and the new trial, tykerb. I havn't been on herceptin since Dec. 05.

I had a 5 1/2 month break from all but zometa for the bone mets. I started xeloda in August. I was on 4000mg dailly for 2 weeks, then 1 week off. Doc dropped me back to 3000mg daily, as my feet were swelling. I'm also on lasix.

If I don't qualify for the tykerb, I might ask Doc if I can go back on herceptin with xeloda.

Blessings from Lu Ann