|
03-19-2009, 05:53 AM
|
#1
|
Senior Member
Join Date: Mar 2006
Posts: 4,778
|
for all you her2+ ER+s, THEY KEEP SEARCHING FOR A MOLECULAR SUBTYPE FOR YOU
some ignore the type, others lump it into Luminal B.
Here is another approach:
Int J Clin Exp Pathol. 2009;2(5):444-55. Epub 2009 Feb 9.
Prevalence, morphologic features and proliferation indices of breast carcinoma molecular classes using immunohistochemical surrogate markers.
Bhargava R, Striebel J, Beriwal S, Flickinger JC, Onisko A, Ahrendt G, Dabbs DJ.
Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center Pittsburgh, PA, USA.
There is dearth of studies that provide a practical working formulation of breast cancer gene expression analysis for the surgical pathologist. ER, PR, HER2 were used as surrogate markers to classify 205 breast carcinomas into molecular classes. Ki-67 labeling index was calculated using an image analysis system. The data was analyzed for molecular class prevalence, and inter-relationships amongst morphologic parameters, Ki-67 index, and molecular classes. Of the 205 tumors, 113 (55%) were classified as luminal A (strong ER+, HER2 negative), 34 (17%) as luminal B (weak to moderate ER+, HER2 negative), 32 (15%) as triple negative (negative for ER/PR and HER2), 8 (4%) as ERBB2 (negative for ER/PR but HER2+), 10 (5%) as luminal A-HER2 hybrid (strong ER+ and HER2+), and 8 (4%) as luminal B-HER2 hybrid (weak to moderate ER+ and HER2+). The average Ki-67 index was lowest in luminal A (15.8%), intermediate for ERBB2 (27.8%) and highest for triple negative tumors (>50%). Multivariate logistic regression analyses found the following associations: ERBB2 tumors with apocrine differentiation (p=0.0031); Triple negative tumors with high Ki-67 index (p<0.0001) and CK5 positivity (p<0.0001); HER2 negative-low receptor positive tumors (luminal B) with increased lymph node involvement (p=0.0141). The immunohistologic criteria were validated on a different set of 359 cases treated with neoadjuvant chemotherapy, which showed a pathologic complete response predominantly in ERBB2 and triple negative tumors. Immunohistochemistry is a reliable surrogate tool to classify breast carcinoma according to the gene expression profile classification.
PMID: 19294003
|
|
|
03-19-2009, 05:31 PM
|
#2
|
Senior Member
Join Date: May 2008
Location: Hershey, PA. Live The Sweet Life!
Posts: 2,005
|
Hmmm, so what's a "luminal A-Her2 hybrid" supposed to think?
__________________
Smile On!
Laurel
Dx'd w/multifocal DCIS/IDS 3/08
7mm invasive component
Partial mast. 5/08
Stage 1b, ER 80%, PR 90%, HER-2 6.9 on FISH
0/5 nodes
4 AC, 4 TH finished 9/08
Herceptin every 3 weeks. Finished 7/09
Tamoxifen 10/08. Switched to Femara 8/09
Bilat SPM w/reconstruction 10/08
Clinical Trial w/Clondronate 12/08
Stopped Clondronate--too hard on my gizzard!
Switched back to Tamoxifen due to tendon pain from Femara
15 Years NED
I think I just might hang around awhile....
|
|
|
03-19-2009, 06:16 PM
|
#3
|
Senior Member
Join Date: Sep 2005
Location: Mountains of Virginia
Posts: 2,267
|
Lani, can you translate for these Luminal A-her2 hybrid girls?
__________________
Rhonda (Sassy)
dx age 45
DX 2/15/05 Stage IIb (at surgery)restaged IIIa
Left mast .9cm tumor 5 of 14 nodes
Triple Positive
4 DD A/C
12 Taxol/Herceptin
33Rads
Strange infect mast site one year aft surg, hosp 1 wk
Herceptin for total of 18 months
Lupron Monthly 4 yrs
Neurontin for aches, pains and hot flashes(It works!)
Ovaries removed 11/09 stop Lupron and Neurontin
Arimidex 6 yrs (tried Femara, no SE improvement)
Tried Exemestane-hips got so bad could hardly walk
Back to Arimidex for year seven
Zometa 2X Annual for 7years, Lasix
Stop Arimidex 5/13
Stop Zometa 7/13-Bi-lateral Stress Fractures in Femurs from Zometa
5/14 Start Tamoxifen
3/15 Stem cell transplant to stimulate femur bone growth/healing
5/15 Complete fracture of right femur/Titanium rods both femurs
9/16 Start Evista stopTamoxifen
3/17 Stop Evista--unwelcome side effects!
NED and no meds.......
14YEARS NED!
|
|
|
03-22-2009, 07:34 PM
|
#4
|
Senior Member
Join Date: Sep 2005
Location: Naples FL
Posts: 1,744
|
ditto!! translate!
__________________
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!!
|
|
|
03-23-2009, 11:45 PM
|
#5
|
Senior Member
Join Date: Mar 2006
Posts: 4,778
|
various researchers decided there were 4 or 5 main molecular sybtypes of breastcancer
several years ago based on gene array studies done on fresh frozen biopsy samples these were
basal usually, but not always triple negative
her type HER2+ ER-
Luminal A ER+her2- with good prognosis
Luminal B those ER+s who don't have as good a prognosis--various researchers argued about where her2+ER+ fit in here, some thought about 50% of these were her2+ ER+ others didn't know if they fit in at all
some also described a Normal type (a lot like normal breast tissue)
If you want to follow articles on this, the major ones have been by Chuck Perou of North Carolina, Sotirou of France/Belgium (?) and Laszlo Pusztai
(sp?) of MD Anderson.
This study is trying to see if using immunochemistry (cheap, more readily available than Affymetrix multigene arrays and able to be done on formal fixed paraffin embedded tumor specimens rather than fresh frozen ones, thus testable on everyone world wide and on old archival tissues) for three
main markers plus a measure of proliferation couldn't tell us a lot about how different tumors behave (prognosis-wise)ie, a poor man's version. They did also look for cytokeratin (CK)5 , a marker of triple negative~basal.
In their system, they identified her2 tumors as being divided into 3 types
(1) her2+ER- which they said constituted 4% of all breast cancers
(2) Her2+ strong ER+ which constitute 5% of all bc
(3) her2+ weak to moderate ER+ which constitute 4% of all bc
her2+ bc is usually felt to represent 20-25% of breast cancer (and these only add up to 13% so the method me not be so good, the IHC testing not so good, or their population scewed) --with roughly half being ER+ and half ER-, but those that are ER+ are usually dumped into the luminal B group because they just didn't know where they belonged.
The interesting news here is that the ERBB2 group (those which are ER+) and the triple negatives had the best results with neoadjuvant therapy (where you can see the results right away) If they keep dividing the her2+ ER+s this way, maybe they can study how neoadjuvant herceptin plus hormonal treatment with or without chemo does to determine whether chemo is necessary for these groups.
Hope this helps!
|
|
|
03-24-2009, 04:40 AM
|
#6
|
Senior Member
Join Date: Feb 2008
Location: Georgia
Posts: 1,486
|
Lani,
When I had my neoadjuvant Herceptin and Taxol, I asked the doctor about putting me on an estrogen suppress because my cancer was 70 or more estrogen driven. He would not.
It will be interesting to see the results of any studies adding Herceptin and an estrogen suppressor.
Amelia
|
|
|
Posting Rules
|
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts
HTML code is Off
|
|
|
All times are GMT -7. The time now is 12:09 AM.
|