Need help! Calling brains in. - Page 2

Jackie07 · 12-18-2010, 03:43 PM

Did a quick search and found this trial result:

Lancet Oncol. 2010 Mar;11(3):266-74. Epub 2010 Jan 13.
Predictive markers of anthracycline benefit: a prospectively planned analysis of the UK National Epirubicin Adjuvant Trial (NEAT/BR9601).

Bartlett JM, Munro AF, Dunn JA, McConkey C, Jordan S, Twelves CJ, Cameron DA, Thomas J, Campbell FM, Rea DW, Provenzano E, Caldas C, Pharoah P, Hiller L, Earl H, Poole CJ.
Endocrine Cancer Group, Edinburgh University, Edinburgh, UK. John.Bartlett@ed.ac.uk

Comment in:

Lancet Oncol. 2010 Mar;11(3):216-7.

Abstract

BACKGROUND: The NEAT/BR9601 trial showed benefit for addition of anthracyclines to cyclophosphamide, methotrexate, and fluorouracil (CMF) as adjuvant treatment for early breast cancer. We investigated prospectively predictive biomarkers of anthracycline benefit including HER2 and TOP2A.

METHODS: 1941 tumours from 2391 women recruited to NEAT/BR9601 were analysed on tissue microarrays for HER2 and TOP2A amplification and deletion, HER1-3 and Ki67 expression, and duplication of chromosome 17 centromere enumeration probe (Ch17CEP). Log-rank analyses identified factors affecting relapse-free and overall survival, and regression models tested independent prognostic effect of markers, with adjustment for known prognostic factors (age, nodal status, oestrogen-receptor status, grade, and tumour size). The predictive value of markers was tested by treatment interactions for relapse-free and overall survival.

FINDINGS: 1762 patients were analysed. 21% of tumours (n=367) were HER2 amplified, 10% were TOP2A amplified (n=169), 11% showed TOP2A deleted (n=191), 23% showed Ch17CEP duplication (n=406), and 61% had high (>13.0%) Ki67 (n=1136). In univariate analyses, only HER2 amplification and TOP2A deletion were significant prognostic factors for relapse-free (hazard ratio [HR] 1.59, 95% CI 1.32-1.92, p<0.0001; and 1.52, 1.20-1.92, p=0.0006, respectively) and overall survival (1.79, 1.47-2.19, p<0.0001; and 1.62, 1.26-2.08, p=0.0002 respectively). We detected no significant interaction with anthracycline benefit for Ki67, HER2, HER1-3, or TOP2A. By contrast, in multivariate analyses, Ch17CEP duplication was associated with significant improvements in both relapse-free (HR 0.92, 95% CI 0.72-1.18 for tumours with normal Ch17CEP vs 0.52, 0.34-0.81 for tumours with abnormal Ch17CEP; p for interaction=0.004) and overall survival (0.94, 0.72-1.24 vs 0.57, 0.36-0.92; p for interaction=0.02) with anthracycline use.

INTERPRETATION: In women with early breast cancer receiving adjuvant chemotherapy, the most powerful predictor of benefit from anthracyclines is Ch17CEP duplication. In view of the location of HER2/TOP2A on chromosome 17, Ch17CEP duplication might explain the inconsistencies in previous studies of factors predicting benefit from anthracyclines.

FUNDING: Cancer Research UK and the Scottish Breast Cancer Clinical Trials Group.
Copyright 2010 Elsevier Ltd. All rights reserved.

Trish · 12-18-2010, 11:27 PM

Thanks Rich-after reading the info I think I will ask for Arimedex to go with my Abraxane, Tykerb, Herceptin cocktail.
Michka the 20 month prognosis is nonsense-excuse the non diplomatic language. Even I have thrived for 4 years post met diagnosis and I have never been one of the lucky NEDers. I have had a lot of chemo but a good quality of life and I am hoping to last long enough to try TDM-1. I am hopeful you will be one of the NED respnders. All the best
Trish

michka · 12-19-2010, 12:29 AM

Thanks Jackie. It is really interesting but how to test "Ch17CEP".? Maybe he has a way since he also works in a big Hospital in Paris called Pompidou were they have research and run trials. But I doubt it.
And take such a toxic chemo with nothing to measure progress seems crazy. Unless it can be done by the CTC tests?
It's an onc who accepts to explain and discuss. And he knows that I will do nothing if I don't understand.
My body was destroyed by the FEC and then the Taxol. I never was ever the same and suffer ever since. So I just can't imagine going for CMF or Taxotere in the blind. He wasn't my onc at the time.
I will take the article with me! My onc knows I am half american (I know! my English should be better but I have been living in France for 50 years out of 54!) so when I come in with my questions or articles, he makes believe it gets him upset and in fact he spends time to understand what I read and answers.
And what I like is often he answers "well we just don't know".
The last time I asked him what France was doing on TDM1. He said he would answer the next time because he wanted the latest update.
Thanks again Jackie! Michka

michka · 12-19-2010, 03:47 AM

Jackie,I read the answer you sent to KDR about ER- PR+. Thank you so much for doing researches. I am unable to find such information without you or Rich or Hopeful and so many others... I am so grateful.

Does this mean, my new met being 20%ER+ and 0% PR+ my idea of still hanging
on to an anti hormonal therapy is useless?
Michka

Jackie07 · 12-20-2010, 04:15 AM

The use of Tamoxifen seems to have been changing due to new findings.

When I was first diagnosed in 2003, my oncologist said I was ER- PR- and couldn't use Tamoxifen. But then two other doctors in a one month period of time (after I had finished chemotherapy) all were ready to start me on Tamoxifen. I thought the first one was crazy. But I contacted my oncologist's office after another doctor had mentioned the same thing.

So my oncologist gave me the Tamoxifen (in 2004).

After I finished chemo for my recurrence 4 years later, same question was asked again. And again my oncologist gave it to me after I had asked for it.

I consulted my 2nd Sister-in-law's oncologist overseas about the matter in 2009, and he told me the following:

Since your breast cancer is ER (+), although the percentage of ER is 5-10%. Hormonal therapy with tamoxifen or AI (arimidex) is the treatment of choice.
The disadvantage of tamoxifen: Uterine myoma, uterine carcinoma...etc. but less osteroporosis.
The disadvantage of arimidex (AI analogue): severe osteroporosis..
Conventionally, chemotherapy will destroy the ovarian functions, oophorectomy, therefore, is not necessroy.
But if you still have menstration indicating the normal ovary function, oophorectomy and hysterectomy (to avoid uterine tumors) followed by tamoxifen treatment are treatments of choice. [I think he meant to use the word 'following' (or 'after') instead of 'followed by'] [12-25-2010: Now my oncologist started me on Tamoxifen again - perhaps my Sister-in-law's oncologist was talking about oophorectomy and hysterectomy 'followed' by Tamoxifen.]

I asked for hysterectomy/oophorectomy after my genetic test came back positive for a BRCA1-'Variant of Unknown Significance'. After the surgery in January, I quit taking Tamoxifen and thought I would start AI.
But my oncologist said 'No'. So I just let it go.

However, my oncologist sent me a note in August a couple of days after my last appointment with him and told me that he "just wanted to make sure that you are taking your Tamoxifen."
So I am back on Tamoxifen again. I later found a couple of articles citing the result of some studies that the benefit of Tamoxifen continues even after 5 years and also for ER- patients.

Joan M · 12-22-2010, 10:03 PM

Michka,

Adding a course of chemo to your regimen might be a good thing. As you know, I had local treatments for both my lung met and brain met and have never been on chemo, only Herceptin, since my disease advanced in January 2007.

However, I now worry about that. If I had to do it over I would have had a course of chemo after the original lung wedge resection.

I mentioned my concerns to my onc, but she absolutely refuses to consider giving me any treatment unless another lesion shows up again.

I feel that I should be doing something more than Herceptin. I can probably get treatment somewhere else, but will wait a few months to decide what to do. I've gotten mixed opinions, with most people telling me not to take anything.

As to the CTC test, they don't believe in it where I go for treatment. I also asked about that test at my appointment last week.

Joan

caya · 01-05-2011, 09:01 PM

Michka, comment ca va? How are you? any updates?

all the best
caya

michka · 01-06-2011, 03:50 AM

Hi Caya! Thank you so much for thinking of me. To tell the truth, I am not too well but much better than a week ago. I had horrible pain below my right ribs after I laughed and was back in the hospital in ER. It was the first time I laughed since the discovery of my met. They gave me morphine and did a scanner and an echo. That was almost 4 weeks after surgery.
They said they saw nothing but wanted me to stay overnight. The surgeon looked very worried but kept saying he did everything perfectly. I had to tell him to stop protecting himself, it was not the point. I just wanted to stop suffering and understand what was going on. The next day I was better although still in pain. Seeing them so worried and not talking I said to myself I had to get out of there and see someone else. They didn't like the idea but had nothing to suggest. I left the hospital and contacted a very good friend who is a "hepato gastro" doctor. How do you say that in english? I figure you understand. With the scan and the echo he told me it was very clear: a stitch or clamp must have broken when I laughed and you could see traces of the bleeding on the scan. he said that's why they were worried not knowing if it would stay stable and heal or if it would worsen. He reassured me telling me I should not wait in a hospital bed but not move at home. He told me what to watch carefully and if some parameters changed to go to the hospital where he works. He said it should get better very slowly but it is very painful. It did get much better but now I am afraid to move, sneeze or laugh. I have had coagulation problems during my 2 breast reconstruction surgeries and I always knew this means cancer although nothing ever came out as being abnormal in all the very intensive work they did on my blood.

I had my first infusion of herceptin 10 days before this episode and was so sick. I did not have that with herceptin before but maybe it is because my liver was not healed. I had very bad nausea, chills, headache and pain but it only lasted 48 hours. I started Tykerb 2 weeks ago. 2 pills for a week and now 3 pills until I see my onc again at the end of next week. It is a little difficult on my intestine so I am on the Brat diet. This part is OK. I know how to handle. What worries me is that on the scan they did in the hospital it also shows they see 2 other pale spots on the liver. That is what worries me the most. They did a scan without contrast. I have a MRI of the liver scheduled the day before I see my onc. I am scared stiff. With my onc we should also discuss chemo or not chemo and what. I would like to go with Navelbine. But if I have no other met, should I go for Chemo or keep it as a future weapon?

I didn't need this complication but I am better. Just hoping I have no other met.I am trying to take hold of my mind and be stronger. Thinking of Steph, Elaine, Andy, Kim, Tricia, Chrisy, Stephanie, Jackie, Lori, Trish, Sheila, Pam, Chelee, K1 and KDR and so many other courageous ladies who don't complain and fight.
Love to all. Michka

Jackie07 · 01-06-2011, 04:39 AM

Oh Michka, I'm so sorry you have had the complication. Nobody should be punished for 'laughing' - that is just not fair.

Hepato Gastro sounds like liver and stomach - the closest one in English I can think of is a gastroenterologist who takes care of the digestive tract problems.

Love to you, too.

Sheila · 01-06-2011, 07:10 AM

Michka
Stay strong, just wanting you to know I am thinking of you and keeping you in my prayers....I am so sorry for the complications,,,hoping they resolve and you can begin treatment soon....I am hoping the navelbine will do its thing...many have had success with Navelbine and liver mets.
Sending a big hug!

Mary L · 01-06-2011, 07:48 AM

Michka, I too am so sorry you had to have this added complication. You are very brave. I am praying for you and that you get a good report on the MRI. Best wishes!! Mary L

caya · 01-06-2011, 02:06 PM

Michka, I'm sorry you had this complication... try not to rire (laugh).
Jackie is right, I think the dr. is a gastroenterologist - gastro for short.
I hope one of our liver braniacs will chime in with some advice.

all the best
meilleur a toi,
caya

StephN · 01-06-2011, 05:00 PM

Dear Michka -
I am wondering why they did the CT without contrast??
And you have an MRI of liver scheduled, but not a PET scan?

Those spots could be scar or some other non-cancer thing showing up.

Sorry about the bleed. You'll have to chuckle more quietly and softly! But - KEEP your sense of humor. I wonder if the MRI will show that the area of the bleeding is being cleared by your body's natural processes. Hope that is what they want to look at - more so than the spots.

I know you will be much better very soon.

Lori R · 01-06-2011, 07:26 PM

Michka,
Amazing connection thing....I was driving home from work this evening and was thinking about you. Although I rarely log on in the evening, I decided to and the first post is from Steph N on your thread.

It is so good to hear from you and pleased you had reason to laugh. But then....sorry to hear it caused problems.

I will be anxious to hear about decide upon. I wish I had some data for you regarding the results of my recent round of Navelbine, but I won't have a scan until mid to late February.

Keep on laughing!!! It is the best medicine.

So glad to see your update....Lori