my sis just got dx. Help!

[kristen]

I haven't posted in quite some time, I have been doing very well, just passed my 3 year anniversary, yipee!
It is with sad news that I tell you my sister 53 just got dx in December with BC. Stage 2, 3mm sentinal lymphnode and all else clean. Double mast and is in recovery right now. She met with her onc today and since I can't keep anything clear in my mind like all you lovely ladies, I thought I would start a post for her and see if you could help her out with all the new stuff going on. Love you guys....
First off she is er+/her2+ and borderline pr. She had blood clots last year and are saying that tamoxifen will not be an option for her, so my question is will they probably put her on an AI and how effective is this with out Tamox?
Shouldn't her tumor be tested for TOPO II? I haven't gone completely insane but wasn't this a factor in how well you responded to certain treatments?
I can't remember if your TOPO if u should get the A/C or Carbo/Taxotere? What she told me today is that he is thinking about 2 different kinds one for 4 tx and another for 4...is this something new? He is also looking into some studies, any you know of and could list would be appreciated. By the way we live in 2 different cities if your wondering.....
I am sure that her doc will run Muga tests and I remember the effects of Herceptin, who could forget that? I had the Car/Tax/treatment with 1 year Herceptin. So any help to get her started or to ask her onc would be greatly appreciated. She may post and ask her own questions later, but thought we could start here.
It's such a long journey and so complicated, but without the help of all of you, I don't think I would be here today. Your support and dedication is unparallel to any other site and I know that you will all take good care of her. Thanks to you all.
ps, anyone know of any other sisters who were both her2 and I don't carry the gene? Wierd.....

[Lani]

Dr. Dennis Slamon has commented at several conferences that he thinks that Faslodex (fulvestrant) is the most effective antihormonal drug for her2 breast cancer, based on its mechanism of action.

AIs still work in her2+ patient but less well than in her2- patients and WHEN GIVEN IN COMBINATION WITH HERCEPTIN (at least for the first year)


It is usually given when a patient with metastatic disease fails tamoxifen or an AI, but may be beginning to be given in the adjuvant setting--I think someone on this board commented that they are on it and I know of someone else receiving it adjuvantly, particularly in someone in whom there is an increased risk of DVT (as she already had one). It is an injectable medication, given monthly and works by a different mechanism of action than either tamoxifen (which sits on the ER blocking estrogen from getting theri) or AIs which block the production of estrogen via one of its 3 ways of being made in muscle, liver, breast, fat tissue, etc.

Perhaps she could get on a trial of Tykerb plus Herceptin vs Herceptin alone (neither option too shabby!) There are other new trials starting including Herceptin+Avastin adjuvantly...there are so many new options available.

As regards the inheritance, I have found two papers on familial her2+ breast cancer--here is the abstract of one:
Am J Clin Pathol. 2003 Dec;120(6):917-27. Links
Her-2/neu gene amplification in familial vs sporadic breast cancer. Impact on the behavior of the disease.

Espinosa AB,
Tabernero MD,
Garcia-Macias MC,
Primo D,
Bernal AG,
Cruz JJ,
Ramos M,
Font de Mora J,
Gomez Alonso A,
Orfao A.
Cancer Research Center, Department of Medicine, General Cytometry Service, University of Salamanca, Salamanca, Spain.
We compared the incidence of Her-2/neu amplification in patients with and without a family history of breast cancer and correlated gene status with clinicobiologic and prognostic features in sporadic and familial cases. Of 108 patients, 28.7% had gene amplification. Among 96 cases with family history information available, 28 had an affected first-degree relative. The gene was amplified more frequently in familial than in sporadic cases (13/28 [46%] vs 14/68 [21%]; P = .01). Among familial cases, amplification was associated with adverse clinicobiologic features (poorly differentiated tumors [P = .05], larger tumors [P = .05], more lymph nodes involved [P = .04], and DNA aneuploid [P = .02] and highly proliferative tumors [P = .005]), and the relapse (P = .02) and disease-related death (P = .05) rates were higher than in cases without amplification. Among sporadic cases, amplification was not associated with significantly different disease features, except for a higher incidence of DNA aneuploid tumors (P = .01), percentage of S-phase tumor cells (P = .006), and lower proportion of estrogen (P = .001) and progesterone (P = .002) receptors. Her-2/neu amplification was observed more frequently among patients with a family history of breast cancer, in whom it was associated with adverse clinicobiologic features and a worse clinical outcome.
PMID: 14671981 [PubMed - indexed for MEDLINE]
will try to post the abstract of the other

Please remember to add your case and that of your sister to my previous posting asking those with her2+breast cancer if there were others with breast cancer in their immediate families and if they knew if the others were her2 as well.

By the way, if you don't mind sharing, how do your tumor characteristics (%ER,%PR, LVI, SIZE, LYMPH NODE INVOLVEMENT, KI-67, ETC) AND THOSE OF YOUR SISTER COMPARE?

Best of luck!

[Lani]

Mt Sinai J Med. 1995 Nov;62(6):415-8. Links
Breast cancer and family history: a multivariate analysis of levels of tumor HER2 protein and family history of cancer in women who have breast cancer.

Lehrer S,
Lee P,
Tartter P,
Shank B,
Brower ST.
Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY 10029, USA.
BACKGROUND: The HER2 gene, located on the long arm of chromosome 17, codes for a protein with the characteristics of a growth factor receptor. In a preliminary study, we reported that high levels of tumor HER2 (erbB-2/neu) protein are associated with a family history of breast cancer (that is, one or more female blood relatives with breast cancer). METHODS: We have now collected a larger number of subjects (94) and performed a multivariate analysis of the independent variables family history of breast cancer, tumor estrogen receptor, age, and tumor DNA index. Family history of breast cancer was assessed by questioning the patient, in many cases by telephone. RESULTS: HER2 levels were significantly higher in women with a family history of breast cancer (p = 0.015, two-tailed t-test). The 27 women with family history were predominantly postmenopausal, mean age 61 +/- 2.3 (mean +/- SEM), versus a mean age of 56 +/- 1.7 for the 67 women with no family history. Of the 27 women with a family history of breast cancer, 13 had a first-degree relative (mother or sister) with the disease. The remaining 14 women had other relatives (grandmothers, aunts, cousins, or a niece) with breast cancer. The results of multiple linear regression analysis, with HER2 as the dependent variable, showed that family history of breast cancer was significantly associated with elevated HER2 levels in the tumors (p = 0.0038), after controlling for the effects of age, tumor estrogen receptor, and DNA index. CONCLUSIONS: The association of family history of breast cancer and elevated tumor HER2 protein suggests that postmenopausal familial breast cancer may be associated with altered HER2 expression.
PMID: 8692153 [PubMed - indexed for MEDLINE]

[kristen]

Lani, just what I was looking for, your a trooper. I don't know exactly how we compare, but I will let you know, when I know. She just went yesterday and that was the one sheet that he didn't give her. Thanks again.