prognosis of her2+er+ breast cancer discussed

[Lani]

http://www.nature.com/bjc/journal/v1.../6605799a.html


Clinical Study

British Journal of Cancer (2010) 103, 475–481. doi:10.1038/sj.bjc.6605799 www.bjcancer.com
Published online 27 July 2010
Increased mortality in HER2 positive, oestrogen receptor positive invasive breast cancer: a population-based study

C A Purdie1, L Baker2, A Ashfield2, S Chatterjee3, L B Jordan1, P Quinlan2, D J A Adamson3, J A Dewar3 and A M Thompson2

1Department of Pathology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
2Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
3Department of Clinical Oncology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
Correspondence: Dr CA Purdie, E-mail:colin.purdie@nhs.net

Received 31 March 2010; Revised 18 June 2010; Accepted 18 June 2010; Published online 27 July 2010.

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Abstract
background: This study assessed the impact of human epidermal growth factor receptor 2 (HER2) status on the outcomes in an unselected population of breast cancer patients who did not receive HER2-targeted therapy.
methods: HER2 status by immunohistochemistry and fluorescence in situ hybridisation was compared with clinicopathological data, overall survival (OS) and disease-free survival (DFS) for all patients presenting with breast cancer over 3 years.
results: In 865 patients (median follow up 6.02 years), HER2 positivity was identified in 13.3% of all cancers and was associated with higher tumour grade (P<10−8), lymphovascular invasion (P<0.001) and axillary nodal metastasis (P=0.003). There was a negative association with oestrogen-receptor (ER) and progesterone-receptor expression (P<10−8), but the majority (57%) of HER2+tumours were ER+HER2 positivity was associated with poorer OS (P=0.0046) and DFS (P=0.0001) confined to the lymph node-positive (LN+) and ER+ subgroups.
conclusion: HER2-positive cancers were less common in this population-based cohort than most selected series. The association of HER2 positivity with poor prognosis was confined to the ER+ and LN+ subgroups. The survival deficit for the 7.5% of patients with ER+/HER2+ cancer compared with ER+/HER2– patients points to a significant subgroup of women who may not (currently) be considered for HER2-directed therapy.
Keywords: breast cancer; oestrogen receptor; HER2; survival; population

[whatz]

Unless I misunderstand...this one is studied patients that did not receive Herceptin (I assume that's what's meant by "...unselected population of breast cancer patients who did not receive HER2-targeted therapy.")
I thought that was already an established fact that Her2 positive automatically made you a candidate for Herceptin because of its agressive nature (therefore no surprise that ER+/HER2- had better rates than ER+/HER2+ without Herceptin therapy). Not sure I understand this abstract correctly at all.

[Laurel]

Well, whatz, that's my take on it too. Kinda a duh, huh?

[tricia keegan]

I was a little puzzled on reading it too and got the same message.!

[das]

It looks like they evaluated 920 patients with invasive breast cancer presenting to a single center in Scotland between June 2000 and June 2003. This time period was before Herceptin therapy was licensed there.

It appears to be a descriptive study. They compared the characteristics (ER+/-, Grade, node status, etc) for HER2+ and HER2- patients. They also looked at the 5-year DFS and OS for HER2+ and HER2- patients stratified by the different characteristics: for example LN-HER2- had DFS of 91.6% and LN-HER2+ had DFS of 87.6%. They also present some survival curves for combinations of HER2 status and other characteristics as well as a regression model showing the effects of each characteristic 'adjusted for' the other characteristics.