Single Hormone Receptor Positive -> ER+/PR-/HER2-
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There seems to be more than one theory on the behavior of er+ pr- cancer. My oncologist did tell me that the pr negative aspect is the most concerning part of my cancer. From what I have read having me take anastrozole instead of tamoxifen was driven by that factor and because I was already post menopausal.
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This recent paper showed a retrospective analysis of PR+ vs PR- and luminal A vs luminal B tumors. My take was that luminal B (grade 3 or high Ki-67) PR- tumor patients had significantly worse outcome (relapse and survival) compared to PR- luminal A patients, and that PR- luminal A were not dissimilar to PR+ patients. Their conclusion was:
"PR positivity may be more protective against metastatic relapse in luminal B-like versus luminal A-like breast cancer, but no strong conclusions can be made. In absolute risk, results suggest an absent PR is clinically more important in high compared with low proliferative ER+ HER-2 negative tumors."
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lmurphy, it is not that clear cut. Not all pr- cancers are high grade or high ki-67. More research is clearly needed. My er was high 95% er was low grade and mitotic score was the lowest.
They really don't know if er + pr - tumors have stopped feeding off estrogen as one study implies. Other studies show AI drugs work significantly better of er+ pr- cancer than tamoxifen, contradicting that estrogen is not fueling the cancer.
You are siting one instance that doesn't explain the whole er+ pr- story, that is the point.
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Interestingly, My cancer was grade 3 but ki67 were low both in tumor and the node, not sure if my almost 100% pr+ was playing a role.
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Pardon my ignorance, how/where do you find about Luminal A or B. I have stage 1A, grade 3, Onco 54. ER+ PR-HER2-. My PR is 2% positive but considered negative on Oncodx. I don’t want to do chemo but no choice. Do I have to do chemo asap or can I delay till January after the holiday
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Hi Anxiouslady, not all labs will report Luminal. Mine didn't. It's more of a research thing than a clinical thing according to my doctor.
fwiw with an onco that high I'd start chemo asap. My oncotype was a bit higher than yours and I started chemo the week after I got the results. Oncotype tells you the aggressiveness of the cancer and its likelihood of spread/recurrence so IMO a high score makes me think it's important to attack hard and fast. Chemo sucks but you will get through it!0 -
Moth, I am hoping my Oncotype score is a mistake. How did they come out with this figure anyway? I am scared and frustrated..I have a daughter who is away in college, she doesn’t know what’s going on, I’m planning to tell her on Christmas vacation when she’s back home. I’ll see my Oncologist on Monday to discuss treatment.
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anxious, you can read a bit about it on their website https://www.oncotypeiq.com/en-US/breast-cancer/pat...
Basically they look at the genes of the actual tumor. They've been tracking various genomic markers in tumors for years now and they know that certain things make a cancer more or less aggressive. They compare your tumor to other people with a similar or same genomic variety. They have looked at how people with your specific type of cancer - at the dna level - do. The higher the oncotype score, the more proven benefit there is to chemotherapy. When you see your oncologist they should give you a copy of your report (you can see samples on the website I linked above) and it will give you a graph showing the predicted odds of the cancer recurring within the next 10 years with no chemo or with chemo.
hang in there. Once the treatment plan is in place most people feel calmer about it all. This cancer thing is tough but you'll get through this.
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Anxious, oncodx is a statistical model, it can't tell you if your cancer will recur or not. My result was a 34, I had 2 one centimeter tumors one idc one ilc both were low grade and mitotic scores of 1. I chose no chemo even though it was recommended. My results were high probably due to er 95% and pr was 0%. This score is given tamoxifen not AI drugs. I chose AI drugs and no chemo, I am 7 years out. I have found studies that say AI drugs are 2x as effective as tamoxifen in the er+ pr- case.
My advice is to look at all the information about your tumor and make a decision. It is your decision not your doctors.
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Meow, is it ok to take hormonal therapy for few months before chemo till have things ready for chemo. I might need some dental works done.
I have one idc 2 cm grade 3 tumor, mitotic rate 3, Onco 54. Before Onco results, I told myself if I’m in the gray area, I will not do chemo but 54is not a gray area. Everything is pointing to chemo.
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Anxious - sorry I do not know the answer to your question about hormonals priors to chemo. Definitely ask this at your visit on Monday as your MO would be best to guide you. Also, you can get a second opinion as to whether you need chemo and if so, what type, what treatment schedule (dose dense versus regular) and whether it can be delayed or not.
There are some studies which statistically run retrospective data through an analysis (because it would be unethical to run a study in which you delayed people's treatment on purpose) and they found worse outcomes for people who started chemo more than 91 days after surgery. (you can read more about it here. https://respectfulinsolence.com/2016/01/12/breast-... First part deals with delays in surgery, second part delays in chemo. )How strong is your ER? Did you already have surgery?
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Moth, I am ER+(90%) PR+(2%) HER2-. UMX & SNB (0/1)done in 10/16/1.
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AnxiousLady / I'm sorry you've found yourself in this situation but glad that you found us. I can only speak from my experience. ER+95, PR-O, HER2-, OncotypeDX 24. That puts me at the very tippy top of the “can safely go without chemo" range according to the TAILORx study. If I'd scored 25, 26, or higher, I would have chosen to have chemo. Yes it's a bear, no it's not fun, but I'll be damned if I'll let cancer have it's way with me without putting up a fight. I consulted my oncologist, a second oncologist in his practice, my radiation oncologist and my primary care physician before deciding that they were all right and that - for ME - AI (letrozole) for 5-10 years was the way to go.
Bottom line: talk with your oncologist at length, listen to him or her, provide your OncotypeDX report to a second oncologist and to your primary care doctor, read the TAILORx study report.
If I were in your position I'd have chemo but only you can make that decision.
Please keep us all posted.
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AnxiousLady, I'm sure you've already found a link to the study, but if not, here's one: https://www.cancer.gov/news-events/press-releases/...
Excerpt: *******According to the authors, the new findings suggest that chemotherapy may be avoided in about 70 percent of women with HR-positive, HER2-negative, node-negative breast cancer:
- older than 50 and with a recurrence score of 11–25 (45 percent)
- any age with a recurrence score of 0–10 (16 percent)
- 50 years old or younger with a recurrence score of 11–15 (8 percent)
The findings suggest that chemotherapy may be considered for the remaining 30 percent of women with HR-positive, HER2-negative, node-negative breast cancer:
- any age with a recurrence score of 26–100 (17 percent)
- 50 years old or younger with a recurrence score of 16–25 (14 percent)
*******
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Anxious, you are grade 3 chemo should be effective in your case. Chemo knocks down fast growing cells, if you do go with hormonal therapy AI drugs are better for er+ pr - cancers almost 2x as effective tamoxifen.
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Meow13--do you have any references for the claim that AI drugs are twice as effective as Tamoxifen on ER+/PR- tumors? I'd like to have something to show my oncologist. Thanks!
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Anxious, hormone therapy will decrease the growth of estrogen sensitive fast proliferating cells. One does not typically take TAM/AI during chemo (or radiation), because chemo is most effective in killing fast proliferating cells and you don't want hormone therapy to interfere with that. After chemo has done its magic, then TAM/AI is given to prevent any possible remaining cells from growing.
You are in my shoes having had essentially PR- and very high oncotype score. Three Oncos recommended chemo for my case and I have no regrets. Your grade 3 status and high Oncotype would suggest that you are luminal B, like me. But your Onco should be able to tell you that. It simply suggests that your tumor is more aggressive than a luminal A, stage 1a.
Okkate, TAM is recommended in pre-menopausal women still secreting estrogen, as it effectively blocks estrogen from binding to its receptor. The Oncotype statistics were all done using TAM. In post-menopausal women and pre-menopausal women who have had their ovaries removed, AIs are shown to be more effective than TAM.
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Another ER+, PR-, HER2- here. What I'm reading is that the single hormone receptor status is similar in outcome to triple-negative. On the same day that I read that, I also read about exercise being an important factor in breast cancer outcomes. I got to this point all because of joint pain from tamoxifen. One article led to another, and here I am with joint pain but needing more exercise.
I'm concerned about being PR- but am doing what I can. I was pre-menopausal at the time of my diagnosis, so tamoxifen it is. And I'm on my second week of walking daily.0 -
okkate,
Here is one another dated 2014 also confirms
http://www.cancernetwork.com/articles/anastrozole-...
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Princessbuttercup, while exercise is great for overall health it doesn't prevent or lessen recurrence. I do 3.5 miles for 1hr on the treadmill everyday and swim 1 mile every other. I have been doing that since about 2009. I was diagnosed with idc amd ilc in 2011. Also eating healthy about 1500 calories or less a day helps. The point I am trying to make there are many BC patients that are in top physical condition who are diagnosed with this disease. Until they actually determine what causes breast cancer it is all noise. However, my cholesterol levels and other blood checks and blood pressure are great. That is always a plus to help with many conditions like heart disease and diabetes but preventing cancer is a stretch.
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Meow, the CMAJ study did find that exercise reduced recurrence: "Physical activity can reduce breast cancer mortality by about 40% and has the most powerful effect of any lifestyle factor on breast cancer outcomes." http://www.cmaj.ca/content/cmaj/189/7/E268.full.pd...
There is also thsi study: "Significantly greater reduction in breast cancer mortality from post‐diagnosis running than walking" https://onlinelibrary.wiley.com/doi/full/10.1002/i...
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Princess, being estrogen positive actually has a better outcome than triple negatives because we can also be treated with anti-hormone treatment (TAM or AI) to help improve our chances. Further, an exercise regimen allows us to be proactive in our own treatment and has been shown to be helpful psychologically as well as physically. I walk every day and tai chi and yoga each 2X week. Certainly doesn't hurt!
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moth, reduce mortality not recurrence. Exercise can improve your overall health.
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lmurphy,
This study (from a few years ago) says that single HR expression tumors have a similar prognosis to TN tumors. (Mine was ER+, PR+, HER2- after the biopsy but reclassified as ER+, PR-, HER2- with oncotype testing.)
https://bmccancer.biomedcentral.com/articles/10.11...
The walking is hard for me due to joint pain from tamoxifen, but I'm trying to stick with it. I'm using MapMyWalk, which inexplicably gives me more motivation to get out there.
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meow - no, it's not just death and it's not death overall that these studies looked at. Cardiovascular benefits are already well known. They were looking specifically at breast cancer recurrence and breast cancer mortality.
CMAJ
"Physical activity has the strongest effect on reducing the risk of breast cancer recurrence and death.""Following the recommended 150 minutes of moderate to vigorous exercise or 75 minutes of vigorous exercise per week, along with two to three weekly sessions of strength training, can help reduce the risk of breast cancer recurrence and mortality. "
Furthermore the running v walking study they specifically looked at breast cancer mortality. Recurrence is implied as those who had worse breast cancer mortality post diagnosis had to have had a recurrence. "There was a significantly greater decrease in breast cancer mortality in per MET‐hours/day run than walked""Analyses presented in this article suggest that post‐diagnosis exercise significantly reduced breast cancer mortality, and that the reduction may be greater for running than walking. Moreover, in breast cancer survivors the benefit of exceeding the current physical activity recommendation by running (≥750 MET‐minutes per week or 1.8 MET‐hours/day) was significantly greater than merely achieving it."
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I'm afraid that I will never get to running, but I'm aiming for walking as fast as I can. I came into this BC situation with bad knees and cartilage loss. Tamoxifen has made that even worse. But, I'm walking!
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Month, thanks for that link. That's a really nice summary of what does and does not appear to help.
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Thanks Moth, I'm finally back to running twice a week and running/walking the rest of the days. So far so good- been on the AIs for 5 months now. Definitely helps to keep moving. Thanks for the links.
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Just reading an article, can't find the link. It was saying chance of early recurrence of er+ pr- is greater than er+ pr+ cancers but the chance of late recurrence is less. It behaves more like triple negative in that the vast majority of recurrences happen before the 5 year mark. Well one little ray of sunshine for having no progesterone receptors!
7 years out.
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Meow...my oncologist told me that those who had HER2 positive with high Ki67, those who had triple negative and those who had ERpositive PGR negative manily could look at them selves as cancerfree after 5 years...
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