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Topic: Difference between C-erb-2 and Her-2-neu

Forum: HER2+ (Positive) Breast Cancer —

Testing, treatment, side effects, and more.

Posted on: Jul 22, 2009 12:49AM

chinit0 wrote:

Good day everyone!

My mother has undergone surgery for her breast cancer last month and her pathology report says she is ER negative and PR negative but her C-erb-2 receptor assay is possitive. Here is the exact text in the result:

C-erb-2 (Her-2-neu) receptor assay:

Positive for c-erb-2 receptors in 90 percent of tumor cells. Stain intensity is +2.

The oncologist says she should take another test just to make sure because the result does not directly say Her-2-neu (and we did last week but the result will take another week to get). I'm not with my mom during my her check-up with the onco (but my dad was). The oncologist also says that my mom will undergo in an aggressive chemo if the test turns out possitive for Her-2-neu. This made her worry too much.I would like to ask what is the difference between the two? I have read somewhere that Her-2-neu is likely the basis the recurrence of the cancer but what about the C-erb-2? How aggressive is the treatment for Her-2-neu?

Here are other information on the pathology result:

 Infiltrating duct carcinoma, gr II (does it mean she's on stage 2?)

 Tumor diameter = 4cm.

 17lymph axillary lymph nodes are neg for tumor metastases

no evidence of lymphovascular peritumoral invasion

Thanks!

Carl

Dx 6/19/2009, IDC, 4cm, Stage IIA, Grade 2, 0/17 nodes, ER-/PR-, HER2+
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Jul 22, 2009 12:28PM orange1 wrote:

Hi Carl,

Sorry that your family has to go through this.

C-erb-2 is a synanym for Her-2-neu.  There several tests for this.  One is an called an ICH test (the one that has probably been done already).  This test is less reliable than a FISH test (the one they are probably conducting now.)  Since the ICH test is less reliable, if it shows positive, it is often verified by the FISH test.

Grade 2 does not mean stage 2.  Grade 2 means that the tumor is only moderately aggressive in growth.  Most Her2+ breast cancers are grade 3 (very aggressive), so grade 2 is a good thing.

Node negative: A very good thing.  This is the most important predictor of your mom's prognosis - chances are she will be fine, even if the final Her2 result (by FISH test) is positive.

No sign of lymphovascular peritumoral invasion - This is also a good finding.  It means it is less likely that the cancer has had the chance to spread.

4 cm tumor - a little on the big side.  But still the fact that your mom is lymph node negative is the most important aspect to predicting her prognosis.

If you read much on the internet about Her2+ tumors it is very scary.  Most of the negative articles were written before a drug called Herceptin was approved to treat early stage breast cancer.  This drug reduces the chance of the tumor recurring by 50%.  So women with Her2+ breast cancer have a much, much better prognosis than they did before 2006.

Good luck with everything.

Jackie

Dx 8/2007, IDC, 1cm, Stage I, Grade 3, 0/3 nodes, ER+/PR-, HER2+
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Jul 23, 2009 12:46AM chinit0 wrote:

Thanks Jackie! It was very helpful.

Dx 6/19/2009, IDC, 4cm, Stage IIA, Grade 2, 0/17 nodes, ER-/PR-, HER2+
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Jul 23, 2009 12:48PM orange1 wrote:

I forgot to address one of your questions.

Generally for your Mom's tumor characteristics, the oncologist will give either AC TH or TCH.  AC TH is a little for aggressive, especially the AC part, but most women tolerate it okay.  The TH part is easier to handle.  Many women also get TCH.  This is easier to handle for most people.  I and many people on these boards did this regimen while working full time.  So while its not fun, its not terrible either.

The choice will depend on your mom's onc preference, and your mom's pre-existing medical conditions.  TCH has a much decreased risk of heart damage compared to ACTH.  AC TH is theoretically 1-2% more effective than TCH, so some oncs like to use that for larger tumors, and node positive.  But the difference in out come between AC TH and TCH is not significantly different.  Because of the reduced risk of heart damage with TCH, over the past year and half, many oncs are suggesting the TCH.

Good luck

Dx 8/2007, IDC, 1cm, Stage I, Grade 3, 0/3 nodes, ER+/PR-, HER2+
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Aug 11, 2009 11:14AM chinit0 wrote:

Hi Jackie,

 Thank you very much for your info. We just got the FISH test result of my mom. It says 3.89. I've read somewhere that ICH test with 2+ means it is in the bordeline and the FISH test would confirm if its positive or negative. My mom is 2+ in ICH and now 3.89 ratio in FISH. The onc said she'll have 6-8 sessions of chemo and she could take the herceptin while doing chemo or after chemo. Not sure what does 3.89 means or how does it affect the cancer. Another thing that we're worried of is the price of Herceptin. The price is too high and we're not sure if we can afford it :(

 Thanks,
Karl

Dx 6/19/2009, IDC, 4cm, Stage IIA, Grade 2, 0/17 nodes, ER-/PR-, HER2+
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Aug 11, 2009 04:10PM orange1 wrote:

Hi Karl,

According to a review I gof from medscape:  www.medscape.com/viewarticle/585224_print 

a positive result for HER2:CEP17 ratio> 2.2 is positive.  Given this, I would try to get the Herceptin.  Does your mom have insurance?  They should pay because the result is positive.  If not, is she eligable for Medicare?  If you're mom's income is pretty low, she may qualify for help from the company that makes Herceptin (Genentech).  For information on this program call Access Solutions at 888 249 4918.  They said they help with copays if you have insurance and if you don't have insurance they may fund the herceptin.

If Access Solutions is unable to help you, and if there are some funds are available and it were me, I would do Herceptin for a reduced period of time - only a few months instead of the entire year.  But I would do it WITH chemo, not after, since a couple studies have indicated that concurrent administration of Herceptin with chemo appears to be more effective than when its given afterwards.  Google "FinHer".  This is a small study that showed very good results even though Herceptin was given only for only 9 weeks. 

If none the above works, there is a vaccine in clinical trials against Her2.  In Phase 2 (mid stage trials, it was shown to be pretty effecitve.  I believe it is in Phase 3 now.  They are only giving it to people who do not receive Herceptin.  If she meets the criteria for the study, the vaccine will be provided without cost.  Let me know if you're interested and I'll find the details.  From what I have read about it, if I were eligible, I would do it (I emailed the company about it but am ineligable because I received Herceptin.)

PM me if you would like to discuss in more detail. 

Best Wishes for your family.  Jackie

Dx 8/2007, IDC, 1cm, Stage I, Grade 3, 0/3 nodes, ER+/PR-, HER2+
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Aug 11, 2009 04:25PM - edited Aug 11, 2009 04:27PM by orange1

Hi Karl,

I just thought of something else for your mom...

If none of the above work, consider either SWOG trial or Zometa for prevention of recurrence.  In one large study in premenopausal women, Zometa reduced the chance of recurrence by 35%.  Most believe the result will be the same in post menopausal women since there has been some signs of this in trials that were using Zometa for another purpose (its is approved to treat bone metastasis and treat/prevent osteoporosis.  But there is evidence it also prevents early stage cancer from coming back. 

Because we have higher risk of recurrence, many of us Her2+ women are in the SWOG trial or take Zometa every 6 months.  If your mom makes it into the SWOG trial, study drug will be provided free.  If she opts to take zometa, the cost is a small fraction of the cost of Herceptin.  I didn't find out about the trial until too late too enroll, so I get Zometa every six months.

The trial that demonstrated reduced recurrence is ABCSG-12.  Let me know if you would like additional information.

Best

Dx 8/2007, IDC, 1cm, Stage I, Grade 3, 0/3 nodes, ER+/PR-, HER2+

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