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Feb 7, 2012 09:01PM
Sugar77 - I'm glad that you too are finding this information helpful and am very happy to have you here! Thank you for sharing your SIL's story. Sounds like a similar dilemma - why wait when you are still investigating?
fluffqueen, how awesome does your doc sound? I loved hearing about your discussion today. Wow, that is indeed very cool that he brought up that study...I bet he was impressed that you had already seen it. Thank you for finding out his opinion on both t1a's and b's. I love hearing about his thought process. So, did he say you were low risk based upon tumor size and grade, combined of course, with the fact that you had treatment? Anything else?
So, I did a bit more research on the oncotype for HER2+ tumors, and posted on the other thread, but wanted to share here for those who aren't on that thread and may want to post feedback. Check out the study I found.
Identification of a low-risk subgroup of HER-2-positive breast cancer by the 70-gene prognosis signature
This study talks about the oncotype and also about the mammaprint (70 gene-signature) gene test. I found the results/discussion fascinating. It think it explains why we've heard so much that a HER2+ test trumps an Oncotest. It also indicates that a mammaprint test may help actually stratify out which HER2 tumors are lower vs higher risk. I'm going to paste the last part of the discussion in full...I'm thinking of asking my doc to what he thinks of running the mammaprint test instead of the oncotype, but I still need to read more before I open my mouth and possibly insert foot (I'm good at doing that and annoying docs!).
"The second widely used prognostic tool is the 21-gene recurrence score (Oncotype DX, Genomic Health Inc., Redwood City, CA, USA; Paik et al, 2004), which is based on real-time RT-PCR and uses formalin-fixed, paraffin-embedded tissue, and is retrospectively validated for ER-positive breast cancer. As the measurement of the expression of the HER-2 gene itself was chosen as important contributing factor in this ‘knowledge-driven approach', most if not all HER-2-positive tumours are classified as intermediate or high risk and therefore, this assay is unlikely to add prognostic information for HER-2-positive disease. Of the 55 HER-2-positive cases identified in the NSABP B-14 trial, 50 had a high recurrence score (RS) and 5 had an intermediate RS, respectively, whereas none of the patients was assigned to a low recurrence score (Paik et al, 2004; S Paik, personal communication). In comparison, the 70-gene signature was developed using the ‘data-driven approach' with unbiased, genome-wide gene expression. The HER-2 gene itself was not on the list of the 70 priority genes selected solely on the basis of differences in gene expression levels from intact RNA of frozen tumours. This study suggests, that a clinically meaningful and larger proportion (22%) of chemotherapy-untreated HER-2-positive tumours are identified as low risk by the 70-gene profile, and these patients experience a favourable long-term outcome. This is especially remarkable, as 13 of 16 ER-positive low-risk patients did not receive endocrine treatment at the time the original studies have been conducted.
Avoiding overtreatment with chemotherapy and/or trastuzumab for truly low-risk HER-2-positive patients is an important goal, taking into account the risk of serious adverse events and the cost of these treatment regimens. Currently, trastuzumab monotherapy in the absence of chemotherapy is not regarded as standard of care for patients with HER-2-positive disease, although many experts at the St. Gallen consensus conference believed that trastuzumab alone may be reasonable for a subset of patients with HER-2-positive disease in the future (Goldhirsch et al, 2007). Our data raises the intriguing hypothesis that this strategy of anti-HER-2 therapy in combination with endocrine therapy might first be tested in patients with highly endocrine-responsive HER-2-positive disease and/or patients with hormonal receptor expression with a ‘good prognosis' 70-gene profile. Recently, Chia et al (2008) reported similar findings, as the HER-2-positive, ER-positive subgroup of T1 cancers had a more favourable outcome with a 10-year BCSS of 92%, as compared with the HER-2-positive, ER-negative subgroup with a 10-year BCSS of only 76%.
In summary, our study suggests the existence of a low-risk HER-2-positive subgroup of patients with favourable outcome, which can be identified by the 70-gene MammaPrint gene signature. The results of this study support the evaluation of less intensive treatment strategies in this low-risk group. Further validation of this important finding is ongoing in the MINDACT trial, whereby patients with HER-2-positive disease deemed to be at a high clinical risk by Adjuvant!Online (Ravdin et al, 2001) with a ‘good prognosis' MammaPrint profile may be randomised to receive no chemotherapy but may be treated with trastuzumab alone at the discretion of the treating physician."
Cold caps work! coldcapphotos.shutterfly.com/p... TCH: 4/10 - 6/13/12; 33 rads; BMX w/fat grafting; DX: 7/29/11 @ age 43: Stage 1A on L (3 mm IDC w/ 6 cm DCIS, Gr 2 ER/PR+, HER2+) 0/3 nodes; Stage 0 on R (2 mm DCIS); see bio.