Slightly Her+ and Oncotype

mattscot

In my Ich test I was 2 equivicol, my FISH was 2.3 positive--- my Oncotype came back with a score of 16 -- a big surprise to me and fairly low for Her+ --- because their test determined I am Her negative (score of 10)  

My initial meeting with my Oncologist (prior to receiving the oncotype results) is that they will treat me as HER+ ...to get me Herceptin... and with that goes the heavy duty chemo.. AC 2mos, T - H 2mos and then Herceptin every 3 weeks for the rest of the year--  But now I am confused -- I am waiting to hear back from my oncologist.

Anyone with similar issues.   Did you have an oncotype test ??.. I am wondering if I can downgrade my chemo... and skip the AC -- I do see that some people are getting Taxol/Herceptin... but they seem to have smaller tumors ---

  

bluedasher

There is also Taxotere, Carboplatin and Herceptin which was tested against AC, TH and produced about as good results in terms of recurrence and mortality but has less heart risk, less side effects and avoids the small long term leukemia risk of Adriamycin. That is the one I chose. I was 100% HER2 positive so I didn't have the issue of conflicting test results.

SusieSwan

I only did 4 A/C and then Herceptin alone for one year (which I just finished last Friday).  Also doing Tamoxifen.

mattscot

I will be meeting with my oncologist tonight but as an update... the oncotype test uses a different method to test Her2....  I still dont know what is the standard in determining equivocal results (ie FISH versus oncotype... His initial response is that this certainly muddies the waters,... that chemo will definately be reccomended...   but may alter the mix... he may not reccomend Herceptin...  My view is Herceptin is a miricle... I would hate to give it up even if I am borderline Her2 +

mattscot

  I enclose below a copy of an article on Oncotype DX and determination of HER2 status... this is pretty recent and they only starting including testing for HER2 status ....   

  

  

Oncotype DX® Accurately Determines HER2 Status in Breast Cancer By CancerConsultants.com
  Oncotype DX® appears to determine HER2 status as accurately as standard laboratory testing methods. By the end of 2008, Genomic Health intends to provide HER2 status with results from all Oncotype DX testing. These results were recently presented at the 2008 American Society of Clinical Oncology (ASCO) Breast Meeting.Adjuvant chemotherapy and/or endocrine therapy have resulted in an improvement in survival in women with early-stage breast cancer. However, the benefit from adjuvant chemotherapy in this group of patients is not uniform, as it is estimated that approximately 85% of women with this disease receive adjuvant chemotherapy that will not ultimately improve their outcomes. Therefore, it is crucial to determine which patients with early breast cancer are at a high risk of developing a recurrence so that individualized adjuvant treatment can reduce the risk of death in appropriately selected patients while sparing low-risk patients from unnecessary toxicities and medical expenses. Though tumor markers have provided some advances in predicting prognosis, it appears that the most promising predictive results may be generated from gene expression profiles. Several recent studies have suggested that the 21 gene assay Oncotype DX is more accurate than other tests for predicting relapse (see related news).Several types of cancers overexpress the human epidermal growth factor receptor 2 (HER2), including approximately 25-30% of breast cancers. HER2 is part of a biological pathway involved in growth and spread of cancer cells, and cancers that overexpress HER2 are referred to as HER2-positive. Overexpression of HER2 is considered an adverse prognostic sign, but patients with HER2-positive breast cancer respond to Herceptin® (trastuzumab). It is now recommended that all breast cancer patients be tested for HER2 status before beginning treatment, as agents targeted against HER2 are available and tend to improve outcomes for patients overexpressing HER2. Standard testing for HER2 includes immunohistochemistry (IHC) and fluorescence-in-situ hybridization (FISH) testing.Researchers recently conducted two studies to explore the accuracy of Oncotype DX in establishing HER status when compared with standard IHC or FISH testing among breast cancer patients. The first study analyzed data from 755 patients who were enrolled in the Intergroup study E2197.¹ These patients had Stage I-III breast cancer with 0-3 three positive lymph nodes; HER2 status was compared between IHC and a RT-PCR using a panel of 371 genes including the 21 in Oncotype DX. One-hundred thirty-four cases were HER2 positive, 175 were HER-2 equivocal, and 378 were HER2 negative. These researchers found a 95% agreement regarding HER2-positive status between IHC and RT-PCR. Importantly, they found that 94% of the equivocal cases were negative by RT-PCR. They also reported that in HER2 normal hormone-positive patients, TOP2A expression was highly correlated with relapse. These authors suggest that Oncotype DX could substitute for conventional testing for HER2. They also suggested that testing for TOP2A could be helpful in predicting relapse and identify individuals likely to benefit from taxanes.The second study evaluated data from a previous clinical trial conducted by researchers from Kaiser Permanente, the University of California-San Francisco, and PhenoPath, Inc.² The study included 568 patients and compared HER2 status as tested by FISH or Oncotype DX testing. Twelve percent of patients were HER-2 positive by Oncotype DX and 11% by FISH. There was a 97% overall agreement between the two methods of testing. The researchers concluded: "Based on this research demonstrating the accuracy and reliability of HER2 measurement using RT-PCR, Oncotype DX can provide additional patient-specific information and insight into each patient's individual tumor biology."