PAM 50 Breast Cancer Intrinsic Classifier

matic22

Hello dear ILC ladies!

 How are you doing? it has been some time since we last talked here....

I miss you a lot so I have come here to report you some more news regarding breast cancer prognosis determination.

In September I was working at the Pathology Department at our Institute of Oncology because as a young Medical oncologist I need to go through all departments inside the Institute. I was lucky to get the best pathologist for being my superviser, so I learned really a lot. One day I was looking H&E stains they have there as very interesting cases of breast cancer and I found my Mum"s biopsy-I know the number:) I looked the biopsy and found her in situ carcinoma was very interesting because it was massive and included both, classical and large cell variant-The pathologist dr. Grčar Biljana told me massive in situ carcinoma means more than 2 cm in diameter and that this finding is very rare for lobular carcinoma because LCIS is almost always accidential finding that is NOT seen macroscopically within the breast. She suggested to go through all H&E stains of the tumour. So, she showed me every detail and explained to me grading, mitotic count, morphology, nodes, MIB-1 , ER,PR, HER-2-everything I wanted to know. She asked me if I would like to do some more IHC testing and I said I did not know what to test more. She did cyclin D1 and FISH for TOPO 2A gene. Topo 2a gene is not amplified, cyclin D1 is positive(which are both good prognostic signs). And we also did EGFR mutation tests and there are no mutations of this gene at all present within the ILC. I am still waiting for nm23 IHC testing.

I am very grateful for this additional testing , so I was very surprised for helping me in this situation.

Last week Mum had an appointment with her oncologist and also got Zometa infusion (the 5th one), mammography and all tests are perfectly fine. The oncologist wants to stop hormonal therapy but I have to admit I am not sure what to do. I thought 6months ago I would stop antihormonals in October 2011, but because I see so many patients relapsing after stopping AI therapy I would continue with it. So I am stucked in my decision.I am aware this is an important decision in life, on the other hand I do not want to harm her with SES.

So, I was researching more and more and have found recently another genomic assay that has been and is being largely validated in Utah, it is called PAM 50 Breast Cancer Intrinsic Classifier, and they have alredy compared it with the Oncotype dx genomic test. It provides your individual tumour in one intrinsic subtype of breast cancer, based on molecular level, and additionally it gives you scores on all gene groups that are included in testing (ER,PR,HER-2 pathways, proliferation group and luminal group). So, I contacted some doctors from ARUP laboratory and they were very kind to me, so they enabled us to do this test for my Mum. Next week we will send all the material and tumour tissue to do PAM 50 and DNA ploidy and S-phase fraction as well.

After that I will decide about hormonal. I am thinking of giving her letrozole for 3 more years and then stop everything.

If you have any clues, I would be grateful to you.

Just google PAM 50 breast cancer classifier and you will find good information.

It is now available for ordering inside the USA and also wordwide (from now on) and it seems it is the best one because it includes the best chosen genes that are purely prognostic, also predictive and they are superior to standard clinicopathological parameters, indication is every invasive breast cancer, regardless of stage and ER status.

I just had to tell you this news because I want you to have all information available to choose the optimal treatment option.

We will pay for test alone.And do not forget: there are also other genomic assays beside Oncotype dx and Mammaprint, but are not well validated , for example two gene ratio or Breast cancer index (Bitoheranostics) and Mammostrat. So, be careful in choosing the right one.

Best regards and look forward to hearing from you again.

Matic from cold Slovenia;)