What can you tell me about luminal B?

BLS

I'm dx with Luminal B. I'm getting four rounds of taxotere and cytoxin. I keep reading it is a poor prognosis. Does this mean I'm definitely going to have recurrence? Is this a death sentence? I'm also worried that four rounds isn't enough. What can you tell me? I had.my double mastectomy in Jan 2015. Two sentinel nodes clear, 1 cm of idc, nuclear grade 3, high ki67, 8 on noddington scale. ER+, PR+ HER2-.... Horrified here at 41 y/o.

Sassa

BLS, I have a different diagnosis from you but let me just compare what my pathology report said about my tumor:

ER/PR negative: poor prognosis

HER+++++: poor prognosis

KI67 70%: poor prognosis

Grade 3: poor prognosis

Sounds like I shouldn't be here to write this post, doesn't it? Well you can't believe all you read. The use of the words "poor prognosis" is based on historical data that doesn't yet incorporate enough data points from newer treatments. Case in point, I am HER2+++++. Before the discovery of herceptin, it was a sure death sentence. Instead my oncologist told me I "lucky" to be HER2++++ because the herceptin is so effective. So the poor prognosis on my pathology report translated into being "lucky" in reality.

Here is the actual good news: Sentinel nodes clear. Best news you can have. Hopefully, everything was contained in the breast and you had those removed.

Your tumor is 1 cm (mine was 1.75 cm). That size and no node involvement means Stage 1.

High KI67 and Grade 3 - you have won the perfecta. Your tumor is fast growing which means a lot of the cells are dividing at the same time. Why is this great news? Because chemo works by destroying cells that are in the act of dividing and your 4 TC will hit any stray cells that might be left like a pile driver. (I had 4 AC) You don't need more then 4 TC; the oncologists have the experience to know exactly how much we need.

Talk to your oncologist about your risks of recurrence. I bet (and I only bet on sure things) between your mastectomies and chemo, you will be writing a post like this one 8 years down the road.

Best wishes.

Mary Jo

Sassa

Because I didn't know anything about luminal B breast cancer, I did some quick research. Two factors I found that play into the "poor prognosis" tag are that patients diagnosed with luminal B cancer usually have larger tumors and are node positive at diagnosis.

Neither is the case in your diagnosis. A 1 cm tumor is small and your nodes are clear.

I also found a several statements that in some studies, women diagnosed with luminal B cancer have survival rates equal to luminal A cancers (considered "good prognosis").

Now about your recurrence fears. Your highest risk of relapse is right after surgery before chemo is started. I know, not to reassuring right now. Second, like my ER/PR-, HER2+ cancer, the luminal B cancers are fast growing which means if you are going to reoccur, it will happen sooner rather than later. Your risk will drop each year until at year 5, you are pretty much in the clear (although your risk never goes away, it will be so low as to not be a worry).

So the next few years will be nerve wracking each time you go in for follow up, but it will get better and your life will return to normal.

Again, you do not have some of the risk factors that play into the "poor prognosis" tag.

And stay away from Dr Google, it messes with your head (advice I didn't take, either).

Gohan1983

Luminal B is aggresive subtype of breast carcinomas, although not as aggresive as HER-2 enriched and some kind of triple negative breast cancer. Compared to luminal A it has different genomic profile (higher expression proliferative gene as MKI67, CCNB1, MYBL2 and somewhat lower expression ER-related gene as ESR1, PGR, GATA3, FOXA1. It doesn't matter ER and/or PGR protein level, because it's often not correspond with appriopriate gene (luminal B may be highly positive ER and PR protein but ER-related gene expression is lower than proliferative gene). When proliferation marker Ki67 is greater than 20% cases of Luminal B are more often than luminal A, similar when PR protein level is less than 20%. Some cases of luminal B show HER-2/neu gene overexpression (about 30% of all luminal . The most common histologic subtype with luminal B profile is Invasive Ductal Carcinoma not otherwise specified and sometimes Invasive Lobular Carcinoma (especiialy histiocytoid, solid and pleomorphic subtype). The rare histologic subtypes which often show profile similar to Luminal B: micropapillary breast cancer, breast cancer with neuroendocrine differentiation, signet-ring cell breast cancer and quite rarely medullary breast cancer, which is more often triple negative. When untreated or undertreated prognosis is poor, similar to HER-2 enriched and basal like. When patient receive chemo and hormonal drugs (sometimes HER-2 blocked drugs as trastuzumab), prognosis are slightly poorer than luminal A. I'm very interested in oncology, so if you have some problems, don't hesitate to contact me