Treatments received for Estrogen + Progesterone - HER -

bumpintheroad3

I don't see treatments specifically for estrogen+ Progesterone - HER- metastatic breast cancer I am interested to hear from others same and there treatments. Currently I have tumors in right chest wall and bone mets. Currently have only been on hormone therapy.

Cure-ious

Hi Bump!

I am also ER-positive, PR-negative and HER2-negative, except grade 3. Just finished one year on Femara/Ibrance (first-line) and had an all-clear bone/PET/CT on Monday. When were your mets detected, and what therapy do you take/ or are considering?

pajim

Hi bumpintheroad, so far as I know ER+/PR- take the same treatments as ER+/PR+. In other words, hormonals first, then eventually targeted and chemo.

I started with tamoxifen, moved to Femara/Faslodex, now I take Femara/Faslodex/Ibrance. All of that is along with Xgeva or Zometa. What's next? Unless a clinical trial comes up, it'll be either Aromasin/Affinitor or Xeloda. Or possibly estrogen itself. I'm hoping not to make that decision for years yet.

Longtermsurvivor

Hi Pam,

Why not try Aromasin without the Afinitor? The steroidal AI, Aromasin, was the gold standard after tamoxifen followed by the non steroidal AIs (Femara and Arimidex) until Afinitor came along.

Afinitor/everolimus, an mTOR inhibitor, is so terribly toxic that many oncologists no longer consider it for their mbc patients.

Even at bco, the A/A topic/thread hasn't been reinvented since 2013. There are good reasons it's unpopular.

Also, Xeloda can be taken at many different potencies and dosing schedules rather than the standard, should the patient need adjustments.

Like the best science, the practice of medicine is a living art of exploration, not one-size-fits-all final solutions.

I too have always read and heard that PR status makes no difference in treatment approaches. It's ER and HER2 status that point clinicians and patients down different treatment paths.

Healing regards all, Stephanie

bloomingdalechik

I'm so happy I found all of you. Four years ago, I was originally diagnosed as ER+/PR+/HER2- but I progressed recently and had to do another biopsy. My new pathology report shows ER+/PR-/HER2-. What are the implications of PR-? It seems that some of you are treated as if you are PR+. Thoughts???

EV11

bloomingdalechick-

In general Er+/PR+ and ER+ /PR- are treated the same, although there are a number of studies that report loss of PR promotes less fidelity to the ER pathway and eventually induces alternate replication pathways and/or ER mutations. Both lead to less responsiveness or resistance to ER-modulating drugs (AIs, Tam, fulvestrant.)

Also, there is some indication that people who are PR- but still ER+ are less response to chemo. But in general, the ER is far more important to treatment decisions and response. I would suggest getting a tissue biopsy or doing a liquid biopsy when you have new progression to help identify if any genomic alterations have developed that might help you make treatment decisions.

There's still so much to learn about treating mBC it makes my head spin...

Elizabeth

Meow13

Er+ pr- her2- respond roughly 2x more to AI drugs than tamoxifen.