Hormonal Changes

keetmom

So I have failed out on Ibrance/falsodex (made it a year), AA after 3 months, xeloda after 3 months, I had a liver biopsy last week and it came back 90% Estrogen positive,it was 60% in 2012  and negative for progesterone,which was 40% in 2012.  I was originally HEr2- but my FISH was at 2, wondering if it changed to HER2+ . Any words of wisdom why it changed so much.

pajim

Hi keetmom, I don't have words of wisdom on the treatments, but there are two reasons for the receptor measurements to change over time.

First is that not all breast cancer cells are the same. So the amount of 'positivity' depends on the particular sample that they take. If they had inserted the needle just a little bit to the left or right, the findings might (will!) be different.

Second is what I call 'survival of the fittest'. Since not all cancers [even the ones in your body] are not the same, treatments kill off some of the cells but not all of them. For instance, if you had a few HER+ cancer cells at the beginning, the Ibrance/Fas would not have killed them off. Over time they would multiply and you would become HER+ overall.

That said, it's puzzling to me why your measurements are coming out MORE hormone positive. Normally the hormonal therapies block those cells from growing and so they die, leaving behind the less hormone positive cells. Maybe someone else has a better explanation.

keetmom

I read today that loosing progesterone tend to become HE2+..just want to know..at this point my appointment isn't for a week from Wednesday but if it comes in sooner they will get me in

JFL

It could either be changes in your hormone status or the sample. Any given sample is going to vary in its % of various characteristics. Also, if the sample is too small, it may not show everything that is really going on.

As for the issue of keeping hormone receptors after hormone treatment, I don't believe that hormone therapy necessarily eliminates those receptors. They tend to remain in the mix in the majority of cases, but the cancer has found another pathway or pathways and no longer needs to use the hormone receptor pathway. Sometimes people can become resensitized to hormone therapy after spending some time on chemo or, very occasionally, through use of estrogen therapy to treat the cancer.

I went from highly PR+ to negative and ultra highly ER+ to moderate-high ER+ upon mets dx. I was HER2- from beginning (but with a borderline 2 score) and am still HER2- upon mets dx. My MO said that I could have lost my PR+ status or the sample may have been too small and didn't include PRs although they may still be in the cancer cells.

I read that losing PR+ status signifies an aggressive shift in the cancer cells (which sometimes involves rerouting things through the HER2 pathway). Based on learning that, I chose to believe I was still PR+ for a long time but have resolved over time (and several progressions) that I probably am PR- because my BC is pretty damn aggressive. I don't have answers but wanted to say you are not alone in the confusion.

I have heard that there are various trials testing whether HER2 treatments work for HER2- people, particularly those who are borderline/in the 2 score range, which are showing that there can be a benefit from HER2 drugs. I have been interested that theory for a long time now. I think there may be something published on this at the June ASCO conference.

I hope you can find some answers.