Questions - hormone receptor test, treatment plan

DivineRuby

Hi,

I've just been diagnosed with grade 3 IDC. Had biopsy done privately as the wait for the nhs appointment was very very hard. The biopsy came back as 8/8 for ER so that is ER positive I think. For PR it was 4/8 - does this mean PR positive as well?

Also it is her2 positive +3.

What sort of treatment plan will I be looking at with this tumour?

I have my nhs appointment this Friday but I'm really very worried.

Any info will be highly appreciated.

Moderators

Dear DivineRuby, Welcome to the BCO community. We are glad that you reached out to our members and we hope that you will find the support and information that you need here from the shared experiences of others as well as at our main site. While you are waiting for others to response take a look at some of these links. Here is a link to some questions for your doctor. Here is some information on Her2 status and Hormone receptor status. We hope that some of this is helpful. Again welcome and keep us posted on how your appointment goes this Friday. The MOds

BarredOwl

Hi DivineRuby:

I am sorry to hear of your recent diagnosis. The waiting and worrying is one of the hardest things.

To your question, ER and PR testing by immunohistochemistry ("IHC" (i.e., methods that rely on antibodies to "stain" receptor proteins so they can be visualized)) can be done a number of different ways. A scale of 0 to 8 suggests that the "Allred" method of scoring was used for ER and PR testing.

One 2008 reference states:

"An Allred score of 3 or more (ie the definition of ER positivity) corresponds to as few as 1% of cells showing weak immunostaining signal. More recent studies have demonstrated the identical cutoff (ie 1% of cells with weak signal) for IHC analysis of PR.[^6] Ideally, however, the laboratory should employ an ER antibody using a cutoff score for positivity that has been clinically validated."

Our local 2010 American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guideline is consistent:

Hammond (2010): "American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations for Immunohistochemical Testing of Estrogen and Progesterone Receptors in Breast Cancer"

http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165-134.6.907?code=coap-site

In Hammond, see the bottom half of Table 3 at page 913 for examples of "validated" tests for Progesterone Receptor ("PR"), the different primary antibodies used in these particular tests (Antibody 1294, Antibody 1A6, and Antibody 312), and their associated "Cut Point for ''Positive'' specified in the last column, which in the case of PR is an Allred score greater than or equal to 3. It appears that an Allred Score of 4 for PR would be considered positive in these tests.

To ensure receipt of accurate, case-specific information based on the particular IHC method used by your pathology lab, please confirm your PR status with your team. As best practice, be sure to request copies of the complete pathology reports (and any supplements or addenda) from all biopsies and surgeries for your review and records.

Regarding possible drug treatments, with IDC that is hormone receptor-positive (ER+ and/or PR+), you are likely to receive a recommendation for "endocrine therapy" (also referred to as "anti-hormonal therapy") with either Tamoxifen or an Aromatase Inhibitor (if post-menopausal). These are pills. Such treatments can reduce the risk of distant (metastatic) recurrence, as well as the risks of same in-breast local recurrence and new contralateral (opposite) breast disease.

With hormone receptor-positive (ER+ and/or PR+), HER2-positive IDC, the additional systemic drug treatments that may be considered or recommended would differ depending largely on the size of the tumor and lymph node status.

(a) In the situations where such treatments are either considered as an option (e.g., smaller, node-negative tumors) or are recommended, a combination regimen of chemotherapy plus HER2-targeted therapy (e.g., trastuzumab (HERCEPTIN)) is typically used. Tumors with a greater recurrence risk may warrant more intensive chemotherapy regimens. Less intensive chemotherapy regimens may be considered for smaller, node-negative tumors (e.g., paclitaxel plus trastuzumab).

(b) With larger and/or node-positive HER2-positive tumors, patients typically meet with a Medical Oncologist (in addition to a breast surgeon) to discuss whether they are suitable candidates for drug treatment prior to surgery ("neoadjuvant therapy").

There is an active group here for "triple-positive" (ER+ PR+ HER2+) members:

Triple-positive Group: https://community.breastcancer.org/forum/80/topics/764183?page=1014#idx_30402

Best wishes to you in your coming consultations.

BarredOwl

DivineRuby

Thank you so much for your response. Makes sense. Fingers crossed for Friday! All the best to you too!

BarredOwl

Hi DivineRuby:

For some reason, even though there were still some unknowns, I felt a lot better after my initial consultation with the breast surgeon, and I hope you do too. Will be thinking of you on Friday. 🍀

BarredOwl