Absence of progesterone and ER positive breast cancer

Meow13

I have recently read an article claiming er+ pr- cancer can have a worse prognosis than triple negative.

Claiming it to be aggressive with high ki67 values. I had er+ 95% and pr less than 1% my nottingham scores were just grade 2 with a 5 and 6, one ilc one idc, the mitotic scores on both were 1. I never received a ki67 value but I did receive just one score from oncodx, it was 34. Don't know which tumor the sample was from.

After 6 years I am still NED. Anyone have any info on the implications of lack of progesterone in hormone positive cancers? Are the high risk of late distant metastasis?

wintersocks

Meow13

I have heard too that without the progesterone er+ is more worrying. i have not heard however that the prognosis is worse than Trip negative. I am 100+ er and PR -. too. I am also nearly 6 years NED.

I too would be really interested in any research about this.

waytooanxiousmommy

My cancer is 10%ER+ Pr- and HER2-

I saw this

http://scienceblog.cancerresearchuk.org/2015/07/08...

JuniperCat

Interesting article... thank you for providing it.

Meow13

That is interesting waytoo..., it says that they are looking at giving progesterone to double positive hormone patients along with say tamoxifen and that the progesterone recepter slows the growth. They don't seem to say what will help pr negative individuals.

It looks like it a few years off, I am banking on no stray cancer cells after surgery and AI drugs.

I do have an article that suggests using AI drugs on er+ and pr- evens the score as far as outcomes with er+ pr+ tumors.

Hopeful research will continue and we all can get safe targeted therapy for our particular cases.

moth

This is interesting.

Have you guys seen the new cancer staging guidelines? The combo of er+/pr-/her2- plus gr 3 is upstaged (as is triple neg)

There's a powerpoint that was linked somewhere on the board which has the full tables but this pdf has some samples & includes these 2 examples (in table 8) http://onlinelibrary.wiley.com/doi/10.3322/caac.21...

definitely seems to indicate it's tougher to treat

Meow13

Also there are fewer of us that are er+ and pr-, so the data and studies take time to build up from samples.

Also so much is focused on tamoxifen I believe because it has been longer in use.

KBeee

Thanks for the info Meow. Fascinating stuff. My cancer was PR positive and came back PR negative. This helps explain what I suspected.

JuniperCat

Does lack of PR have anything to do with luminal status or is that unrelated?

BarredOwl

Hi moth:

I took another look at Giuliano (2017) that you linked above and the examples you noted in Table 8. Regarding the first three examples in Table 8, I didn't understand the meaning of "T" in the first column, but note the second example with upstaging from IA to IIA in a particular subset of patients.

I also checked the actual content of the 8th edition of the AJCC manual re breast cancer (chapter available on-line for free). However, I could not reconcile the content of Giuliano's Table 8 with the Pathologic Prognostic Stage chart of the 8th edition re breast cancer relating to grade 3, HER2- ER+, PR- disease (page 81 of on-line pdf).

In view of the apparent discrepancy, I checked for a correction to Giuliano (2017) and learned that Table 8 as originally published contained errors. A Corrected Table 8 has been published which substantially differs from the original:

ERRATUM TO GIULIANO (2017) IN TABLE 8:

http://onlinelibrary.wiley.com/doi/10.3322/caac.21401/full

I have not compared the revised version of Table 8 against the manual, because I lost steam.

BarredOwl

moth

BarredOwl, thank you for this! Whoa about the mistake. (Or suspicious me wonders - was this one of the reasons that this revision was delayed? Was there an argument about this? )

I had that long Chapter downloaded but honestly have been avoiding reading it - but finally cracked open the pdf. Now I'm confused about the table on p. 75 versus the table on p. 81.

p. 75 in the clinical prognostic staging, grade 3, HER2- ER+, PR- is listed as IB
p. 81 in the pathological prognostic staging, grade 3, HER2- ER+, PR- is listed as IA

That seems like an odd discrepancy. I understood that pathological staging might downstage someone with low genomic recurrence scores but otherwise I thought the pathological staging would either stay the same or *increase* due to recognition of increased risk based on certain disease characterstics... .

And now that I look at it more closely, p. 75 has a mistake on it as it's missing Grade 3 triple neg. It's not on the chart at all.

Wow. The editing on this is not what I'd expect to see from the AJCC.

Meow13

As far as luminal B, I asked my mo if I was luminal B. He said they don't do the luminal testing at their labs and that I can consider my lack of pr high risk on a similar level as luminal B. But he seems to not be too concerned since I am 6 years out. He still wants to see me once a year.

wintersocks

I wonder if the % er with negative pr is important? I am 100% er. meow I too am I nearly 6 years out. Does the lack of pr mean the cancer is aggressive? or just that it's not quite as good as having pr?

I am confused!

BarredOwl

Hi moth:

The paper was first published on-line in March, 2017, which was after AJCC announced deferring the implementation, which might tend to suggest (but does not prove) that the error in the paper was unrelated to the decision to delay implementation:

On Jan 19, 2017 11:53AM BarredOwl wrote:

. . . Although the 8th Edition of the Manual was published in late 2016, the implementation of the 8th Edition is currently slated for January 1, 2018, per this announcement from the American Joint Committee on Cancer ("AJCC")

https://cancerstaging.org/About/news/Pages/Implementation-of-AJCC-8th-Edition-Cancer-Staging-System.aspx

During my dive into the manual yesterday, I also noticed the missing category on page 75 and discrepancy in one of the stage assignments (IB versus IA) in the charts on page 75 and 81. I can't think why that would be either. One possibility is that it may be a snafu related to the missing row in the table. Yesterday, I sent the AJCC an email noting the missing information in the chart on page 75, noted the difference in stage assignment information on pages 75 and 81, and asked them to review it: ". . . .please review the accuracy of the Stage IA and Stage IB assignments in the . . . Clinical Prognostic Stage chart (currently IA; IB; IB; one missing)."

I'll post here again if I receive a reply.

BarredOwl

Meow13

wintersocks, me too 95% er+ but no pr. They seem to think having the pr receptor regulates the er receptor halting the growth of the tumor. So we don't have that braking system.

Was your tumor or tumors small? My 2 were 1cm and the mitotic rate was 1 on both. The nottingham scores were 5 and 6. I had 1 idc and 1 ilc.

wintersocks

Meow

tumour huge @ 6 cm , I dont know the Nottingham score. I still not dare look at all the pathology. I am not sure how much to be concerned about the lack of pr. just another thing to worry about.

BarredOwl

Hi Moth:

This evening, I took another look at the pdf of the breast cancer chapter from the AJCC Staging manual (8th Edition). The triple-negative group that we thought was missing is not actually missing. It can be found (orphaned) at the top of page 76. Oops. Tricked by kludgy formatting.

The "Clinical Prognostic Stage" chart and the "Pathologic Prognostic Stage" chart appear to be generated from patient data, but from differing types of information, which might lead to some differences.

The explanation of how they were developed begins at page 57 of the pdf, under the heading "Incorporating Biomarkers into TNM – Prognostic Stage". The work of two groups is described. One group used an MD Anderson database and one group used the National Cancer Data Base (NCDB). On page 62, it states:

"The NCDB analyses were used to establish Clinical and Pathological Prognostic Stage Groups for the 8th Edition that are included in this chapter."

The NCDB analyses were of two types, and were used to generate the two charts:

"Two analyses were performed. The first used clinical information that includes all patients to provide Clinical Prognostic Stage. The analysis included 334,243 patients diagnosed with invasive breast cancer in 2010-2012 with a median follow up of 41.7 months.102 This included all patients regardless of the type of subsequent therapy, though most received stage and biomarker appropriate local and systemic therapy. Clinical Prognostic Stage should be assigned on all patients.

The second analysis was restricted to patients from among those with clinical stage who received surgical resection as the initial treatment. It excludes those who received pre-surgical systemic or radiation therapy (neoadjuvant therapy). It includes all such patients regardless of subsequent therapy, though most received stage and biomarker appropriate local and systemic therapy. Therefore, these patients had pathological information to allow assignment of a Pathological Prognostic Stage. The analysis included 305,519 patients diagnosed in 2010-2012 with a median follow-up of 42.3 months. Pathological Prognostic Stage should be calculated on those patients who receive surgical resection as initial treatment."

It appears that the TN status is a clinical determination in the Clinical chart, whereas the TN status is a post-surgical pathologic determination in the Pathologic chart. At least that is my current layperson understanding until I study it further.

BarredOwl

Meow13

https://foodforbreastcancer.com/articles/er+-slash...

This was interesting on ssri drugs increasing chances of er+ pr- breast cancer and hormone replacement therapy.

I happen to have both of those drugs for years before my dx.

JuniperCat

Meow, that is very interesting. The article also mentions certain statins that might promote Er+Pr- status.

balance

Wow...I also had taken an SSRi and HRT prior to my diagnosis. I had been off the SSRI for 3 years and HRT for a year at the time of my diagnosis.