MAMM article HER2-Promising Times Ahead

Based on my reading of various studies and just paying attention to the diagnoses of women on this board who have progressed and had a recurrence, my opinion is that eventually the hormone positive, HER2 negative BC  will be the least desirable form of BC and the one with the worst prognosis and outcomes.

Ohhhh...that made my day!

Thanks for posting!

Gees, Sassa, that doesn't bode well for me if that is true.  I am 100 percent ER positive.  I hope they don't forget us since we always have estrogen in our bodies.  Maryiz

Sassa

Was wondering if you could elaborate a bit more, from my research and discussions with several top Onc's they tell me that triple negative seems to be have a poorer prognosis than ER+,

I was with the head Onc yesterday at U of A and he has worked at MD Anderson etc. and he states that the prognosis for early HER2 gets better and better. When I was first dxed they said most likely a 10-15% chance of lifetime reocurrannce, now with retrospective study they are giving me only a 5% percent chance of reoccurance. I never know who to believe, I have several friends that were stage 3C Her2 positive that have no recurr. after 5 years yet I believe there are some that Herceptin has not worked.

What is everyone else hearing?

Hello all !  Wanted to weigh in on this because I had already read the article.  A couple of clarifications:

1) The prognosis for Her2 positive cancers has indeed improved dramatically with the development of herceptin.   However, there is still some inconsistency as to when to prescribe and when not to based on on tumor size.   The MD Anderson study referenced both above and in the article recommends that any Her2 positive tumor be "considered" for systemic treatment, specifically anti-her2 agents (i.e. herceptin) regardless of tumor size (this study only examined tumor sizes less than 1 cm).  This is a change to current thinking in which the standard protocol was to consider systemic treatment for only those tumors over 0.5 cm.   This study basically made Her2 a defining consideration as opposed to size.   The study found that over expression of Her2 to correlate to a 3-4 higher incidence of recurrence vs. her2 negative tumors, regardless of tumor size.   However, as we know, those odds change dramatically when herceptin is introduced.  

2) Given the multiple tumor types out there and the treatments available, it is still generally a "positive" to be highly ER/PR positive because this means that the hormone therapies will "work".  They have been proven to be effective over the years and the prognosis is better when using those therapies for those women.   The effect is additive to any effect from treating her2,  and hence, the prognosis even better.  I hope that makes sense.

 3) By and large, given advancements in Her2 treatment, triple negative is largely considered now the most stubborn to treat.   The reason for this is that there are not readily available treatments that are proven to work beyond standard chemotherapy for this type of disease (i.e. no hormone therapy, no herceptin).  

 4) There are still other considerations playing in here that have to be taken into account when thinking about a treatment protocol.  Age, menopausal status, ER/PR status, tumor size, node status still play an important part.  In my case, for example, while I had a little itty bitty tumor, I was on the down side of all the prognostic indicators (43 years old, weak ER, PR neg. pre-menopausal, her2+, etc).  Because of the combined effect of these factors, my doc was a little more aggressive with me.   Goes to show there is still some art in the science. 

In general, my take is that tumors that have a Her2 overexpression are still considered the most "aggressive".  However, the development of anti her2 agents such as herceptin has made a world of difference in terms of our prognosis.   While I don't exactly like having to go through a year of this treatment, for me, the benefits far outweigh the inconvenience (especially as they are monitoring my heart function closely).  

I hope this helps and good luck to all you ladies out there !

Jill