Where are the tri-negs!

I had a recurrence in other breast also. I had my 2nd mast a year later than my first.  I hope the scans today bring you good news and it's not bc.

Flalady

nana,

I don't know where your doctor did his research but TN do not have higher incidence of bone mets. TN is the smallest % by far of any kind of bc. The highest is Hormone+ and than her2 is not far behind.  TN has the highest incidence of brain mets.  Most of the ladies we lost this year were from spine and brain mets.

See the stage iv threads and this will show our progession..

Flalady

Let's look at the research. 

Tuesday, April 21, 2009

Zometa: Not Proven for Hormone-Negative Zometa (zoledronic acid) has been touted as a life-saving drug, based on research in the February New England Journal of Medicine.    And it looks like the drug has serious potential-for women with hormone-positive disease.  Some things for women with hormone-negative breast cancer, including triple negative, to consider:The women studied were all premenopausal who were hormone-positive and were given hormonal therapy-either tamoxifen or Arimidex-plus goserelin (Zoladex) to suppress ovarian function.None received adjuvant (after surgery) chemotherapy;The study found a 98 percent chance of survival in young women who were given ovarian suppression and hormone therapy drugs but did receive any chemotherapy.So this could be great news for a narrow group of women.  Unfortunately, this does not include those of us with hormone-negative disease.The Dr. Susan Love Research Foundation has a great analysis of this. Back to the drawing board, docs.  Find us a cure.

Survival shortened when ER/PR negative breast cancer spreads to the brain

24 Jan 2008

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Two studies from Mayo Clinic's site in Jacksonville, Fla., of women whose breast cancer spread to their brain, have found that women whose tumours do not have oestrogen or progesterone receptors have the worst overall outcomes. Because of this, these patients should be treated aggressively after an initial diagnosis to help prevent such a metastasis, say the investigators, who presented their findings at the San Antonio Breast Cancer Symposium.

Those cancers include so-called triple negative tumours - cancer that does not exhibit HER2 growth factors or oestrogen (ER) or progesterone receptors (PR) - as well as HER2 positive cancers that are also ER/PR negative, say Mayo investigators.
This research is the first to look at differences in brain metastases and survival by different breast cancer subtypes. In one of the studies led by Stephanie Hines, M.D., investigators found that the median survival from diagnosis to death in women with triple negative tumours with brain metastases was 26 months, compared to 49 months in women with other types of breast cancer brain metastasis.

The second study, led by Laura Vallow, M.D., looked only at HER2+ tumours that had spread to the brain, and concluded that median survival from initial diagnosis to death in patients with ER/PR- tumours was only 17.5 months, compared to 55 months for women with ER/PR+ cancer.

"We need to be aware that this kind of cancer is high risk and we should do all that we can to prevent brain metastasis," says Dr. Hines. "For women with triple negative breast cancer, improvements in outcome will likely come when new treatments for this type of cancer are successfully developed."

Targeted therapies are available for cancers that are ER/PR+ or HER2+ before they metastasize to the brain. Herceptin, which treats HER2+ cancer, is theorized to be too large to breach the blood-brain barrier, and patients who have triple negative or HER2+ ER/PR- breast cancer do not have targeted therapies. "What's needed, therefore, are treatments for HER2+ and triple negative tumours that can reach the brain, as well as treatments that are specifically targeted to treat triple negative breast cancer cells," Dr. Hines says.

Metastatic breast cancer accounts for 20 percent to 30 percent of the 170,000 cases of brain metastases diagnosed annually, and as improvements in systemic therapy prolong survival, brain metastasis in breast cancer patients is becoming more evident, says Dr. Vallow. "These results suggest that more aggressive therapy in ER/PR- tumours may be warranted because patients with ER/PR- disease tend to develop brain metastasis even if the cancer has not spread anywhere else, and this metastasis develops sooner and survival is shorter compared to breast cancer that is ER/PR positive," she says.

While the outcome looks worse for HER2+/ER/PR- tumours than for triple negative cancers, findings from the two studies cannot be matched against each other because the studies did not directly compare these two groups of patients against each other. "One compared triple negative cancers against all other subtypes, and the other compared HER2+/ER/PR+ cancers against HER2+/ER/PR- cancers," Dr. Hines says. "We didn't directly compare outcomes from triple negative tumours against HER2+ ER/PR- cancer."
"For now, what we can say is that both the triple negative group and the HER2 + ER/PR- groups appear to have a poor outcome, which is unfortunate," she says.

The studies looked at women treated for breast cancer at Mayo Clinic Jacksonville from 1993 to 2007 (Hines study) or from 1996 to 2006 (Vallow study) whose cancer spread to the brain.

Dr. Hines found in a study of 103 patients that those with triple negative tumours developed systemic and brain metastasis sooner than patients with other types of breast cancer, and had significantly shorter survival overall. Specifically, investigators concluded that time from:

West China Hospital, Sichuan University, Chengdu 610041, PR China.

Bone is one of the most common sites of distant metastasis for breast carcinomas. In this study, our objective is to identify molecular markers and molecular subtypes that may predict patients at higher risk of developing bone metastasis. Immunohistochemical analysis with antibodies against estrogen receptor alpha, progesterone receptor, androgen receptor, Her2/neu, epidermal growth factor receptor, CK5/6, CK14, CK17, CK8, and CK18 was performed on representative sections of 21 breast carcinomas with bone metastasis and 94 cases without bone metastasis. The expression rates of receptors, subtype distributions (basal versus nonbasal) of 3 molecular classifications (cytokeratin, triple negative, and cytokeratin/triple negative), and 5 subtypes of cytokeratin/triple negative classification were compared between these 2 groups. We found that (1) the breast cancers with bone metastasis were associated with a significant percentage of estrogen receptor-positive/progesterone receptor-negative tumors compared with tumors without bone metastasis (38% versus 6%, P < .0001). (2) There was significant difference on estrogen receptor expression between high grade and non-high grade in tumors with or without bone metastasis (P = .0084 and 1.0000, respectively). (3) The breast cancers with bone metastasis were more likely to be estrogen receptor positive (85%) and androgen receptor positive (95%) compared with those without bone metastasis (59% and 74%, respectively, both P < .05). (4) There was no significant difference between tumors with or without bone metastasis in subtype distribution (basal versus nonbasal) among all 3 molecular classifications. (5) Luminal B carcinomas of cytokeratin/triple negative classification tended to be associated with bone metastasis but not to a statistically significant extent. ****In conclusion, bone metastasis is strongly associated with estrogen receptor-positive/progesterone receptor-negative tumors.

 Significant difference in estrogen receptor expression between high-grade and non-high-grade tumors with bone metastasis suggests that different panels of molecular markers should be used to predict bone metastasis in these 2 groups of tumors.

Triple Negative Breast Cancer: Making Sense of Estrogen, Progesterone and HER2 Receptor Status

Most oncologists now are thinking of breast cancer as at least four diseases based on endocrine features - luminal A, luminal B, Her2 positive and the so called "triple negative" - breast cancers that express neither estrogen receptors, progesterone receptors nor Her2 receptors. These latter breast cancers, or "triple negative" breast cancers have a reputation (deservedly so) for being difficult to treat.

Yet many oncologists, like myself, have dozens of patients with "triple negative" breast cancer who are cured. And many who are not. What is the difference?

Well the therapeutic armamentarium is not as great with a triple negative breast cancer. Hormonal therapy (tamoxifen, aromatase inhibitors) does not work. The benefit we see with Herceptin (and a newer agent Tykerb) in combination with chemotherapy, is not available in either the curative (newly diagnosed) or metastatic setting.

And yet many women are cured. There was a recent article in one of our oncology journals that I read; it was the fifth out of five articles that issue and not a high profile article, but it reinforced thinking about triple negative breast cancer.

This was a study of many patients treated at MD Anderson Cancer Center in Houston with triple negative breast cancer. At this cancer center many women receive chemotherapy before surgery, or neoadjuvant chemotherapy, and thus the tumor can be examined to see what sort of response the cancer had to chemotherapy.

*******The results? Those women whose cancers shrank from chemotherapy had a higher chance of cure than those women who didn't. Another finding which was probably confirmed, rather than new, was that those women who developed metastatic disease with triple negative breast cancer were more likely to develop metastases to internal organs (like the liver and lung) rather than the bone. And a third finding was that many women whose cancer did recur had a recurrence within the first three years after diagnosis.

What is the take home message for our readers? I think the main message should be to keep fighting and to never lose hope - even though triple negative breast cancer is a tougher cancer to treat, if it responds nicely to chemotherapy then a survival advantage - and a good cure rate - will be seen.

We don't have a way of "looking" for that response in the traditional adjuvant setting - chemotherapy given after surgery - so maybe it's best to assume that we are curing each patient with triple negative breast cancer for starters. And we continue to look for better chemotherapy agents and better ways of determining which agents are right, so that we can cure even more patients with triple negative breast cancer.