HER2+++ but FISH came back HER2 negative!??

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joys
joys Member Posts: 15
edited June 2014 in Just Diagnosed With a Recurrence or Metastasis

My mum has just had a recurrence 5 years after original triple neg Grade3 BC (lumpectomy, clear nodes, FEC chemo, rads).

This new one was reported to be triple positive based on immunohistochemistry whatever report. Recommendation was 4-6 cycles TCH, Herceptin one year and Femara min 5 years.

However, FISH came back today showing it as HER2 negative...? Not sure how this is possible seeing as the lab report stated strong positive all tumour cells for HER2. While this is good news, and onc now says 4 cycles of TC + Femara min 5 years is enough, I am not sure what to believe seeing as report originally said strong positive.

Is this normal for lab report & FISH to be so different? Oncotype test is too pricey and needs to be sent to the US so will take too long (they don't really offer it in Malaysia)

Also, what treatments are other Grade 2, Stage 1 (1.2cm) IDC hormone positive HER2- ladies receiving?

Mum (aged 59) is still not sure about chemo (she hated it first time around, unsurprisingly) but report notes some perineural invasion and lymphovascular permeation so onc is defo recommending chemo. 

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  • RobinWendy
    RobinWendy Member Posts: 1,983
    edited November 2009

    I don't have the definitive answer but can tell you that the same thing happened to me.  Pathology came back with strongly Her2nu positive.  However, because my mets are so unaggressive, an onc I consulted with just didn't believe it and he had the FISH test done on the biopsy sample and there you go... HER2nu NEGATIVE.  I believe the FISH over a simple pathology report.

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  • joys
    joys Member Posts: 15
    edited November 2009

    What was your treatment RW? Are you hormone positive?

    4th onco today said he would be content if she decided to just go the Femara route although of course chemo would give her greater cover (he recommends 4 cycles of just Taxotere).

    Mum's bone scan still o/s but we a re assuming no mets still at this point.

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  • pj12
    pj12 Member Posts: 25,402
    edited November 2009

    My stats are similar to your mom's.  I was 62 at time of DX.  Three doctors said no chemo.  I am 99% ER+ so they said Arimidex was a better way to treat.  I had lumpectomy, SNB, 36 rads, and take Arimidex daily.  I had some vascular invasion but no + nodes.

    Thanks for being there to help your mom.

    pam 

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  • RobinWendy
    RobinWendy Member Posts: 1,983
    edited November 2009

    Joy,

    I am ER/PR + and, of course, HER2nu -.  Femara kept me stable and then NED for three years.  Since then, I have been on Xeloda, Aromasin, Faslodex/Tykerb, Taxol/Avastin, Tamoxifen, estradiol and now Femara again (estradiol was to reboot efficacy of Femara).  

    I think it makes sense to try Femara first.  For me, it has been a breeze to tolerate and gave me three years.  Why go right to chemo if your mom does not have to.

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  • kt57
    kt57 Member Posts: 425
    edited December 2009

    This link has a good explanation of the FISH:

    http://www.amp.org/CP/weblinks_files/HER2_Guidelines.pdf

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  • joys
    joys Member Posts: 15
    edited December 2009

    Mum had bone scan today and the results say "The accumulation in the manubrium needs radiological correlation as solitary bone metastasis is a possibility" so she's going in for an MRI and chest xray.

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