Her2, weight, and disease progression

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orange1
orange1 Member Posts: 930
edited June 2014 in HER2+ (Positive) Breast Cancer

This study basically says that if you are Her2+, and you relapse, you do better if you are normal weight versus overweight.  To me it suggests that for non-relapsed Her2+ patients, it might be good to keep our weight under control too.  I'm not sure if this is good news or bad news.  Bad because now I will feel guilty for every cookie I ingest.  Good, because weight control is possibly another tool in our arsenal against this disease.

From ASCO 2010 meeting held in Washington last week.

The prognostic and predictive impact of BMI on clinical outcome of HER2-positive breast cancer.Print Print this page
 Sub-category:New Systemic Agents – New drugs and targets (includes anti-angiogenics) - HER2 directed  Category:Systemic Therapy  Meeting:2010 Breast Cancer Symposium  Session Type and Session Title:General Poster Session C  Abstract No:289  Author(s):V. Parolin, E. Fiorio, A. Mercanti, M. Riolfi, E. Surmacz, A. Molino; Department of Medical Oncology, Ospedale Civile Maggiore, Azienda Ospedaliera Integrata Universitaria, Verona, Italy; Medical Oncology, Policlinico G. Rossi, Azienda Ospedaliera Integrata Universitaria, Verona, Italy; Sbarro Institute for Cancer Research, Temple University, Philadelphia, PA Abstract: Background: Obesity and HER2 overexpression are associated with poor prognosis in breast cancer (BC). Recent studies suggest the existence of functional crosstalk between the Leptin Receptor and HER2: stimulation with Leptin can rapidly transactivate HER2 in BC cells. Resistance to trastuzumab, a mAb antiHER2, is an increasing problem related to activation of alternative cell signaling. The aim of the study was to evaluate the impact of overweight and obesity on outcome of patients with HER2 positive BC treated with trastuzumab. Methods: We analyzed retrospectively 155 patients with HER2 positive BC treated with trastuzumab for early stage or metastatic disease from 2003 to 2008. Overweight and obese patients were classified by Body Mass Index (BMI) according to WHO classification. Overall survival (OS) and time to progression (TTP) curves were calculated by the Kaplan-Meier method and comparisons were made using the log-rank test. Results: 103 patients were treated with adjuvant trastuzumab (median age 53.3 years). 12.5% of the population relapsed: 31% and 23% were overweight and obese, respectively. In relapsed patients OS and TTP decreased with increasing BMI: we found the median OS for normal weight, overweight and obese patients was 40, 36.5 and 31 months, respectively (p=ns); median TTP was 11, 8 and 5 months, respectively (p=0.0351). 52 patients received trastuzumab for metastatic disease in association to chemotherapy (median age 50 years); 20 (38%) patients were defined as postmenopausal and 32 (62%) as premenopausal. 33% and 15% were overweight and obese, respectively. Median OS was 65 months and TTP 10.5 months. We observed that OS and TTP decreased with increasing BMI: median OS for normal weight, overweight and obese patients was 67, 54 and 39 months, respectively (p=0.0010); median TTP was 12, 7.5 and 7 months, respectively (p=0.0442). The negative impact of increasing BMI was confirmed in the subgroup analysis by hormone receptor and menopausal status. Conclusions: Our results suggest that obesity is not only a risk factor and indicator of poor prognosis for BC, but also a negative predictive parameter in presence of HER2 overexpression, impairing therapeutical response to trastuzumab and promoting resistance. 
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  • CoolBreeze
    CoolBreeze Member Posts: 4,668
    edited August 2013

    I can't believe that many people relapsed - no matter what they weighed.

    News to me that it's up to 12% in such a short time frame.  Makes me worry a bit more about the bone scan I had today, and I don't feel protected because I'm skinny, considering I'm sipping a beer.

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  • orange1
    orange1 Member Posts: 930
    edited October 2010

    Yeah, it sucks.

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  • PiscesMoon
    PiscesMoon Member Posts: 206
    edited October 2010
    Frown dammit.
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  • PiscesMoon
    PiscesMoon Member Posts: 206
    edited October 2010

    bump

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  • misfit
    misfit Member Posts: 60
    edited August 2013

    There must be more to the story than weight and BMI. Insulin resistance may be a factor as well, and just happens to be more likely if you are overweight. Women of normal or average weight can still have high levels of insulin, which apparently also fuels breast cancer cells. Diet (low glycemic) and exercise can reduce insulin levels and increase insulin sensitivity, even without weight loss.

    Lots of small lifestyle changes may end up making a big difference, you never know. Here's one for those of us on Herceptin...

    http://www.ncbi.nlm.nih.gov/pubmed/15642702

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  • PiscesMoon
    PiscesMoon Member Posts: 206
    edited October 2010

    misfit - it lloks like this study was done with the cells.  i wonder if any follow up studies have been done? indeed, very promising. :-)

    ~M

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  • mmm5
    mmm5 Member Posts: 1,470
    edited October 2010

    I don't think 12 percent any higher than the stats we have been seeing on Herceptin when you take into consideration all stages observed here.

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  • swimangel72
    swimangel72 Member Posts: 1,989
    edited November 2010
    sigh.............this alone should give me more motivation to rejoin Weight Watchers and increase my exercise.Embarassed
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  • blondie45
    blondie45 Member Posts: 580
    edited November 2010

    yeah I am reading all over and my GYN confirmed that low glycemic diet works best for those of us that need to lose weight. I gained 30+ pounds on steroids while on the chemo. I am also taking tamoxifen. I really have to totally buckle down NOW. Not sure why but I don't have the willpower anymore, and I have successfully lost this much weight before so yeah this SUCKS.

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  • lovemygarden
    lovemygarden Member Posts: 342
    edited November 2010

    What jumps out immediately to me is that there's no mention in that abstract of either Stage or Node Status as a subgroup data breakdown, especially in non-metastatic patients.

    The total number of patients in the study was 155, of which 52 were metastatic and 103 were not. How many of the 103 were Stage III and Stage IV? The abstract does not say. Nor does it mention how  many in the study were node-negative vs node-positive, or even if those elements were factored into the conclusion at all.

    The abstract itself is VERY poorly worded, both grammatically and structurally. For instance it says "103 patients were treated with adjuvent trastuzumab" and then "12% of the population relapsed." Okay... are they saying that 12% of the 103 non-mets patients relapsed? Because the entire population is 155 (52 mets + 103 non-mets = 155). 12% of 103 = 12 patients. 12% of 155 = 19 patients. Again, how many of the 12% were mets patients and how many were non-mets? 

    Abstracts are fine for those who have access to the entire text of the paper or study, but more often they contain merely enough information for the layman or the mass media to latch onto and interpret as cause for either false hope or unnecessary despair, as the case may be. 

    And lastly, a sample population of only 155 people is laughably small for a generalized conclusion like this, especially for a retrospective study. No wonder it was only presented as a paper at a symposium but not (as far as I can see) published in any of the major journals. If the rest of the paper is as sloppily presented as this abstract, it'd never make it past a decent scientific-journal editor (which I was for a number of years, btw). 

    IMO the symposium must have been hard up for paper presenters in that particular time slot (or perhaps someone on the symposium board owed one of the researchers a favor; "connections" have much more to do with such things than most people realize) .....who knows?

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  • swimangel72
    swimangel72 Member Posts: 1,989
    edited November 2010

    Thanks for your intelligent comments Lovemygarden..........makes perfect sense BTW - what science journal did you edit? Years and years ago I worked (as a secretary and re-writer) for a medical journal - used to surprise me how poorly written the articles and studies were!

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