Confused-am I triple negative or not?

This is amazing.  I haven't heard about Herceptin for Her2+1, but I have heard that there is some controversy about it working for more women than they thought it would in some trials.  I know they give hormonal therapy if you have even 1% ER positive. It's great that you have had such a good response already to treatment.  Best of luck as you tackle the next phase. Please let us know more when you know more.  G.

http://www.nsabp.pitt.edu/B-47.asp

Just lost a long post I wrote about the history behind this trial and how I found out about it.  Anyway,  it's exciting because there IS evidence that there is benefit in Her2 - and Her2 low patients for Herceptin.  This link is to a new trial NSABP B-47 , patients are randomized to TC or AC plus/minus Herceptin (for 1 year I think).  Exciting stuff.  You're breaking new ground here!

I've also read that Avastin can have good effect in triple negative, especially BRCA +.  The PARP inhibitors look good, too.    

Will be thinking of you.  Hope your treatments really do the job,  B. 

Sherri .. I tried to locate that article in Cure magazine and couldn't find it online.  I was HR2 ++ and wasn't offered Herceptin.

If you can find the article for me, I would really appreciate it.

Thanks,
Bren

In the NSABP B-31 study,  available blocks were tested centrally with FDA-approved Her2 FISH assay.  Surprisingly, there was no association between Her2 gene copy number and benefit from trastuzumab (interaction p=0.60)  Even patients with normal gene copy numbers appeared to benefit from Trastuzumab treatment (RR- 0.40)

This finding was studied, restudied and scrutinized extensively by many experts in many ways.  Independent study results clearly suggest that the benefit may not be restricted to Her2 positive patients as currently defined. They don't know if current clinical essays are not precise enough or if there are other molecular determinants of response besides Her2.  The current thinking is that the latter is true.  Another possibility may be that there there are micromets that are Her2+ in patients with Her2-  tumors.  This has been demonstrated by several investigators in small-scale studies that measured Her2 in circulating tumor cells.  I am sorry, but I don't have those studies, but I'm sure your oncologist can find them.

Analysis of NSABP B-31 outcomes did not find any genes or sets of genes or clinical variables (like age, ER, size, nodes, etc.) that predicted benefit, but they found that women with ER+, 1-3 positive nodes, and t-size <2cm didn't seem to benefit statistically, even those that were Her2+.

There is an experimental assay, the NanoString-based HER2 assay, that the NCI is recommending be used in the NSABP B-47 protocol.  It has identified a set of genes, measures their mRNA, and seems to identify those that may benefit from trastuzumab better than other measures.  I believe that this either is or was written up in The New England Journal of Medicine, but I haven't looked for it yet.

I was able to get all this info by googling NSABP B-47, then downloading a PDF document (30 pages long) I found on page 3.  It's called "Final Progress Report for Research Projects Funded by Health Research Grants" about research done between 2/08 and 12/09, then presented to NCI in 2/10.  

I know this is long, but if it will help you I'd be very happy,  Hugs, G. 

Edited to add this great discussion I found.

http://podcast.researchtopractice.com/podcast/pdf/bcu/BCUTT1_09.pdf

Starts talking about Her2 and B-31 down on page 9 with lots of references/history for your oncologist.   

Bumping topic .. hoping Sherri will see my note about the website article!

Thanks,

Bren