When do most recurrences for HER2 happen? Revived round 2...

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  • GMarie23
    GMarie23 Member Posts: 3
    edited January 2014

    Hi there!

    Its admirable reading your stories. All of you are so strong it's incredible. Bless all of you warriors 

    I have a question: how have you been doing? My mom has exactly the same diagnosis and Im desperate for words of wisdom.

    Thank you,

    Gina

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  • joanp6
    joanp6 Member Posts: 16
    edited January 2014

    its so great to hear some success stories.

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  • sciencegal
    sciencegal Member Posts: 1,120
    edited January 2014

    GMarie I just saw your post, so sorry i missed it. I am only one year post chemo but doing great so far-just some joint pain but otherwise I am back to being myself in every way.

     I sure wish your mom luck!

    Hi Joan, I agree, I sure also like to hear from the others with this diagnosis who are through their treatments and doing well, it is really inspiring. But, good or bad, all information is good and helps us fight.

    Thank you to all who post an update!

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  • BlueFox
    BlueFox Member Posts: 99
    edited March 2014

    In relation to the original question, my layperson's understanding is as follows:

    If we firstly look at HER2 negative cancers, the hormone negative ones have a much higher risk of early recurrence cf hormone positive (everything else being equal), but this risk falls away more rapidly with time compared with hormone positive. 

    What is the impact of HER2 positive on the way recurrence behaves?  For hormone negative cases, the increased risk due to HER2 appears to be constant with time.  So HER2 positive, hormone negative behaves with time rather like Triple Negative.

    The effect of HER2 on hormone positive cancers is very different.  It increases the recurrence risk by nearly a factor of two in the first year, but the hazard ratio decreases with time so by the time you get to year 9, the annual risk of recurrence is the same for HER2 positive or negative.  See: http://www.nature.com/bjc/journal/v107/n5/fig_tab...

    Now this is before taking into account the effects of Herceptin, which overall tends to cancel out the extra risk from HER2+. But how does the risk reduction from Herceptin behave with time?  I've not seen any year by year figures for this.  We might expect the greatest benefits to be in the earliest years, but it still seems to be providing risk reduction benefits on the 10th year.  See:  http://www.newevidence.com/oncology/entries/Trastuzumab_plus_adjuvant_chemotherapy_for_HER2/

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  • BlueFox
    BlueFox Member Posts: 99
    edited April 2014

    I've now found a paper which better seems to answer this question.  My previous analysis was mainly based on the scaling factors used in the Predict Model.

    Here is a recent paper that directly looks at recurrence risk by time (from surgery) for the different subgroups:  http://breast-cancer-research.com/content/15/5/R9...  

    Have a look at Figure 5 in this paper.

    Hormone negative/HER2 positive corresponds to the HER2 Enriched group and hormone positive/HER2 positive corresponds to Luminal HER2 in the 6 subgroup analysis.  

    The graphs in Figure 5 indicates that:

    Luminal HER2 (eg Triple positive) recurrence has a broad peak centred at 2 years post surgery and then gradually falls away (but never to zero).

    HER2 Enriched recurrence has 2 peaks, the highest one peaks just before 2 years and there is a second smaller one which peaks around 5 years.

    This is based on a group of 1249 patients between 1982 and 2008 of which only 18 had Herceptin, so these results do not reflect the impact of Herceptin which should roughly half the recurrence risk.  

    A study based on a larger group of patients would give more confident estimates.

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  • BlueFox
    BlueFox Member Posts: 99
    edited April 2014

    Don't know why that link doesn't work. http://breast-cancer-research.com/content/15/5/R9...

    But if you just Google the title of the paper "Pattern of recurrence of early breast cancer is different according to intrinsic subtype and proliferation index" you should find it easily

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  • LindaKR
    LindaKR Member Posts: 1,577
    edited April 2014

    Great info!! Thank you, Bluefox!

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