Is it actually better to be Her2 positive than not?
It's commonly believed that ER+/PR+/Her2- is the diagnosis with the best prognosis. But it seems that an equal or greater percentage of women with that diagnosis recur than those who are Her2+.
Of course it might just seem that way since ER+/PR+/Her- is the most common diagnosis. But on this board and another board I post on, I don't see a lot of Her2+ ladies recurring.
Those of us Triple Positives are the only ones that have FIVE different tools for killing the cancer. And ER-/PR-/Her2+ has a pCR rate of 50 percent, which no other diagnosis has.
My unscientific opinion? ER+/PR+/Her2- is still the best diagnosis to have IF it's lower grade and caught early. Good prognosis and you likely get to skip chemo and all the related side effects. But if it's higher grade and/or caught later - when you'll need chemo anyways - its better to be Her2+ because you have another tool to throw at it and the cancer is more likely to eat up the chemo.
At least that's what I tell myself to help myself sleep at night.
Comments
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my MO told me that since Herceptin her2 survival rates are almost the same( by stage ) as her2 negative. Now I don't know if that compares all her2 negs or those with a certain grade of tumor. IMO there are way more her2 negs diagnosed (over 70% or something close to that) so you would see more total number of relapses but close to the same percentage
either way its great news for us her2's!
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Unfortunately the cancer types with the highest pCRs tend to be the most aggressive ones and conversely.
Hormone positive/HER2 negative has the best survival rate everything else being equal (grade, stage) despite its relatively pCR rate.
The bad news is that HER2 positive/hormone positive cancers are roughly twice as likely to recur as HER2 negative/hormone positive cancers (everything else being equal).
The good news is that Herceptin reduces the risk by somewhere half and a third, which means that by taking Herceptin you largely offset this extra risk.
If you have a hormone negative cancer, then HER2 positive is actually a good thing (as it were) as otherwise the cancer would be triple negative (worst prognosis, everything else being equal).
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I am ER/PR-, HER2 +. At 6 1/2 years from the end of herceptin, I am told that my chance of recurrence at this point is almost zero. At ten years, I was told I should consider myself "cured."
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I hope this is the right forum to ask my question. My friend is triple positive with a 1 cm tumor and no nodes involved. She has finished A/C and has her 12th taxol coming up. Then she moves from weekly herceptin to a higher dose every 3 weeks. She does not need radiation as she had a double mastectomy. She will be taking tamoxifen as she is premenopausal. Her onc has told her she will have scans every 3 months. I am surprised because my onc says no scans, just report any symptoms of pain that does not go away after 2 weeks and they will evaluate what is needed at that time. She is Stage 1 and I am a higher stage. I appreciate any thoughts you have about this. Is her schedule overkill or am I not being adequately monitored?
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grandi - Are you sure her onc said scans, and not just appointments with possibly tumor markers or blood tests? I don't know anyone, of any stage, who has scans every three months.
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SpecialK, she said scans every three months. I can't imagine she is correct. I will double check.
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just spoke to her again. She said that looking at the heart is every 3 months but the other scans, we are assuming like bone scans,etc., is every 6 months. It still doesn't make sense to me.
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I get a Pet Scan every 4 months right now. It will eventually taper off over the next 5 years.
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grandi - the echo or MUGA every three months is normal while on Herceptin, the majority of us have that. an assortment of Bone/CT/PET every 6 months sounds off to me, and excessive radiation exposure. I had a pre-chemo PET, a post chemo PET, then one a year later, but none since and I was stage 2B, node positive.
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Thank you, SpecialK. I have done a bit more research and everything I read is that standard of care is no unnecessary scans for any stage patient. It doesn't change overall survival and the radiation is not good. Appreciate you taking the time to answer me.
Annie, thank you for sharing your experience. I guess every oncologist is different in what they view as important.
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Sassa, I want your onc! Mine never gives an optimistic word, but I trust her skills and her2 expertise so am sticking with her. You just tell me all the good stuff your onc says and I'll believe it!
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and blue fox- bco's resident expert- thank you!
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bad, I had the same thoughts reading people's tag lines on the board. It seems like more ifthe women with recurrences are HER2 negative. Maybe it is because there are just more of those to begin with. I do believe Blue Fox is correct. I spoke to my BS at the last appointment and was telling her about the vaccine trial I am in targeting Her2. I said I wish they could do something like that for triple negative women. She told me the good thingaboutbeing trip,e negative was if you get to 5 years, you have virtually no risk of recurrence.
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What Sassa's onc says makes plenty of sense. With hormone negative cancers, most of the recurrence risk is in the earlier years. If you get through them safely, then you are out of the woods (mostly anyway).
One of the downsides of the less aggressive cancers like hormone positive is that the risk doesn't fall off as steeply with time, so you are never out of the woods, although after 20 years, your risk will still be very low.
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Kay g, which trial are you in?
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Somewhere, and I don't remember where, I read a report that said the benefits of having herceptin basically are gone 4 -5 years after the completion of herceptin. After that, you revert to the recurrence risk to your ER/PR status. I verified this with my oncologist.
As a ER/PR-, HER2+, and more then 4 -5 years out from herceptin, the triple negative recurrence rate now applies to me. That is where the 5 year and 10 year chances come from in my previous post.
So while the first few years after diagnosis was nerve racking because my grade 3 tumor was extremely aggressive and those years were when my occurrence rate was highest, I now know why my oncologist told me at diagnosis that I was "lucky" to be HER2+ (I thought she was crazy at the time). I am also happy that I am ER/PR negative; no worry about an indolent ER/PR+ cell making its unwanted presence known.
By the way, my oncologist was extremely aggressive in monitoring me because of my cell pathology. I was given a CT/PET scan and echo-cardiogram before chemo started. My chem was 4 AC given every three weeks( a total of 3 months long). Another CT/PET scan and echo-cardiogram was done at the end of AC before starting herceptin.
I had another at 6 months and 12 months (end) of herceptin. Because I had no heart issues that was the end of the echo-cardiograms .
However, I had CT/PET scans, and blood work every 3 months during the first three years after finishing the AC. During Years 4-5, that dropped to every 6 months. At year 6, I had a a CT/PET scan and the usual blood work. I am now a yearly recall schedule with a chest x-ray and blood work.
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BlueFox - What do you think of triple positive with a grade 3 tumor? I know ER+ Only is Typically a grade 1 or 2. That makes their risk level the same for many years before it drops off. Can the same be said for triple positive? Does this lower our risk significantly after 3 years because of the higher grade tumor? Or do we need to be concerned with the ER+ risk later (7-20 yrs)?
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I am in the AE37 vaccine trial. It may be closed now. I hadn't heard that about 5 years and herceptin. I am not sure I understand what you mean. Are you saying it's like triple negative and if her2 cancers don't return in 5 years they are not likely to return except as ER+, her2-?
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KayG,
I was referring to the ER/PR status. I am ER/PR negative, am now far enough out from my herceptin treatment that the benefits of herceptin no longer exist for me. Therefore, my HER2+ statusis no longer a factor in my recurrence chances. Instead I go by my ER/PR negative status and look at recurrence rates for ER/PR- tumors.
ER/PR negative, HER2 negative tumors (known as triple negative) and ER/PR negative, HER2 positive tumors are both very aggressive and have a tendency to reoccur within the first 1-3 years after finishing chemo. By five years after chemo, the chance of reccurrence is very low, about 1-2%. The risk keeps dropping and by 10 years,while never completely disappearing, is so close to zero that it would be rare for a recurrence to happen. If one did and the tumor had the same pathology as the original diagnosis, it would be ER/PR-, HER2+.
ER/PR positive, HER2 negative tumors are using a grade 1 or 2 which means they are slow growing. So after treatment (and usually a hormone blocking drug is given for 5 years). The hormone blocker prevents the cancer from getting the ER/PR that it need to grow and a cell may just be dormant. After treatment ends, the ER/PR positive cell may slowly start to grow and a patient is eventually diagnosed with a recurrence. That is why after 5 years out from diagnosis, there is a slow rise in recurrence occurring 5 - 20 years after the original diagnosis. Again if the second tumor has the same pathology as the first, it will be ER/PR+, HER2+.
An ER/PR positive, HER2 positive tumor is usually more aggressive and a grade 2-3. Treatment will involve herceptin and the hormone blocking drugs. About the time the effects of the herceptin are no longer working (4-5 years after treatment), the hormone blocking drug 5 year treatment period is also up. Because the herceptin is no longer working in the body, the ER/PR+ status becomes important for reccurrence risks and they are as stated for the ER/PR positive, HERE 2 negative tumors. If there is a recurrence and it has the same pathology as the first tumor, it will be ER/PR+, HER2+.
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Mommato3, I think Triple Positives (as well as aggressive hormone pos/Her2 negs) split the difference. Our recurrence risk is by far the highest in the first 2-3 years and we can breathe a sigh of relief when we pass that point. But our recurrence rate will never plummet to close to zero like hormone negatives.
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not sure if I explained incorrectly, but that is what my onc told me as well. She did tell me current thinking is all hormone positive people should be on hormone therapy for ten years rather than 5.
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More recent data shows that the benefits of Herceptin just keep going on and on, well out beyond 5 years. It is a truly amazing drug.
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After 4 ac and taxotere which had a total bad reaction to. Left me with some toenails loss , Neurotomy I only got to have one treatment of herceptin when heart showed damage . Er-pr-hers2 pos stage 111b grade 3. IBC and Idc . Plus the cherry on top brac 2 gene. Have had bilateral mast and sentinel node I pos 13 neg. all left side . No reconstruction for year or more because of IBC watch . So ovaries removed In near future because of brac 2 . I guess I don't have a very good attitude . I'm sad when I read how great herceptin is and I can't have it. Not unless heart recovers, then maybe . So I am on symptom watch and scans and blood antigen tests . If that doesn't turn me in to a hypochondriac I don't know what will.
Just found tiny lesion /meningioma on anterior middle fossa of brain. The sudden occurrence of on and off headaches and unbalance was just dismissed as post chemo and weakness (used to be a gym addict lifting 40 pounds of weight, planks , squats. Oh how I miss that. Anyway neurologist consult told me I don't need him. So see rad onc and onc next week. Routine blood work. But how in the world can anyone tell me how long this growth in brain has been and if it is fast growing never had MRI before . He said it's b9. Good. Made me crazy . Still am. What is my prognosis Hate the cards I was dealt. I know this is long , but have a lot to get off my chest . Thanks for being here
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Hi Ladies,
Unfortunately for me I have lost all my maternal female relatives to BC. I was dxed in 2005 with a stage IIIC er/pr her2 pos nasty a** tumor with 12 pos nodes and every unfavorable prognosticator in the book. ( I am also a nurse and needless to say stunned!)
It's been 9 yrs and 4 months, (but who's counting!) and I am well and grateful for everyday.
Her 2 positive used to be the " worst" dx , however since the advent of Herceptin, and now Perjeta and TDM-1 the prognosis is much much better. ( I actually prayed back then that I would be HER2 positive to and get the newly approved herceptin to up my chances.)
I wish all a gentle road no one wants to travel on!
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Linda- God love you and thank you! My last chemo was today and this is the cherry on top!
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Linda that is Fantastic!!! So glad your enjoying life...,:)
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What does ER+ PR- HER2+ mean? I haven't seen anyone that has that diagnosis.
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Hi Deb, It means that a tumor has estrogen receptors but not progesterone receptors. I don't think it is as common as straight ER/PR neg or ER/PR pos but I could be wrong.
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I also am PR+/ ER- and her neu. I am trying to find more information. I have read that tamoxifen may not be as effective and that this classification is more aggressive. My tumor was 2.0 cm but sentinel node biopsy said no lymph node involvement. Lack of information is in itself ....scarey.
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Re: Tamox not being as effective in Her2 pos, I've read a few mentioned that OS+AI might be substantially better in Her2 pos than Tamox. Hopefully there will be a detailed analysis released alongside the rest of the results from the SOFT trial in December. I have a hard time believing that, being 80% ER pos, hormone therapy will do little for me. And I'm still confused as to how PR fits into all this. My PR was off the charts (95%). Is that good? Bad? Neutral?
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