What to expect if ER+ PR- Her2- and postmenopausal?

I have the same type of tumor as you. My tumor is er+ pr- her2-. I had my lumpectomy almost 1 year ago on Feb 6/07. I am postmenopausal. My doctor say it doesn't make much difference if I am pr- as long as I am er+ which is good. I am on arimidex for 5 years. I had lumpectomy and re-excision(close margins) with 5 weeks of radiation. My tumor is also 2 cm. So far I feel great with no side effects from arimidex. I read arimidex works much better than tamoxifen for tumors that are er+ pr-. As far as er+ pr- being more aggressive than er+ pr+ tumors, I've read they are more aggressive if they have a over expression of Her2 which ours do not.

Hi Otter,



I'm ER+ PR- Her2- as well.



I was diagnosed with a regional recurrence this past November. I had been on tamoxifen since February, when my radiation ended.



They've since switched me to zoladex and an AI, which is shrinking the tumour.



I had heard that also about tamoxifen and PR- tumours, and it seems it was true in my case.



The AIs are not too bad so far. Some bone pain, but not intolerable. Quite a lot of fatigue, but it seems to be getting better. Hot flashes of course.



I hope that's of some use to you,

Darya

Otter and Others,



I have found two sources of information about ER+ PgR- Her2 - breast cancer.



• The first is a 2007 ASCO abstract. Go to asco.org and look at the 2007 ASCO Annual Meeting abstracts. Abstract No. 538. What you want to look at are the presentation slides. Look under the abstract at #1 and click on the "slides" icon.



Title of Abstract:

Central assessment of ER, PgR and HER2 in BIG 1-98 evaluating letrozole (L) compared to tamoxifen (T) as initial adjuvant endocrine therapy for postmenopausal women with hormone receptor-positive breast cancer.

B. B. Rasmussen 
Abstract - No. 538    2007 ASCO Annual Meeting - Category: Breast Cancer--Local-Regional and Adjuvant Therapy



• The second is a study of gene expression profiles. This was also presented at ASCO in 2007 but I found it on Medscape, not the ASCO site. They found that ER+ PgR- tumors were a mixture of three different subtypes. This was based on the DNA copy number profiles of only 89 tumors so it's very preliminary research at this point. In analysis of patients treated with tamox or no adjuvant treatment, the Subtype 3 breast cancers defined by gene expression profiling tended to have poor outcome as compared to Subtypes 1 and 2. These differences are not observed using IHC to assign ER and PR.



* Subtype 1 tumors manifesting the ( + + ) signature

* Subtype 2 tumors manifesting the ( - - ) signature

* Subtype 3 tumors not associated with either, but sharing patterns with both



Title of Research Article:

Gene expression profiles of ER+/PR-breast cancer are associated with genomic instability and Akt/mTOR signaling, and predict poor patient outcome better than clinically assigned PR status.



Authors:



Creighton CJ, Osborne CK, van de Vijver M, Foekens JA, Wang Y, Zhang Y, Klijn JGM, Horlings HM, Hilsenbeck SG, Lee AV, Schiff R. Baylor College of Medicine, Houston, TX; Netherlands Cancer Institute, Amsterdam, Netherlands; Erasmus MC-Daniel den Hoed, Rotterdam, Netherlands; Veridex LLC, a Johnson Johnson Company, San Diego, CA



Since it is early days in this kind of research and since we can't know at this point which subtype we have this is not much to go on, is it?

Girl53, like many breast cancer subtypes, there is little clear information about ER+/PR-/HER2- tumors. I was well into my treatment before my oncologist and I had time to talk about this. Her take was that this subtype was on a continuum...not as favorable as ER+/PR+ but she was emphatic that they have no research that provides a different protocol for this subtype. She told me to be happy that I was highly ER positive and that was just as beneficial as being slightly positive for both ER and PR. I have yet to find any research comparing patients with different levels of ER/PR positivity, so I am filing that comment away as a patronizing one. What I do know is that a low PR score will affect your oncotype result because that is one of the factors that determine your score.
I also have read that Tam is not as effective with this subtype....since I am post meno, that was not an issue, but for the gals who are pre-meno, I would recommend that you seek out multiple opinions before you decide to suppress your ovaries and do AI instead of Tam.
Good luck, this is the hard part....getting information and making decisions.
MsP

I'm also ER+, PR- HER2-. My ER is only 3% so a very weak positive. My MO told me that he considers anything over 1% positive. I'm still going thru chemo, 6 more weeks of Taxol to go. Reading some of the side effects of tamoxifen, I'm wondering if the risk of those out weighs any benefits I might get from it. We'll be chatting about this at my next appointment as he wants me to start before rads begin 4/18/27.

Anyone else have a weak ER+?

Mine was 95% er and less than 1% pr, her2-. I was already postmenopausal so went to AI drugs. I am 5.5 years out no recurrence. The problem we face is the majority of the people that are hormone positive are both er and pr positive and tamoxifen is an effective drug for this population. But the number of people er+ and pr- is significantly less and even less so are people er- and pr +. So statistical analysis is less valuable for us. The data just isn't updated and is based on tamoxifen use only.

Remember that oncologist are focused on cancer treatment and throwing the kitchen sink at a problem. My advice is to look carefully at your pathology consult your doctor and make a decision with everything considered.

Look at side effects and balance out a treatment approach. In some case going full throttle heavy chemo followed by hormone therapy might keep the cancer at bay in other cases it might not be that clear. Ask yourself what do you think will help you.

chiming in this discussion. According to pathology from surgery mass I am ER+PR+HER- ; but Oncotype report said ER+PR-HER- (PR is just below 0).

I am Pre-menopause. Haven't decided on treatment. Saw one MO who recommend "standard" ACT plus radiation and Tam. Will see another MO tomorrow.

I was just diagnosed ER+PR-HER2- on Friday April 27th (two days ago) so I’m curious to anyone else’s experience I don’t have much more info yet getting 2nd and probably 3rd opinions as well as scheduled for MRI and genetic testing this week. I found my lump 2 weeks ago it’s just under 2cm and was not seen on 3D mammo only ultrasoun

Did any of you have the oncotype analysis done? I wasn't sure if my IDC ER99%+ PR0%- HER2- would trigger the oncotypeDX testing tu wouldn't it be important ? If the surgeon and oncologist don't suggest it, can I request (firmly) that it be done? I'm on Medicare + and excellent supplemental so I'm hopeful it'd be paid for but Husband agrees with me that we would pay out of pocket if needed for anything we feel necessary (and I realize I am fortunate to be in that position).

I want to know as much as possible about this thing and the oncotype piece of the puzzle seems crucial.

Thoughts?

Patsy, it sure sounds like you qualify so be sure to ask. Women that know initially that chemo is first line choice of treatment would not need the test since they are getting chemo anyway. They send your tumor at time of surgery to California after It is examined at the hospital lab. It takes a good 2 weeks to get it back. Ugh. More waiting. If you are in to statistics and where you will be if u doing nothing vs doing chemo, ALs this test will give you those numbers and you can make the best decision for you. Some women score low to moderate and decide chemo. Some score high risk and decide no chemo. It is an individual decision but it may help guide you on which way to go. I found piece of mind so important going through this journey.

PatsyKB - I didn't have an oncotype test done. My tumor was grade 3 and a positive node so chemo was highly recommended.

wintersocks, 6 years you go girl! As you know different pieces of the puzzle can swing the pendulum one way or the other as far as chances of recurrence. The PR negativity is less favorable as the hormone is the "braking system" so we do not have that benefit. I guess we never know if the decisions we made as far as treatment is what keeps things at bay or if we would have been one of the lucky ones anyway. From what I read recurrence from PR neg tumors tends to be sooner rather than later. You seem to be on the good side of the coin flip as you are 6 years out. I don't know that I will ever "not worry" but my decisions were made so that I would not be "consumed with worry" I feel there is a difference and that is important to me as go on with my new normal. You have some time to gather any info and ask questions at your next appt. Seems like you are doing really well, that's great!

meow, may i ask which AI are you on? One more month and i will start. I'm assuming i will give it time and if side effects too bad switch to another. Silly question but is sticking with the same manufacturer important?

I'm ER+ PR- and my onc said that was part of the reason chemo was recommended for my small tumor. It has aggressive features, and I think that's part of it. I did the Oncotype test anyway, and I came out at the top end of "Intermediate." He assures me PR- doesn't necessarily mean a worse prognosis, but I do expect to be moved to AIs pretty quickly. I'm coming to understand that there is just a bunch of stuff they do not know, so we just have to make the best decisions we can with limited information. Sigh.