Grade 1 but Her2+

Hi CindyB,

 I posted a similar comment to yours earlier today - I am also stage 1 and Her2+ and I was told not to worry about it!  I am also ER/PR+and now being treated with Tamoxifen and had rads.  Just don't understand why everyone seems to think Herceptin should be given automatically.  My oncologist said there are very varying views on the importance of the HER2 factor.

I just found out that I was HER2+ and low ER/PR (they are retesting).  I was grade 1 as well and only 3 mm.  Pretty upset.  I may have chosen a different treatment plan had I known this at the time I was diagnosed. 

G. Kenneth Haines III¹ , Elizabeth Wiley², Barbara Susnik³, Sophia K. Apple⁴, Snjezana Frkovic-Grazio⁵, Carolina Reyes⁶, Lynn C. Goldstein⁷, Farnaz Dadmanesh⁸, Allen M. Gown⁷, Mehrdad Nadji⁶, Matej Bracko⁵ and Fattaneh A. Tavassoli¹

Received: 29 October 2007  Accepted: 2 January 2008  Published online: 18 January 2008

Abstract   Background In addition to providing a timely and accurate diagnosis, pathologists routinely provide prognostic and predictive information to assist in the treatment of patients with invasive breast cancer. As our understanding of breast cancer at the molecular and genetic level improves, sophisticated new treatment options have become available to patients. The demonstrated improvements in disease-free and overall survival with the use of trastuzumab (Herceptin) has made HER2 testing a standard of care in the evaluation of patients with breast cancer. Specialized breast centers have accumulated sufficient experience to recognize that HER2 positive tumors tend to be of higher grade and to be estrogen receptor negative, whereas well-differentiated breast cancers rarely are HER2 positive. Methods To determine whether HER2 testing is necessary in well-differentiated breast cancer, we analyzed the frequency of HER2 positivity among 1,162 cases from 7 major breast centers or commercial laboratories in the United States and Europe. Results Well-differentiated breast cancers, defined by either nuclear grading or the Scarff-Bloom-Richardson system, rarely are HER2 positive (mean 1.6%, range 0-2.8%). Conclusions Given the low rate of well differentiated HER2 positive tumors, falling within the range reported for false negative IHC tests for HER2, and the absence of published data demonstrating a beneficial effect of trastuzumab therapy in this subset of patients, HER2 testing should not be considered a standard of care for all patients with well-differentiated breast cancer.

Feb22/08   Yes/ I'm recently with er+pr+Her2+ 1.5 cm /clear margins node negative   Stage 1 Grade 1 cells well differentiated

FISH 3 overexpressed    Trying to decide if I should have chemo ..it's a given on the Herceptin and rads but it's chemo that is the big?

My mom was stage 1 and Her2+, Aug 2004.  At that time Herceptin was not given to node negative people, so my mom didn't get it.  Unfortunately Sept 07 she was dx with widespread and extensive mets to liver and bones.  Now she is able to get herceptin, and it is crushing the life out of the cancer in her body along with Taxol and Zometa.  Pity she couldn't have had this 4 years back though. 

The FDA last month approved Herceptin as a stand-alone agent meaning it can be used without chemo for early stage.  http://www.caring4cancer.com/go/breast/news?NewsItemId=41257

Genentech is the maker of Herceptin, although Hoffman LaRoche is the European distributor.

I had chemo for a 7mm (yes mm) grade 2 tumor.  Actually it was a border 1/2 grade.  diagnosed at 35.  Don't fool yourself on size, the pathology of the tumor is much more important.  Her 2 likes to move.  That being said, I chose to hit it with everything I had, as quick as I could.  I did AC x 4 and a year of herceptin.  I wish I would have done taxol as well, but I did chemo before that evidence came out.

Good luck on your decisions.  

Dejaboo, I'm glad you found this part of the BCO boards, because I was running out of ideas for you.  I was just going to ask whether you'd had an Oncotype test done.  I guess not, huh?

So, basically, with the Herceptin + Zoladex, they are suppressing your ovarian function (to decrease the amount of estrogen you make) and blocking the HER2 proteins in any stray tumor cells.  That is sort of a "Herceptin-only" chemo regimen, with an estrogen blocker.  Since your tumor was so small and was grade 1, that sounds like a reasonable approach; but I honestly don't know.  I will keep looking, though.  I haven't done any lit searches yet (Medline, PubMed), which is how I usually investigate things.

There are a few women on these boards who have ER- PR- HER2+ tumors and are getting more aggressive chemo protocols, like TCH (usually that's Taxotere/Carboplastin/Herceptin, I think).  Since your tumor is/was ER+, you have the additional weapon of estrogen blockage that they don't have.

My tumor was ER+ PR- like yours, although it was HER2 neg.  There was some discussion among my oncos that the PR- status complicated things, and it might mean I would  need a more aggressive approach than if it had been ER+ PR+.  That was one of the arguments my first (former) onco used to support his recommendation of chemo.  I did have a much bigger tumor than yours, though (1.8 cm), and it was grade 2; plus my Oncotype score was 26.  So, I'm in the middle of a 4-cycle Taxotere/Cytoxan regimen.

When will you have to decide what to do?

otter 

Hi Otter,

  Thanks for your input.

(I dreamed my Onco score was 10- The Night before they called to tell me - there wasnt enough tissue to do the test)

Hmmm- I guess I wasnt told when I had to decide/start.   Do they usually tell you that?  Or must we ask.  I didnt think  to ask.

My Onco did say she wanted to see me again after my Surgery...She said after I am healed a little...Like Mid to late June (id say about 1 month after BPM)

And since I am waiting on the BRAC results (should be in around May 7th)   That might be a deciding factor on Zoladex or not 

My Initial Surgery- Lumpectomy & SNB was April 1st...Does that give me a time frame for any of this?

Mary,

You said "I didn't know that it was unusual to be Stage 1 and yet herceptin positive."

It's not unusual at all to be STAGE 1 and Her2 positive. I think maybe you're confusing stage with grade. What IS unusual (VERY unusual) is be GRADE 1 and Her2 positive. So unusual in fact, that some consider the finding of a FISH Her2+ in a confirmed well differentiated, grade 1 IDC to fall within the realm of false positive results and feel that Her2 testing on well-differentiated tumors is unnecessary.  Even FISH testing does, on rare occassion, yield  false positive results. In my opinion, it would be wise for someone with a grade 1 tumor being labeled as Her2 positive to have the grade re-evaluated by a different pathologist to be sure it really is grade 1.

I am getting scared about my onco results and chance for recurrence.  I have read all of your posts and I seem to be the only one with a HER/2 score of 3+.  I am Stage 1 grade 2. 

Does anyone out there have a 3+ and came back with a low onco score? 

Hi Cindy - I'm glad you had most of your questions answered. For the record - my oncologist was quite surprised when my Fish report came back Her3+ since my tumor was small, well-differentiated, Stage 1, Grade 1, and just .9cm. I opted for a mastectomy to hit it with everything I got - and was so happy to think I only need the Arimidex orally for five years (I'm 53 and post-menopausal) - but to my BIG disappointment, had to reorganize my brain to accept my onc's recommendation (after a second Fish test at a different lab confirmed that my Her2 expression was over 4) - so last week he started me on Herceptin and Navelbine every two weeks for 4 months, then continue on Herceptin every two weeks for a year, with the Arimidex. My Oncotype DX was 23 (risk of recurrence at 14%) - intermediate - so that was a deciding factor since my onc believes this treatment will reduce my risk by half down to 7%.

I feel like I'm the only one on this board who's on Navelbine.....it burns your veins, so I need a port installed (next Wednesday).

Cindy - did you get your heart tested - what was your Muga score? Mine was 67% - be sure you get that done before starting on the Herceptin. Good luck to you with your treatment!