How Long Should Herceptin Be Administered
The HERA study was a phase III clinical trial that randomly assigned HER2-positive early breast cancer patients to one of three treatment groups following adjuvant chemotherapy: observation, one year of Herceptin, or two years of Herceptin.
Overall survival and cancer-free survival were significantly better in the women randomly assigned to one year of Herceptin compared to the women in the observation group. Risk of death was 34% lower among women treated with one year of Herceptin. Herceptin protected against both distant metastases as well as local recurrence.8
Concern of side effects to the heart from Herceptin have led doctors to evaluate shorter courses of Herceptin treatment. The net result of these studies according to Dr. Harold Burstein M.D. a leading authority on the topic is that the optimal duration of Herceptin treatment remains one year for ESBC patients.
Mavroudis and colleagues conducted the HORG trial to examine 6 versus 12 months of Herceptin therapy in a cohort of 481 women with early, HER2-positive breast cancer.9
The analysis included 240 women in the 6-month group who were followed for 51 months and 241 women in the 12-month group who were followed for 47 months. Disease relapse rates were 11.7% in the 6-month group and 7.1% for the 12-month group. Overall survival was comparable between the two treatment arms, as was cardiac toxicity.8
All five trials that have examined the question of 6 vs. 12 months of Herceptin have similar results.4-8
Vertical Inhibition Of The Her2 Pathway
With a vision to further improve the results obtained with trastuzumab administration in a neoadjuvant setting, lapatinib was investigated. It was hypothesized that targeting the HER2 pathway from 2 different mechanisms at the same time might improve the response rate and pCR . The trials indicated that lapatinib was inferior to trastuzumab in the rate of pCR and that it was associated with a greater toxicity . Dual HER2 blockade with the trastuzumab/lapatinib combination produced significant improvement in pCR, but unfortunately it did not translate to a significant EFS improvement . In a meta-analysis, in patients receiving a combination of lapatinib and trastuzumab in comparison to trastuzumab only combined with chemotherapy, the absolute improvement in the pCR rate was 13% .
Table 2.
Neoadjuvant trials with vertical blockade of the HER2 pathway
Newer tyrosine kinase irreversible inhibitors of different HER receptors, such as afatinib and neratinib, have been tested in the neoadjuvant setting with results similar to those achieved with lapatinib. In the DAFNE trial patients received a combination of paclitaxel, trastuzumab, and afatinib followed by an EC. The rate of pCR was 49.2% .
Ethics Approval And Consent To Participate
This work was approved and need of informed consent was waived by the Medical Ethics Committee of the Erasmus MC . This Medical Ethics Committee of the Erasmus MC approved that the rules laid down in the Medical Research Involving Human Subjects Act do not apply to this work. Therefore, there was no need for an informed consent. The study was performed in accordance with the Declaration of Helsinki.
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What Women Can Do Themselves
There are some things women can do themselves to lower their risk of late recurrence:
- Regular exercise is associated with a lower risk of death from breast cancer as well as death from all causes.
- It’s important for everyone to have their vitamin D level tested, although the role of vitamin D is still uncertain. Vitamin D deficiency is associated with bone loss, a concern for most people who have coped with breast cancer.
- Losing weight if you are overweight, or maintaining a healthy weight is important as well.
Factors That Can Influence Survival Rate
There are a number of lifestyle factors that can influence outcomes for women with HER2 positive breast cancer. To give themselves the best chance at achieving a favorable outcome, it is recommended that patients:
- Maintain a healthy weight
- Eat a healthy and balanced diet
- Remain physically active, if possible
- Avoid tobacco use
Moffitt Cancer Center is a leader in cancer research and treatment. We provide our patients with individualized treatment plans and a full range of supportive care services to ensure all their needs are met as they undergo treatment. As a result, we are able to achieve the best possible outcomes and quality of life for our patients.
Those who have questions about the survival rate for HER2 positive breast cancer are encouraged to consult with a physician at Moffitt. To request an appointment with or without a referral, call or submit a new patient registration form online.
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Pcr As The Primary Endpoint In Neoadjuvant Clinical Trials
The pCR rate at the time of surgery is associated with a better prognosis and provides information regarding the responsiveness of the tumor to systemic therapy. A pooled analysis defined pCR as the strongest discriminator of long-term outcomes for patients in the neoadjuvant setting . Collaborative trials in neoadjuvant breast cancer performed a meta-analysis including 12 neoadjuvant trials with 11,955 patients and follow-up of 3 years and evaluated pCR as a surrogate marker for long-term outcomes . Of all breast cancer subtypes, pCR was associated with EFS and OS . The highest pCR rates were reported in triple-negative breast cancer and HER2-positive breast cancer. Additionally, the response to neoadjuvant treatment in HER2-positive disease is dependent on the hormone receptor status. A pCR rate of 30.9% was observed in patients with HER2-positive hormone receptor-positive breast cancer with trastuzumab therapy versus 18.3% without trastuzumab and 50.3% in HER2-positive hormone receptor-negative breast cancer with trastuzumab versus 30.2% without neoadjuvant trastuzumab . Overall, patients with pCR had a longer EFS and OS .
What Is The Life Expectancy For Each Cancer Stage
Your outlook depends on thestage of your cancer when its discovered. Cancer is staged by number, starting with 0 and going to 4. Stage 0 is the very beginning and stage 4 is the last stage, also called the metastatic stage, because its when cancer has spread to other areas in the body.
Each number reflects different characteristics of your breast cancer. These characteristics include the size of the tumor and whether the cancer has moved into lymph nodes or distant organs, like the lungs, bones, or brain.
Research on survival statistics for people with breast cancer tends to separate participants into categories of women and men.
Survival statistics of women with the major subtypes of breast cancer such as ER-positive, HER2-positive, and triple-negative are grouped together. With treatment, most women with very early stage breast cancers of any subtype can expect a normal life span.
Survival rates are based on how many people are still alive years after they were first diagnosed. Five-year and 10-year survival are commonly reported.
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Risk Of Recurrence Low In Small Her2
Patients with small, node-negative, HER2-positive breast cancer tumors had a low risk of invasive recurrence after 5 years
Lou Fehrenbacher, MD
Patients with small, node-negative, HER2-positive breast cancer tumors had a low risk of invasive recurrence after 5 years, according to an article published in the Journal of Clinical Oncology.1
Among 171 patients with HER2-positive T1a/T1b N0M0 tumors, who did not receive treatment with adjuvant trastuzumab or chemotherapy, the distant recurrence-free interval was 98.2% .
This is the first large study to demonstrate that the smallest lymph node-negative HER2-positive breast cancers have a very low chance of returning, lead author Lou Fehrenbacher, MD, medical director of Kaiser Permanente Oncology Clinical Trials, said in a statement.
In the analysis, 234 patients with HER2-positive T1a/T1b N0M0 tumors were identified in a database of 16,975 patient cases from between the years 2000 and 2006. The most commonly used treatments in this population include surgery, radiation therapy, trastuzumab, and chemotherapy.
Of the 234 patients with HER2-positive T1a/T1b N0M0 tumors, 171 were not treated with adjuvant trastuzumab or chemotherapy. The DRFI of patients with T1a tumors was 99.0% , while the DRFI was slightly lower among patients with T1b tumors, at 97.0% .
References
Impact Of Late Recurrence
The impact of late distant recurrence cannot be stressed enough. Once breast cancer is metastatic, it is no longer curable. While there are some long term survivors with stage 4 breast cancer , the average life expectancy is currently only around three years.
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Integrative Subtypes And Late Recurrence
Researchers recently developed a model to identify 11 integrative subtypes of breast cancer with different risks and timing of recurrence, according to the findings of a 2019 study published online in Nature.
Four integrative subtypes were identified that were associated with a high risk of late recurrence . Altogether, these four subtypes accounted for roughly 26% of breast cancers that were estrogen receptor-positive and HER2 negative.
These subtypes included tumors that had an enriched copy number alterations in genes that are thought to drive the growth of cancer , including:
- CCND1
- RPS6KB1
- MYC
They were also able to identify a subgroup of triple-negative tumors that were unlikely to recur after five years as well as a subgroup in which people continue to be at risk of late recurrence. A Breast Cancer Recurrence Calculator including integrative subtypes has been developed but, at the current time, this is meant for research purposes alone.
Risk Of Recurrence: Early And Late
Research has shown the HER2-positive early breast cancers are two to five times more likely to recur than HER2-negative tumors. Even very small HER2-positive tumors with negative lymph nodes have a much higher risk of recurrence relative to tumors that are HER2-negative. Treatment with Herceptin can cut this risk by half.
The pattern of breast cancer recurrence may also differ. Small tumors are also more likely to have a metastatic recurrence if they are HER2-positive.
Despite the fact that HER2-positive and estrogen receptor-negative tuors are more likely to recur early on than estrogen receptor-positive and HER2-negative cancers, late recurrences are much less common.
With estrogen receptor positive breast cancers, the cancer is more likely to recur after five years than in the first five years, and the risk of recurrence remains steady each year for at least 20 years following the diagnosis. In contrast, those who have HER2 positive tumors and reach their five-year mark are much more likely to be “in the clear” and remain recurrence free.
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What Are The Symptoms Of Her2
Its not possible to self-determine whether you have HER2-positive breast cancer. If your doctor suspects cancer, further testing will reveal whether you are HER2-positive.
Overall, its important to see your doctor right away if you notice any of the following symptoms:
- any new or changing lumps in your breast or armpit areas
- clear, colored, or bloody nipple discharge
- unexplained pain in your breasts
- changes in your nipples or breast skin, such as dimpling, reddening, or scaliness
- nipples that turn inward
Hormone treatments may be an option for cancer thats also HR-positive.
Her2 Positive Breast Cancer Survival Rate
The survival rate for HER2 positive breast cancer is a very broad, general indication of outcomes only. Those who are learning about the survival rate for HER2 positive breast cancer should remember that it does not predict what will happen for any particular patient. Rather, the survival rate is an average based on a large number of patients with HER2 positive breast cancer. Therefore, the survival rate should only be used as a point of reference.
Survival rates are discussed in terms of years. For example, the five-year survival rate for HER2 positive breast cancer shows the percentage of patients who survive five years or longer following their diagnosis. It is likely that the survival rate for HER2 positive breast cancer will continue to improve as new and better treatments are developed, and patients who are diagnosed today are projected to have better outcomes than those whom the current survival rates are currently based on.
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Why Is This Study Important
The results of this study offer an immediate new treatment option for some people with HER2-negative metastatic breast cancers. Doctors look for the presence of the HER2 protein in breast cancer cells to guide treatment. In the past, people with breast cancer were considered HER2-positive
breast cancer. They are relevant to both hormone receptor-positive and hormone receptor-negative metastatic
Survival Rates For Stage Iv Breast Cancer
Stage of breast cancer at diagnosis is one of the most important prognostic factors. Above is a bar chart from the National Cancer Institute statistics for 2012. As we can see, the 5-year survival rate for women diagnosed with Stage IV breast cancer was 22%.
Remember, these figures are still quite dated as it takes 5 years to determine survival rates and treatment is improving all the time.
A recent study found that 37% of women survived for three years after a Stage IV breast cancer diagnosis, although some women do survive longer.
However, although the 5-year survival rates are much higher for earlier stages of breast cancer at diagnosis, there is no predicting which cases will progress to metastatic breast cancer in the future.
Although it is important to be realistic regarding the survival of metastatic breast cancer, each individual situation is unique and ultimately, statistics are meaningless.
There is a small subcategory of people with Stage IV breast cancer who beat the odds and live for years. However, it is difficult to predict who will fall into this group.
All that is known is that people in this group have secondary spread to the bones. Furthermore, cancer is often estrogen positive and responds to hormone treatments.
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Study Design And Participants
Our analyses are based on data from the placebo arm of the adjuvant Tykerb evaluation after chemotherapy trial , the design and main outcomes of which have been previously published . Briefly, between August 2006 and May 2008, the study recruited 3,161 women with stage I to IIIC HER2+ invasive BC who were disease-free at any time in follow-up after completion of prior adjuvant chemotherapy, but who had not received adjuvant trastuzumab. By randomizing patients at any time after diagnosis, the design of this trial and the resulting cohort of patients included are unique, as patients as late as 179 months from diagnosis were randomized , resulting in a very long follow-up period from diagnosis.
The study was approved by ethics review boards at all participating centers . Patients gave written, informed consent. The study complied with the Declaration of Helsinki and Good Clinical Practice. Only patients assigned to the placebo group and with centrally confirmed HER2+ disease are included in this analysis.
Patients were randomized to oral lapatinib or placebo, daily for 12 months or until disease recurrence, development of a second primary cancer, or unacceptable toxicity. Details of randomization and stratification have been previously published .
How Can I Prevent Breast Cancer Recurrence
There is no definitive way to prevent breast cancer or breast cancer recurrence. However, treatments such as surgery, chemotherapy, radiotherapy, targeted therapy and/or hormone therapy do reduce the risk of recurrence, depending on the type and stage of the cancer. These can be discussed with your treatment team.
Understanding breast cancer risk factors and participating in regular breast screening through BreastScreen in Australia and BreastScreen Aotearoa in New Zealand can help to pick up any breast changes. Discussion with your healthcare team can help to catch any changes or abnormalities early and act on them.
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Her2+ Status Cancer Stage And Survival
The importance of HER2 status for survival will depend on how far the cancer has spread. If itâs only in the breast, then it wonât make much difference. Most women in the early stage of the disease do well because a surgeon can remove the tumor.
Itâs when a breast tumor grows and spreads to lymph nodes or farther away in the body that HER2 status becomes more important for treatment and survival. Thatâs because there are now drugs that target HER2, but these work only for cancers that are HER2+. A common drug for HER2+ breast cancer is trastuzumab , but there are others. Because there are more treatments, women with more advanced HER2+ breast cancers today will on average have better survival rates than those with more advanced HER2- breast cancers.
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Vaccine Derived From Her2 Protein May Help Prevent Breast Cancer Recurrence
A new breast cancer vaccine that is derived from the HER2 protein may help prevent recurrence in patients with HER2-positive disease and appears safe. Phase II study results of the vaccine were released at the 2014 Breast Cancer Symposium, September 46, in San Francisco.
The HER2 protein, also known as human epidermal growth factor receptor 2, is found on the surface of certain cancer cells, including breast cancer. In normal cells HER2 helps control cell growth. Cancer cells, however, can make too much of the protein, which can cause cells to grow more quickly and be more likely to spread to other parts of the body.
The HER2-derived vaccine, known as GP2, is designed to provoke the bodys immune system to fight cancer by recognizing tumor cells that express HER2. It is administered in addition to standard breast cancer treatment, such as Hercpetin® , with the goal of preventing recurrence.
Based on these findings, the GP2 vaccine appears promising in addition to standard therapy in women with HER2-positive breast cancer, as it might have the potential to safely and effectively prevent recurrences. The researchers also speculate that GP2 works with Herceptin in a specific way to stimulate immune response and that further research into this interaction is warranted.
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