Trastuzumab Provides A Comparable Prognosis In Patients With Her2
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Background and Purpose: We investigated the locoregional effect of trastuzumab, and determined whether patients with human epidermal growth factor receptor 2-positive breast cancer treated with trastuzumab could achieve comparable efficacy to that of patients with HER2-negative BC.
Materials and Methods: This was post hoc analyses of data of 793 BC patients from a randomized controlled trial comparing post-mastectomy hypofractionated radiotherapy with conventional fractionated radiotherapy. Survival rates were analyzed by the KaplanMeier method and compared by the log-rank test.
Results: Patients were classified into three groups: HER2-negative , HER2-positve with trastuzumab , and HER2-positive without trastuzumab . The HER2+ + T group had significantly lower locoregional recurrence , distant metastasis and higher disease-free survival at 5 years than that of the HER2+ T group . The HER2 group had significantly lower LRR , DM and higher DFS at 5 years than that of the HER2+ T group . The difference in LRR, DM and DFS at 5 years was not significant between the HER2+ + T group and HER2 group . Different annual LRR patterns was found among groups according to HR status.
Subcutaneous Herceptin Now An Option
Dr. Jackisch M.D. and colleagues from Germany reported the results of an open-label, multi-center, international clinical trial to compare the effectiveness and safety of subcutaneous and IV Herceptin in patients with HER2-positive ESBC.
A total of 596 individuals were enrolled in the clinical trial between October 19, 2009, and December 1, 2010 and have now been followed for 6 years.
Patients were given 8 cycles of standard chemotherapy and either a fixed-dose of subcutaneous or IV Herceptin for 10 after surgery to complete 1 year of anti-HER2 therapy.
The overall survival and progression free survival were essentially identical for IV and subcutaneous Herceptin. Moreover, the rates of significant cardiac and other serious side effects were similar.
The study suggests that subcutaneous Herceptin is as an effective alternative route of administration for patients with HER2-positive ESBC.16
References:
Survival Of Breast Cancer Based On Stage
Statistics are given below for the overall survival rates for breast cancer based on certain stages of disease development.
I made this page many years ago, when there was nothing like this data available on the internet. Recently this page has been up-dated with the most recent statistics that we can find. Prognosis will be even better than the numbers here suggest because modern targeted treatments have improved a lot.
Breast cancer staging is determined by many factors and these include:-
- The presence and size of a tumor
- Whether the tumor is node negative or positive, this means whether lymph nodes are involved or not
- If the cancer has metastasized beyond the breast
If breast cancer is diagnosed and it is determined that there is no metastasis to the lymph nodes then the chances of survival are extremely good.
Once breast cancer has spread to the lymph nodes the mode of treatment tends to shift to the chemotherapy medicines, and the odds of survival are somewhat lower.
An updated page on breast cancer survival rates. A new page on Breast cancer TNM stage.
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Survival Rates And Statistics
A relative survival rate helps give an idea of how long a person with a particular condition will live after receiving a diagnosis compared with those without the condition.
For example, if the 5-year relative survival rate is 70%, it means that a person with the condition is 70% as likely to live for 5 years as someone without the condition.
It is important to remember that these figures are estimates. A person can talk with a doctor about how their condition is likely to affect them.
Some factors affecting a personâs survival rate with breast cancer include:
- individual factors, such as the personâs age and overall health
- the stage of the cancer at diagnosis
- the treatment the person receives
HER2-positive cancers are than HER2-negative cancers. With treatment, however, the chances of survival are high, especially with an early diagnosis. In some cases, they may be higher than for HER2-negative breast cancer due to effective targeted treatment.
According to the , the likelihood of living for another 5 years with HER2-positive cancer, compared with a person who does not have breast cancer, is as follows. These statistics are based on figures for the years 2011â2017.
| Stage |
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How Are Breast Tumors Tested For Her2
Either a test called an immunohistochemistry test or fluorescence in situ hybridization test is used to find out if cancer cells have a high level of the HER2 protein.
See Testing Biopsy and Cytology Specimens for Cancer and Understanding Your Pathology Report: Breast Cancerto get more details about these tests.
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There Are Known Risk Factors For Her2
While exact cause is difficult to pinpoint, researchers have identified some risk factors for HER2-positive disease, according to Moffit Cancer Center. For example, being a higher weight, not living an active lifestyle, having a child for the first time after age 30, and using tobacco products can up your risk. This cancer is also more likely to occur in younger women, adds Brian Czerniecki, M.D., chair of the department of breast oncology at Moffit Cancer Center in Tampa, FL. According to one 2020 study, 23% of younger women had HER2-positive breast cancer compared with 13% of older women.
What Is The Outlook For Her2
As mentioned before, HER2-positive breast cancers are more likely to grow faster and to come back after treatment than cancers that are HER2-negative. However, the development of the drugs discussed above that specifically treats cancers expressing HER2 has led to significant improvements in the outlook for people with HER2-positive breast cancer.
While survival rate statistics for breast cancer are not broken down to show rates for HER2-positive cancers, the 5-year survival rate for all localized breast cancers is 99%. However, the 5-year survival rate for metastatic breast cancer is 27%, so it is important to treat HER2-positive breast cancer as early as possible to reduce or prevent spread.
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Availability Of Data And Materials
The dataset analysed in the current study is not publicly available, but was obtained from the Cancer Registry of Norway under a specific ethical approval by the Regional Committee for Medical and Health Research Ethics in the South East Health Region of Norway. Researchers with appropriate approvals can apply for Norwegian health registry data from .
Survival For All Stages Of Breast Cancer
Generally for women with breast cancer in England:
- Around 95 out of every 100 women survive their cancer for 1 year or more after diagnosis
- Around 85 out of every 100 women will survive their cancer for 5 years or more after diagnosis
- Around 75 out of every 100 women will survive their cancer for 10 years or more after diagnosis
Cancer survival by stage at diagnosis for England, 2019Office for National Statistics
These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account that some people would have died from other causes if they had not had cancer.
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Why Receptor Status Matters
Breast cancer is not a single disease, and researchers now have the ability to break down breast cancer into different subtypes based on the receptor status of the tumors. Among the variations between different types of breast cancers are the proteins found on cell surfaces, which are involved tumor growth. These proteins are related to the genetic material of cancer cells.
For example, with estrogen receptor-positive breast cancer, estrogen binds to specific receptors on breast cancer cells, stimulating proliferation. Similarly, HER2 receptors on the surface of breast cancer cells are stimulated by HER2 protein, promoting the growth and spread of breast cancer.
It’s important to note, however, that all breast cellsboth cancerous and noncanceroushave HER2 receptors on their surfaces. The difference is that HER2-positive breast cancer cells have 40 to 100 times more receptors than HER2-negative breast cancer cells or normal breast cells. In positive cases, the abundance of receptors fuels the cancer.
Breast Cancer Discussion Guide
Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.
Risk Factors For Overall Recurrence
There are several risk factors that raise the risk of recurrence overall . These include:
- Tumor size: Larger tumors are more likely to recur than smaller ones both early and late.
- Positive lymph nodes: Tumors that have spread to lymph nodes are more likely to recur at any time than those that have not.
- Age at diagnosis: Breast cancer recurrence is more common in younger people.
- Treatments received and response to treatments: Both chemotherapy and hormonal therapy reduce the risk of recurrence in the first five years.
- Tumor grade: More aggressive tumors are more likely to recur than less aggressive tumors , especially in the first five years
There are also factors that do not appear to affect the risk of recurrence. Recurrence rates are the same for women who have a mastectomy or lumpectomy with radiation and are also the same for women who have a single vs. double mastectomy.
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Her2 Mrna Expression Comparison By Her2 Ihc/ Fish Status
HER2 mRNA expression was determined by qRT-PCR and recorded as CT . The medians of CT were 2.94 , 2.61 , and 1.18 for HER2 0, HER2-low, and HER2-positive cases, respectively . HER2-positive cases showed the highest mRNA expression level while HER2 0 showed the lowest mRNA expression level, and all pairwise comparisons were significantly different . When further stratified by IHC score in HER2-low tumors, the medians of CT were 2.80 and 2.47 for HER2 1+ and HER2 2+/FISH cases, respectively . We found that HER2 mRNA expression of HER2 1+ cases was similar to that of HER2 0 cases , and both were much lower than HER2 2+/FISH cases . Significant overlaps were shown between HER2 0 and HER2 1+ groups, relatively distinct from HER2 2+/FISH group .
Understanding Her2+ Status And Survival
Doctors use three markers to help define breast cancers and guide treatment. One of those is the HER2 protein. The other two are hormone receptors . When a cancer has none of these, doctors call it triple negative. Until recently, there wasnât much information about how these markers changed survival rates for breast cancer.
A recent study looked at the National Cancer Institute data to see if there were differences in survival for women based on these markers. The study shows there are. Overall, women who have HR+ and HER2- breast cancer do best. But in the later stages, those who have the HER2+ type have better survival rates than those with HER2-. Breast cancers that are triple negative have the lowest survival rates. The 4-year survival rates are as follows:
- HR+/HER2-: 92.5%
- HR-/HER2-: 77.0%
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Treating Aggressive Breast Cancers
Women diagnosed with breast cancer undergo testing to determine the form of the disease and whats driving its growth. This information is key to developing an individualized treatment strategy. Choice of treatment also depends on how extensive the cancer is within the breast, whether it has metastasized, and whether the patient is menopausal.
When either HER2-positive or triple-negative breast cancer is diagnosed early, surgery is often performed to remove the tumor and its surrounding tissue or the entire breast . Nearby lymph nodes sometimes are removed as well.
Neoadjuvant therapy, a treatment given as a first step before the primary treatment, is standard for both HER2-positive and triple-negative breast cancers if the tumor can be surgically removed. Chemotherapy is often used as a neoadjuvant therapy before surgery to shrink the tumor. The goal is to reduce the area that needs to be removed so the surgery can be less extensive, possibly avoiding a mastectomy. For HER2-positive cancer, chemotherapy may be combined with targeted therapy, medication that acts on the specific cause of the cancer.
After neoadjuvant therapy and surgery, the treatment strategies for HER2 and triple-negative breast cancers differ.
Where To Get Support
The American Cancer Society is a good starting place to find the support you and your family may need during treatment and after.
You may want to join a support group. That’s a good way to meet people who know what you’re going through because they’ve been through it, too.
Let your family and friends know how you’re feeling. Tell them what they can do to help you. They may want to help but don’t know what to do.
Also, consider talking with a counselor. That could help you handle the emotions that can come with having cancer.
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Trastuzumab Has Radically Improved Prognosis For Her2+ Breast Cancer
HER2-positive breast cancer has gone from & quot worst to first& quot because of the success of the monoclonal antibody drug trastuzumab in combination with chemotherapy.& nbsp
Harold J. Burstein, MD, PhD
HER2-positive breast cancer has gone from “worst to first” because of the success of the monoclonal antibody drug trastuzumab in combination with chemotherapy, said breast oncologist Harold Burstein, MD, of the Dana-Farber Cancer Institute, speaking Saturday in Chicago at the 19th Annual Lynn Sage Breast Cancer Symposium, sponsored by Northwestern University’s Robert H. Lurie Comprehensive Cancer Center.
Disease-free survival rates have increased so dramatically since trastuzumab was introduced in 1998, and without significant toxicity from the drug, that, for a large proportion of patients, being diagnosed with this aggressive cancer is not the dire event it used to be.
About 1 in 5 of the 250,000 new breast cancers diagnosed every year is HER2 positive. About half are stage I and the remainder are stage II or III. Though HER2-positive cancers are more common in young women, they can occur at any age.
However, trastuzumab remains the starting point. A study of more than 4000 patients, published in 2014, showed that adding trastuzumab to chemotherapy led to a 37% relative improvement in overall survival, increasing 10-year survival from 75.2% to 84%. The 10-year disease-free survival rate increased from 62.2% to 73.7%. All patient subgroups benefited.2
References
Regional Relapse Following Breast Cancer Treatment Carries A Poorer Prognosis
Most localized breast cancers are treated by either breast conserving surgery with radiation therapy, or by mastectomy.
A medical study from 2010 estimates that around 40% of all women with breast cancer will suffer a recurrence.
The prognosis following a breast cancer recurrence is influenced by a number of factors. These include:-
- The Disease Free Interval: This is the time elapsed from diagnois and treatment of the first breast cancer to the recurrence
- The location of the recurrence: Whether the recurrence is in the same breast , or if it recurs in the contralateral breast, regional lymph nodes, or the chest wall .
Patients with breast cancer relapses are typically generally treated with either a salvage mastectomy, or radiation to the chest wall, regional lymph nodes, or both.
Systemic therapy may be implemented at this point. However, this will be determined on an individual basis, based on the likelihood of distant metastasis, characteristics of the tumor, and other factors.
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What Is The Treatment For Her2
Your health care team needs to evaluate all therapy and provide guidance in response to all test results available and the specific circumstances of your cancer. Treatment for HER2-positive breast cancer typically involves a combination of chemotherapy and specific drugs used for cancers expressing the HER2 protein:
- Trastuzumab : This is a monoclonal antibody against HER2, as well as the first drug developed that targets the HER2 protein.
- Pertuzumab : This is another monoclonal antibody that targets HER2-positive cancers.
- Ado-trastuzumab emtansine or TDM-1 : It’s a monoclonal antibody that is attached to a chemotherapy drug, emtansine.
- Lapatinib : Medical professionals usually use this kinase inhibitor with chemotherapy or hormone therapy.
- Neratinib interferes with the cancer cells’ ability to respond to growth signals.
Is Stage 4 Breast Cancer Curable
Theres currently no cure for stage 4 breast cancer, but with treatments it can be kept under control, often for years at a time.
People with metastatic breast cancer need to receive treatments for the rest of their lives. If a certain treatment stops being effective, another treatment regimen may be tried.
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Brain Metastasis In Her2+ Disease
HER2-targeted therapies could be considered instead of locally directed therapies, such as radiation, in patients with brain metastasis from HER2+ breast cancer. After progression while on trastuzumab with a taxane, trastuzumab-emtansine is typically utilized, based on the retrospective exploratory analysis from the EMILIA trial . Among patients with CNS metastasis, there was significant improvement in overall survival in the T-DM1 arm, compared to the lapatinib + capecitabine arm . The efficacy of capecitabine + lapatinib was studied in the LANDSCAPE trial . In this trial, 66% of the patients were found to have a partial response, with a median time to progression of 5.5 months. The 6-month overall survival was 90%. The combination of lapatinib and capecitabine is typically utilized as a later-line therapy.
The next line of therapy for patients with HER2+ CNS metastasis, after progression while on kadcyla, is typically a combination of tucatinib, capecitabine and trastuzumab . Specifically in relation to brain metastases, 25% of the patients with brain metastases had a one-year PFS when treated with tucatinib with capecitabine and trastuzumab, compared to 0% in the trastuzumab + capecitabine arm . The median PFS in the tucatinib arm was 7.6 months versus 5.4 months in the capecitabine + trastuzumab arm.