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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What Is The First Step In Diagnosing Breast Cancer
When diagnosing breast cancer, one of the first steps doctors take is identifying the type of breast cancer. The type provides key information about how the cancer may behave. About 13 percent of women in the United States will develop invasive breast cancer. Anyone can develop HER2-positive breast cancer, regardless of their sex.
Is Triple Negative Breast Cancer Aggressive
Triple-negative breast cancer accounts for about 10% to 20% of all breast cancer cases. Every cancer diagnosis is unique, but in general, triple-negative breast cancer is a more aggressive type of tumor with a faster growth rate, higher risk of metastasis and recurrence risk. Therefore, it often requires chemotherapy as part of the treatment.
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Will I Need Radiation
Most oncologists generally recommend radiation treatment for all breast cancer patients who undergo only removal of the tumor .
For women who undergo whole-breast removal, radiation may be recommended for those who are considered high-risk, especially those with tumors larger than 5 centimeters and with more than four cancerous lymph nodes.
Study Shows Women With Stage 1 Her2
Results of a phase 2 study showed that women with small, stage 1 HER2-positive breast cancer who received a combination of lower-intensity chemotherapy and Herceptin following surgery were highly unlikely to have a recurrence.
Results of a phase 2 study showed that women with small, stage 1 HER2-positive breast cancer who received a combination of lower-intensity chemotherapy and the targeted drug Herceptin following surgery were highly unlikely to have the cancer recur within three years.
The study found that 98.7 percent of women treated with the combination after surgery were alive and free of invasive breast cancer three years after receiving treatment. Many previous studies have excluded women with HER2-positive breast tumors less than 2 cm in diameter that hadnt spread to nearby lymph nodes from clinical trials of Herceptin, because it wasnt considered prudent to expose them to an investigational drug, given the relatively low risk that the disease would recur.
Without a single, standard treatment for this group of patients, treatment approaches have varied widely. These phase 2 results, published in the New England Journal of Medicine, may help establish the therapy as the first standard treatment approach for this group of patients, the authors write.
In addition to the high likelihood of preventing cancer recurrence, the study also found that the side effects were generally milder than those associated with traditional chemotherapy regimens.
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Questions To Ask Your Doctor About Her2
- What are my treatment options?
- What is the best course of treatment for my cancer, and why?
- Whats the overall goal of treatment in my case?
- When should I start treatment?
- Can I still work and manage my regular activities during this time?
- How often will I be coming in to see you for treatment?
- Will I be coming here for all my visits and treatments, or going elsewhere?
- What short-term side effects and long-term risks are associated with my treatment?
- What are the next steps if the desired treatment doesnt work?
- How likely is it for my cancer to come back in the future? What symptoms should I be aware of?
- What is the cost of my treatment?
- What should I discuss with my insurance company?
Why Mammograms Are The Best Defense
Breast cancer is now the number one diagnosed cancer worldwide it has overtaken lung cancer in the United States, says Dr. Samuel. But more people still die of lung cancer than breast cancer. Thanks to screening mammograms, wereable to detect breast cancer early, when its more likely to be curable, meaning early detection increases overall survival rates.
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Health Tips – HER2-Positive Breast Cancer
HER2 is actually a protein that promotes the growth of cancer cells. HER2-positive breast cancer basically means that those cancer cells have this protein and typically have it in abundance. What this translates into is that the cancer itself is aggressive, can grow rapidly, and unfortunately it can spread to other places quickly.
HER2-negative cancers do not have the HER2 protein and therefore do not behave the same way as HER2-positive breast cancers behave. A woman can have HER2-negative breast cancer diagnosed at the age of 50. God forbid, 22 years down the line, she gets a second type of breast cancer, that breast cancer can be very different and now is HER2-positive.
One in five breast cancer patients will have a HER2-positive protein.
Breast cancer is now the number one diagnosed cancer worldwide, and in the US. It has overtaken lung cancer.
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How Breast Cancer Cells Are Graded
- G1. Cells are well differentiated this is considered low grade.
- G2. Cells are moderately differentiated this is considered intermediate grade.
- G3. Cells are poorly differentiated this is considered high grade.
Your healthcare team will also test the cancer cells for receptors that are located on the outside of the cells. Knowing which receptors are present can help determine what type of treatment is likely to be more effective.
What Is Her2 In Breast Cancer
HER2 is a growth-promoting protein on the outside of all breast cells . Breast cancer cells with higher than normal levels of HER2 are called HER2-positive. These cancers tend to grow and spread faster than other breast cancers, but are much more likely to respond to treatment with drugs that target the HER2 protein.
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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%
Systemic Treatments For Stage 1 Breast Cancer
Systemic treatments, often termed add-on or adjuvant treatments, treat breast cancer throughout your body and not just at the site of the tumor.
These treatments help destroy cancer cells that have spread beyond your breast but are still too small to be spotted. They include the therapies outlined below.
Chemotherapy
Doctors may recommend chemotherapy, also called chemo, after surgery to help destroy any undetected cancer cells. Chemotherapy may also lower your risk of the cancer coming back at a later stage.
Chemotherapy may be recommended for a smaller tumor if:
- Any cancer cells were found in the lymph nodes.
- You score high on a gene test such as Oncotype DX, which shows whether chemotherapy could help treat your breast cancer and if its likely to come back after surgery.
- The cancer cells are progesterone receptor- and estrogen receptor-negative.
- The breast cancer cells are positive for human epidermal growth factor receptor 2 various therapies can target these receptors.
Hormone therapy
Hormone therapy can be used to help slow down the growth of cancer cells in people with estrogen receptor-positive or progesterone receptor-positive cancer cells. Hormone therapy works by blocking hormone receptors on the cancer cells or by lowering the amount of estrogen produced in your body.
Its important to ask your doctor about the potential side effects of hormone therapy before you begin this treatment, so can you know what to expect.
Targeted therapy
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Side Effects And Quality Of Life
Women treated with Herceptin and chemotherapy were more likely to have a severe side effect not related to blood counts compared to women treated with Herceptin alone 29.8% vs. 11.9%.
The most common side effects of any grade were:
- low white blood cell counts
- loss of appetite
Health-related quality of life scores went down faster in women treated with Herceptin plus chemotherapy, compared to women treated with Herceptin alone, 2 months after starting treatment and 1 year after starting treatment.
In light of the lower toxicity and more favorable profile, trastuzumab monotherapy can be considered an adjuvant therapy option for selected older patients, the researchers wrote.
In an editorial accompanying the article, researchers not affiliated with the study agreed with the conclusion.
on the basis of the results of the RESPECT trial, it is possible to consider that adjuvant trastuzumab monotherapy could be an option for a subset of patients, particularly those who may have a higher risk of toxicity with chemotherapy and those with a lower anatomic risk of disease recurrence , they wrote. It is important to stress, however, that the choice of therapy in older patients should never be made on the basis of age alone. Comprehensive geriatric assessment is the standard of care for evaluation before chemotherapy and should generate a care plan to be implemented during treatment to minimize the risk of complications and maintain and functionality.
Blocking Her2 Slows Or Stops Some Types Of Breast Cancer
NCI-funded researcher Dennis Slamon, M.D., was among the many scientists searching for genes that can lead to cancer. In 1987, he and his colleagues discovered that the growth factor receptor gene HER2, which produces HER2 proteins, might be a good candidate.
At the same time, a team of NCI researchers led by Stuart Aaronson, M.D., were among the first to show that the HER2 protein could cause normal cells to grow uncontrollably like aggressive cancer cells.
Dr. Slamons team found that the HER2 protein is present at high levels in about 30 percent of breast cancers. They also discovered that high levels of HER2 are linked to a greater likelihood of metastasis and relapse and an overall decrease in patient survival. The group concluded that HER2 might play a role in the development and growth of breast cancer.
NCI-funded researcher Dennis J. Slamon, M.D., discovered the genetic link between HER2 and breast cancer.
This led researchers to a groundbreaking hypothesis: If HER2 could be blocked, the growth of HER2-positive breast cancer might be slowed.
One way to block the action of a protein is to use laboratory-made monoclonal antibodies that attach to a specific protein and disrupt its function. With NCI support, Dr. Slamon and colleagues from the University of Texas Health Sciences Center had a breakthrough. They showed that an antibody specific to HER2 could slow the growth of metastatic breast cancer cells and other types of cancer in a laboratory dish.
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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.
Treatment Options For Her2
Treatments for HER2-positive breast cancer may include targeted therapies , surgery, radiation therapy, and chemotherapy. If the breast cancer is also hormone receptor-positive, hormonal therapy will likely be part of your plan.
The types and order of treatments can be different from person to person depending on individual needs, so donât worry if your treatment plan seems different than someone elseâs. Usually, more than one treatment is given at a time to treat HER2-positive breast cancer.
If you have early-stage breast cancer, you may also be offered pre-surgery, or neoadjuvant, treatment. Usually, if your tumor size is 2 centimeters or greater and/or cancer has travelled to lymph nodes under your arm, you will be offered neoadjuvant therapy, which can include chemotherapy given with targeted therapy before surgery. This kind of treatment is also considered for smaller tumors, although itâs not routinely given. If you do have neoadjuvant treatment, your care team will evaluate how the cancer has responded to that treatment at the time of surgery. This information is then used to guide the treatment given after surgery. Receiving treatment before surgery can make surgery less extensive by shrinking the size of the tumor.
Next, weâll talk about the targeted therapies used to treat HER2-positive breast cancer.
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Experts Take A Fresh Look At Strategies For Early
Christina T. LoguidiceOncologyLive
Although trastuzumab-based regimens remain the standard treatment for patients with early-stage HER2-positive breast cancer, unanswered clinical questions surround the use of other agents in the neoadjuvant and adjuvant settings.
Although trastuzumab -based regimens remain the standard treatment for patients with early-stage HER2-positive breast cancer, unanswered clinical questions surround the use of other agents in the neoadjuvant and adjuvant settings. With several options on the table, risk-adapted approaches to therapy have paved the way for personalized medicine and the opportunity to move away from therapies with higher toxicity profiles, such as anthracyclines.
The debates that are going on are whats the appropriate chemotherapy backbone and do you need an anthracycline, for example? Lisa A. Carey, MD, said during a recent OncLive Peer Exchange®. Whats the extent to which we need all those drugs, and can we rationally optimize therapy even for patients at higher clinical risk?
A panel of breast cancer experts examined neoadjuvant and adjuvant systemic therapy approaches for patients with HER2-positive early-stage breast cancer. They also unpacked key updates to clinical trial data and shared how these affect their decision-making.
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.
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How Her2 Affects Treatment
Treatment for breast cancer depends in part on the stage and type and is different in each case, but typically involves some combination of surgery, radiation, chemotherapy, or other drug therapies. These other drug therapies depend partly on whether your cancer is HER2-positive. If it is, certain medications can work well, such as:
Monoclonal antibodies. These are lab-made versions of immune system substances designed to attach to HER2 protein on breast cancer cells.
Antibody-drug conjugates. These drugs target chemotherapy directly to HER2 protein on cancer cells.
Kinase inhibitors. These medications stop proteins like HER2 from sending signals.
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M Categories For Breast Cancer
M followed by a 0 or 1 indicates whether the cancer has spread to distant organs — for example, the lungs, liver, or bones.
M0: No distant spread is found on x-rays or by physical exam.
cM0: Small numbers of cancer cells are found in blood or bone marrow , or tiny areas of cancer spread are found in lymph nodes away from the underarm, collarbone, or internal mammary areas.
M1: Cancer has spread to distant organs as seen on imaging tests or by physical exam, and/or a biopsy of one of these areas proves cancer has spread and is larger than 0.2mm.
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Researchers Develop Additional Her2
Despite these successes, many women with breast cancer dont benefit from current HER2-targeted treatments, or they become resistant to the effects of these drugs after initial treatment.
Therefore, researchers continue to test new or modified drug combinations. For example, in 2012, FDA approved pertuzumab as a treatment for women with HER2-positive metastatic breast cancer to be used in combination with trastuzumab and docetaxel , a chemotherapy drug. In 2017, pertuzumab received approval for use in combination with the same drugs as an adjuvant treatment for patients with HER2-positive early breast cancer at high risk of recurrence. Pertuzumab works by blocking HER2 from sending signals to other proteins that cause cells to grow and replicate.