Four Steps To Avoid A Recurrence
Theres nothing you can do to guarantee that your cancer wont come back, but you can make some changes to help you feel your best after cancer treatment and keep your body stay strong.
Eat a balanced diet. Reach for a colorful mix of fruits and vegetables, good sources of fiber like beans and peas, and whole grains like whole wheat bread and brown rice every day. Avoid or limit drinks that are high in sugar and red or processed meat like beef, pork, hot dogs and sausages. You probably dont need to take vitamin or mineral supplements, unless your care team suggests them. In fact, taking more of certain vitamins or minerals than you need can have a negative effect on your cancer recovery, so be sure to discuss any supplements youre considering with your care team before taking them.;
Exercise on most days of the week. Being active can improve your mood, boost self-esteem and reduce fatigue. Its even been shown to lower anxiety and depression and relieve nausea, pain and diarrhea.
Lean on a strong support system. Cancer might be all about the cellular changes in your body, but you know it certainly doesnt stop there. Taking care of your emotional health, whether it be cultivating a strong circle of friends and family as support or getting mental health services, can help you manage the stressors that cancer treatment and recovery can bring.
What This Means For You
This study underscores how important it is to have a sample of a recurrent breast cancer tumor undergo the same tests as the initially diagnosed breast cancer, including testing for HER2 status. If the HER2 status has changed, you may benefit from treatments that wouldnt have helped treat the primary cancer.
Its important to know that HER2-low is not an official type of breast cancer yet, and no medicines have been approved to treat HER2-low breast cancer. Still, studies are underway to see if current anti-HER2 medicines can help treat HER2-low cancers.
If youve been diagnosed with recurrent breast cancer breast cancer that has come back after your initial diagnosis its a good idea to talk to your doctor about this study and ask for a full pathological work-up on the recurrent breast cancer tumor.
Knowing all the characteristics of the recurrent breast cancer and how those characteristics might be different from the primary breast cancer will help you and your doctor make the best treatment choices for your unique situation.
If the primary breast cancer was HER2-negative and the recurrent breast cancer is HER2-low, you may want to consider being part of a clinical trial that is testing anti-HER2 medicines to treat HER2-low breast cancer.
Treatment For Local Recurrence
Treatment for local recurrence will depend on a number of factors, including what treatments you have previously had.
If you had breast-conserving surgery then you will usually be offered a mastectomy. For some people it may be possible to repeat the wide local excision.
If you previously had a mastectomy, surgery may be possible to remove the affected areas.
Nearby lymph nodes may also be removed.
Radiotherapy is usually only an option if you havent previously had radiotherapy in the same area.
The way radiotherapy is given for a recurrence is similar to how its given to someone newly diagnosed.;
Radiotherapy may be offered if surgery isnt possible.;
If the cancer is oestrogen receptor positive you may be offered hormone therapy.
Which treatment you are offered depends on whether you have gone through the menopause and any hormone therapy you have previously had or are currently taking.
Its not clear how much benefit chemotherapy will be to you if you have a local recurrence, but it might be offered in some cases.;
If you have previously had chemotherapy then different chemotherapy drugs may be used.
The most widely used targeted therapies are for HER2 positive breast cancer.
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What Questions Should I Ask My Healthcare Provider
You may want to ask your provider:
- What type of breast cancer recurrence do I have?
- Has the cancer spread outside the breast?
- What stage is the breast cancer?
- What is the best treatment for this type of breast cancer?
- What are the treatment risks and side effects?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Most breast cancer recurrences respond well to treatments. You may be able to try new drugs or combination therapies in development in clinical trials. Your healthcare provider can discuss the best treatment option based on your unique situation.
Last reviewed by a Cleveland Clinic medical professional on 03/24/2021.
New Treatment Approved For Her2
Breast cancer is the most common form of cancer in the U.S. According to the National Cancer Institute , approximately 15 percent of patients with breast cancer have tumors that are HER2-positive.
This summer, the U.S. Food and Drug Administration approved a new breast cancer treatment that aims to reduce the risk of the cancer returning. The drug, neratinib, is intended for patients with early-stage, HER2-positive breast cancer.
NCI estimates approximately 252,710 women will be diagnosed with breast cancer this year, and 40,610 will die of the disease. This approval is a major step forward in helping to improve survival rates in some breast cancer patients.
National Cancer Institute; Food and Drug Administration
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At Three Years 883 Percent Of People Treated With Kadcyla In The Adjuvant Her2
South San Francisco, CA — December 5, 2018 —
Genentech, a member of the Roche Group , today announced the Phase III KATHERINE study met its primary endpoint, showing Kadcyla® as a single agent significantly reduced the risk of disease recurrence or death by 50 percent compared to Herceptin® as an adjuvant treatment in people with HER2-positive early breast cancer who have residual disease present following neoadjuvant treatment. At three years, 88.3 percent of people treated with Kadcyla did not have their breast cancer return compared to 77.0 percent treated with Herceptin, an 11.3 percent improvement. Kadcyla improved iDFS irrespective of hormone receptor status, lymph node status and prior HER2-targeted treatment regimen received in the neoadjuvant setting. The safety profile of Kadcyla was consistent with that seen in previous studies, and no unexpected or new safety signals were identified.
The KATHERINE results demonstrate a significant reduction in the risk of recurrence of HER2-positive early breast cancer in people with residual disease after neoadjuvant therapy, and we look forward to submitting these data to health authorities as soon as possible, said Sandra Horning, M.D., chief medical officer and head of Global Product Development. We come closer to the goal of helping each person with early breast cancer have the greatest opportunity for cure with every advance in reducing disease recurrence.
About;the KATHERINE study
KATHERINE Study Results
About The Breast European Adjuvant Studies Team
The Breast European Adjuvant Studies Team is a specialised clinical trials unit located at the Institut Jules Bordet, Brussels, Belgium. It was created in 1997 in order to conduct large, international phase III studies in breast cancer aiming to register new drugs. The unit is responsible for setting up, coordinating and managing the data collected in these trials, which are run in collaboration with pharmaceutical companies and the Breast International Group . BrEAST manages complex trials involving more than 20,000 patients in over 40 countries.
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Study: More Breast Cancer Patients Can Safely Skip Chemotherapy
A federally funded study has found that many women with the most common type of early stage breast cancer likely do not need chemotherapy after surgery. The study was presented June 3, 2018 at the American Society of Clinical Oncology meeting in Chicago, and simultaneously published in the New England Journal of Medicine. It is likely to change the way many newly diagnosed breast cancer patients are treated.
“With results of this groundbreaking study, we now can safely avoid chemotherapy in about 70% of patients who are diagnosed with the most common form of breast cancer,” said Kathy Albain, MD, a co-author of the study. “For countless women and their doctors, the days of uncertainty are over.”
Treatment For Breast Cancer Recurrence
If your care team thinks you might have a cancer recurrence, theyll recommend diagnostic tests, like lab tests, imaging or biopsies, both to be sure the cancer has come back and to get more information to guide your treatment.
Treatment options depend on where the cancer has recurred and what treatment youve had before:
- Local recurrence is likely to be treated surgically first with a mastectomy;if you didnt have one already or a surgical removal of the tumor if you did. After surgery, chemotherapy and radiation are commonly used, as well as hormone therapy or targeted therapy if your kind of cancer will respond to one or both of them.
- Regional recurrence is also typically treated first with surgery to remove affected lymph nodes. After the surgery, youll likely have radiation and possibly chemotherapy, hormone therapy and/or targeted therapy, too.
- Distant recurrence is mainly treated with drug therapychemotherapy, hormone therapy, targeted therapy;or a combination of these. Surgery and/or radiation might be used, too, but only in cases where the aim is relieving symptoms.
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Other Her2 Therapies Combined With Herceptin
Tykerb and Herceptin Combination Therapy Fails to Improve Outcomes for Early Stage HER2 Breast Cancer
The ALTTO trial, begun in 2007, enrolled 8381 women in 44 countries with HER2-positive early breast cancer. Patients were assigned to one of four treatment groups: Herceptin alone, Tykerb alone, Herceptin followed by Tykerb, or Herceptin plus Tykerb. Patients were treated with the regimens for 1 year. All patients were also receiving chemotherapy.
Researchers found that disease-free survival at 4 years did not improve when the concurrent combination therapy was compared to Herceptin alone. It was also true that the sequential administering of Herceptin and Tykerb versus Herceptin alone did not improve disease-free survival.16
Researchers also reported that patients with the dual therapy when compared to Herceptin alone had higher rates of side effects such as diarrhea, rash, and problems with the liver and biliary tract.
Locally Advanced Breast Cancer
If breast cancer has spread to the chest wall or skin of the breast, or the lymph nodes around the chest, neck and under the breast bone, but has not spread to other areas of the body, its called locally advanced breast cancer.; Sometimes breast cancer is locally advanced when it is first diagnosed.
People who have locally advanced breast cancer are thought to have an increased risk of cancer cells spreading to other areas of the body, compared to those with stage 1 or 2 breast cancers.
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Determining Your Her2 Status
A breast biopsy is used to determine HER2 status. The biopsy can be sent for laboratory testing with an immunohistochemistry test. The fluorescence in situ hybridization test looks for the HER2 gene in breast cancer cells.
The results of an immunohistochemistry test show different levels of HER2 positivity. For example, a tumor may be reported as 0, 1+, 2+, or 3+.;Tumors with a higher number may be referred to as having an overexpression of HER2.
According to the American Cancer Society, immunohistochemistry test results should be considered as follows:
The impact of being HER2-positive on breast cancer survival is, of course, a top concern. Unfortunately, statistics can be misleading without considering other aspects of your diagnosis, including cancer stage at diagnosis and whether the tumor is also estrogen and/or progesterone receptor-positive.
With this in mind, you may also be tested for progesterone and estrogen receptors. Triple-negative breast cancers are negative for HER2, estrogen, and progesterone, while triple-positive breast cancers are positive for all three.
Her2+ Breast Cancer Patients Live Longer If Drugs Given Before Surgery Eradicate Tumour
Final analysis of results from a randomised clinical trial of lapatinib and trastuzumab given before surgery in patients with early HER2-positive breast cancer has found that women who had no signs of residual disease after treatment survived longer without the cancer returning than patients who did not. This was more likely to happen in patients who received the two anti-cancer drugs together, rather than as single agents.
Speaking at the 12th European Breast Cancer Conference on Saturday, Dr. Paolo Nuciforo, principal investigator at Vall d’Hebron Institute of Oncology, Barcelona, Spain, presented results from nearly ten years of follow-up from the international NeoALTTO BIG-06 trial, in which patients were randomised to receive either trastuzumab or lapatinib alone or in combination.
He said: “Patients who achieved a pCR had significantly better long-term survival compared to those who did not achieve pCR. Although overall survival rates did not differ significantly between the three treatment groups, nearly twice as many patients achieved pCR if they received both drugs, 51% compared to 27.1% of patients receiving only one drug in the other two arms of the study combined.”
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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 wasnt 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%
Treatment Type And Breast Cancer Survival
One major decision you may face with early breast cancer is whether to have lumpectomy; plus radiation therapy or mastectomy. They are equally effective in treating early breast cancer.
Overall survival is the same for lumpectomy plus radiation therapy and mastectomy. This means both treatments lower the risk of dying by the same amount.;;;
For a summary of research studies on lumpectomy plus radiation therapy and mastectomy in the treatment of early breast cancer,;visit the Breast Cancer Research Studies section.;
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What’s The Risk Of Recurrence
Everyone who has had breast cancer has some risk of recurrence, but its typically low.;;
In general, the more time that goes by, the lower the risk of recurrence. Cancer is most likely to recur in the first two years after treatment, and once people get to five years of living cancer-free after treatment, its considered to be a significant milestone to be celebrated. Recurrence after that five year markrare, but possibleis called late recurrence.;
Theres still so much that is unknown about cancer recurrence, but researchers have found some patterns in recent years that point to clues about why it happens. These factors might be linked to a higher risk of breast cancer recurrence:;
- Having high blood sugar
- Not eating enough fruits and vegetables
- Having had a surgical site infection after your surgery
Certain characteristics of your original cancer also might mean a higher risk of recurrence, such as:
- A tumor of more than five centimeters across
- Cancer cells that are HER2-positive;
- Cancer cells that are triple negative;
- Cancer cells in four or more axillary lymph nodes at the time of surgery
- Cancer cells in the chest muscles or breast skin
You might be at higher risk for late recurrence if you had:
- A tumor of more than two centimeters
- A high number of affected lymph nodes
- A hormone receptor-positive cancer
- A HER2-negative cancer
- Hormone therapy for only a short time after surgery;
Targeted Therapies For Her2
The newest of those four main treatments are effective drugs that specifically target the HER2 protein, says Dr. Kulkarni. There are three main types of targeted drugs for HER2, according to the American Cancer Society: Monoclonal antibodies, antibody-drug conjugates, and kinase inhibitors. They all work in different ways to attack the HER2 protein in your cancer cells and can be used in combination with other treatments, like chemo. The first to be approved has increased survival rates for women with stage 1-3 HER2-positive breast cancer more than 30%, according to the National Cancer Institute.
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About The Breast International Group
The Breast International Group is a not-for-profit organisation for academic breast cancer research groups from around the world, based in Brussels, Belgium.
Global collaboration is crucial to make significant advances in breast cancer research, reduce unnecessary duplication of effort, share data, contribute to the faster development of better treatments, and increase the likelihood of cures for patients. Therefore BIG facilitates breast cancer research at an international level, by stimulating cooperation between its members and other academic networks, and collaborating with, but working independently from, the pharmaceutical industry.
Founded by leading European opinion leaders in 1999, BIG now constitutes a network of 56 collaborative groups from Europe, Canada, Latin America, Asia and Australasia. These entities are tied to several thousand specialised hospitals and research centres worldwide. More than 30 clinical trials are run or are under development under the BIG umbrella at any one time. BIG also works closely with the US National Cancer Institute and the North American Breast Cancer Groups , so that together they act as a strong integrating force in the breast cancer research arena.