Treatment For Pr Positive Breast Cancer
Most PR positive breast cancers are also ER positive, and you may be offered hormone therapy.
The benefits of hormone therapy are less clear for people whose breast cancer is only PR positive. Very few breast cancers fall into this category, but if this is the case your specialist will discuss with you whether hormone therapy is suitable.
How Is The Test Used
Hormone receptor testing of breast tumor tissue is used to determine if estrogen receptors and/or progesterone receptors are present and whether the tumor tissues depend on estrogen and/or progesterone to grow. Knowing if a tumor grows under the influence of hormones indicates whether removal of ones ovaries, which produce the hormones, or blocking the hormones with drugs can inhibit tumor growth to prolong survival. Studies have demonstrated a benefit from such hormone therapy for patients with ER-positive tumors.
What Is The Survival Rate For Hr Positive Breast Cancers
The survival rate for breast cancers are excellent if the cancer is detected early, and in general HR positive cancers grow slower and have a better prognosis. Overall, breast cancers that are both HR positive and HER2 negative have the best outcomes.
According to recent National Cancer Institute data, the four-year survival rate for combined stages of cancer, based on HR and HER2 status are:
- HR positive/HER2 negative: 92.5%
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About The Medical Reviewer
Dr. Burstein graduated from Harvard College before earning his MD at Harvard Medical School. He also received a PhD in cellular immunology and a master’s degree in the history of science from Harvard. He trained in internal medicine at Massachusetts General Hospital before his oncology fellowship at DFCI. In 1999, he joined the staff of DFCI and Brigham and Women’s Hospital, where he is a clinician and clinical investigator in the Breast Oncology Center.
Receptors For Breast Cancer
Some breast cancer cells have hormone or protein receptors that affect how the cancer grows.
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Breast cancer cells may have receptors that hormones or a protein called HER2 can attach to and encourage the cells to grow. A pathologist tests the cancer cells that were taken during the biopsy or surgery for these receptors.
The results help you and your doctor decide on the most effective treatment for you.
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The Promotion Of A Pro
A novel approach to ER+ mBC treatment was recently published by Lok et al., presenting an idea to attack ER+ mBC via an apoptotic mechanism of BCL2 inhibition . Reminiscent of the renowned Hallmarks of Cancer work by Hanahan et al., their focus promoted apoptosis as the means to maximally reduce the opportunity for further mutations and achieve maximum clinical benefit . In 2000, Perillo et al. showed that BCL2 expression can be upregulated downstream effector molecule during ER stimulation which is significant knowing 30% of ER+ mBC patients possess ESR1-activating mutations . Since then, it has been established that approximately 85% of primary ER+ BC demonstrate BCL2 overexpression .
Important cellular signaling in ER+ BC, drugs either FDA approved or currently under development and their mechanisms of action. Insert shows the detailed mode of action of venetoclax.
The Following Statistics Are A Little Old Now They Are Much Better
There are of course many factors that contribute to the survival of breast cancer. However, some older studies show that only about 60%of patients with HER-2 positive status invasive breast cancer are disease free after 10 years.
In addition, about 65% survive overall .
And, a greater number of HER-2 positive patients succumb to the illness during the first five years than those who are negative for HER-2 overexpression.
At the same time, all other factors assumed to be equal, patients with negative HER-2 status tumors tend to be disease free at a rate of 75% over 10 years and have a slightly higher overall survival rate.
From this, we can informally estimate that women with breast cancer which overexpresses HER-2 are about 10% more likely to have significant difficulties and ultimately succumb to the disease within the first five years, than those who do not.
Because some of the Incidence and Prognosis rates are a little old now check out our brand new Index of Posts on Survival Rates.
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Questions To Ask Your Doctor
To learn more about estrogen and progesterone receptor testing for breast cancer, consider asking your doctor the following questions:
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What are the results of the ER and PR tests on my tumor sample? What do they mean?
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Does this laboratory meet the standard guidelines like those from ASCO and the CAP?
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Has a board-certified pathologist diagnosed my cancer?
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Do you know if this is an experienced lab and if my tissue was quickly given to the pathologist after my biopsy or surgery, as recommended by guidelines?
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Can I obtain a copy of my pathology report ?
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Is my ER and PR status indicated on the pathology report? Was the ASCO-CAP guideline recommendation used to define the status?
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Based on these test results, what treatments do you recommend and why?
- What are the possible side effects of these treatments?
Progesterone And Breast Cancer
Progesterone is another hormone that plays a role in the female reproductive system.
Sometimes breast cancer cells contain progesterone receptors. This is called progesterone receptor positive or PR positive breast cancer, often shortened to PR+.
Invasive breast cancers should also be tested for progesterone receptors.
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Selective Estrogen Receptor Response Modulators
Selective estrogen receptor response modulators act as blockers on the breast cells. They attach to the estrogen receptors in breast cells. In this way, they stop estrogen from sending the signal to the cell to grow.
Examples of SERMs include:
- toremifene , for people with advanced ER-positive breast cancer after menopause
A doctor may prescribe one of these drugs alongside another option.
Possible adverse effects include:
- vaginal dryness or discharge
Taking additional medication may help reduce these effects.
Much less commonly, there may be a higher risk of uterine cancer, blood clots, deep vein thrombosis, pulmonary embolism, and stroke.
The 2013 Asco/cap Her2 Testing Guidelines
- Always test HER2 status on newly diagnosed, invasive breast cancers .
- Ensure that at least one tumor sample is tested for either HER2 protein expression or for HER2 gene amplification.
- Discuss the role of HER2-targeted therapy if the HER2 test result is positive and if there is no apparent histopathologic discordance with HER2 testing.Delay the decision to recommend HER2-targeted therapy if the HER2 test result is equivocal.
- Mandatory re-testing should be done on the same specimen, using the alternative test if the initial HER2 test result is equivocal, or on an alternative specimen.
- Do not administer HER2-targeted therapy if the HER2 test result is negative. If there is apparent histopathologic discordance with the HER2 test result, additional HER2 testing should be considered.
- Report a HER2 test result as indeterminate if technical issues prevent one or both tests from being done in a tumor specimen, or prevent the test from being reported as positive, negative, or equivocal.
- Confirm that the testing laboratory conforms to standards set for accreditation by CAP or an equivalent accreditation authority.
- In rare cases, it may be difficult to know for sure if the result is positive or negative. If additional testing on other tissue specimens is not possible, pathologists and oncologists should consider all available clinical data on the patient prior to recommending HER2-targeted therapy.
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What Do The Results Mean
After testing, your doctor will be able to tell you which of the following categories best describes the breast cancer. Most breast cancers are hormone-receptor-positive.
- ER+: About 80% of breast cancers are estrogen-receptor positive.
- ER+/PR+: About 65% of estrogen-receptor-positive breast cancers are also progesterone-receptor-positive. This means that the cells have receptors for both hormones, which could be supporting the growth of the breast cancer.
- ER+/PR-: About 13% of breast cancers are estrogen-receptor-positive and progesterone-receptor-negative. This means that estrogen, but not progesterone, may be supporting the growth and spread of the cancer cells.
- ER-/PR+: About 2% of breast cancers are estrogen-receptor-negative and progesterone-receptor-positive. This means that the hormone progesterone is likely to support the growth of this cancer. Only a small number of breast cancers test negative for estrogen receptors but positive for progesterone receptors. More research is needed to better understand progesterone-receptor-positive breast cancers.
- ER-/PR-: If the breast cancer cells do not have receptors for either hormone, the cancer is considered estrogen-receptor-negative and progesterone-receptor-negative . About 25% of breast cancers fit into this category.
Why Do I Need An Er/pr Test
You may need this test if you’ve been diagnosed with breast cancer. Knowing your hormone receptor status will help your health care provider decide how to treat it. If you have ER-positive, PR-positive, or HR-positive cancer, drugs that lower hormone levels or stop the hormones from fueling cancer growth can be very effective. If you have HR-negative cancer, these types of drugs won’t work for you.
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Solving A Breast Cancer Mystery Why Do Double
- 5 minute read
Dr Jason Carroll working in his lab
When a doctor suspects a woman might have breast cancer, one of the first things they do is take a small sample of cells from her breast, , for tests.
The cells in this tiny tissue sample carry answers to crucial questions about what happens next. First and foremost is it cancer or not? If it is cancer, has it started spreading? And how aggressive it is likely to be?
The levels of different molecules within these cells also yield information about cancers nature and in breast cancer, one of the most crucial for helping guide treatment is the oestrogen receptor .
Women with high levels of this molecule in their cancer cells benefit from hormone therapy drugs that either lower their oestrogen levels, or prevent cancer cells responding to the hormone. About 7 out of ten women have ER-positive breast cancer.
But theres a second molecule the progesterone receptor levels of which inside breast cancer cells also seem to be important. Doctors have known for a long time that women with high levels of both the oestrogen and progesterone receptors have the best chance of surviving they respond better to treatment, and their cancer is less likely to spread.
But these double-positive women are given the same hormone therapy as those who have no progesterone receptor in their breast cancer, so doctors dont always routinely test for this second molecule any more.
All About Er Positive Her2 Negative Breast Cancer
About one in eight women in the United States will develop breast cancer, according to commonly used statistics.
But other reports indicate that breast cancer rates are on the decline, likely because of improved recognition, prevention, and treatment. One advancement is the ability to identify different breast cancer types based on specific molecules found in tumors. The distinction greatly aids in breast cancer treatment selection and helps doctors predict how aggressive cancers will advance.
A crucial step in the process of beast cancer evaluation is testing tumor tissue removed during a biopsy or surgery to determine if it has estrogen and progesterone receptors molecules that the hormones bind to.
Cancerous cells may have none, one, or both receptors. Breast cancers that have estrogen receptors are called ER-positive . Those with progesterone receptors are referred to as PR-positive .
In addition to hormone receptors, some breast cancers have high levels of a growth-promoting protein called HER2/neu. If a tumor has this property, it is called HER2-positive. HER2 positive cancers are more aggressive than HER2 negative cancer.
Knowing breast cancer type, leads doctors to determining best treatments.
HER2 negative cancers will not respond to treatment with drugs that target HER2, such as trastuzumab and lapatinib .
Overall, estrogen receptor-positive breast cancer is treatable, especially when diagnosed early.
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Finding The Type Of Cancer
A pathologist looks at the cancer cells under a microscope to see which type of breast cancer it is. They can tell this by the shape of the cells and the pattern of the cells in the breast tissue.
Pathologists also sometimes use particular dyes to stain the cells and show up certain proteins or features of the cells.
What Are The Stages Of Breast Cancer
Breast cancer is staged by the size of the tumor and extent of spread. Breast cancers are also graded from one to three, based on how abnormal the cancer cells look and how fast they grow. One is low grade cancer and three is high grade cancer that grows and spreads rapidly.
The four stages of breast cancer are:
- Stage I: The tumor is relatively small and localized to the original site, with possible spread to the sentinel lymph nodes, which are the first lymph nodes the cancer is likely to spread to.
- Stage II: The tumor has grown and spread to a few nearby lymph nodes.
- Stage III: The tumor has grown into many lymph nodes and other tissue in the breast.
- Stage IV: The cancer has spread to distant parts of the body.
Another highly detailed classification system is the TNM classification system based on tumor size, lymph node involvement and metastatic spread.
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What Is The Treatment For Triple Negative Breast Cancer
The primary treatments for triple negative breast cancers are surgery, radiation and chemotherapy in the first three stages of cancer. In addition, treatment for stage IV cancer include:
Targeted therapy
Targeted therapy used to treat triple negative cancer include:
- PARP inhibitors: PARP inhibitors are used to treat triple negative, as well as HR positive and HER2 negative breast cancers which have BRCA mutations. Poly ADP ribose polymerase is an enzyme that helps DNA repair, and PARP inhibitors block the cancer cells from repairing their DNA so they die. PARP inhibitors include:
- Olaparib
- Talazoparib tosylate
Immunotherapy
Immunotherapy drugs enhance the ability of immune cells to identify and kill the cancer cells. Immunotherapy is used to treat triple negative cancers that have a protein known as PD-L1 in them.
- PD-1 inhibitors: PD-1 protein in immune cells prevents them from attacking the bodyâs cells, including cancer cells. Blocking PD-1 activity improves T-cellâs ability to kill cancer cells. PD-1 inhibitors used to treat triple negative cancers that have PD-1 in them include:
- Pembrolizumab
There Are Two Ways To Measure The Her
The most common way to measure the HER-2 status of a potential breast cancer tumor is through an immunohistochemistry test. This will likely be part of an overall histological/pathological evaluation of the tumor.
Various tumor markers, including the HER-2 status indicators, give the pathologist a characterization of the tumor. This helps to predict the future behavior and probable responses, of the tumor to different types of treatments.
The immunohistochemistry test of the HER-2 status measures the over-expression of a particular protein and is typically given a score of 0 to +3.
The pathologist actually counts the number of receptors on the surface of the cancer cells. Indeed, the pathologist can see the cells microscopically because they are receptive to certain protein-based dyes and change color.
Scores of 0 and +1 are indicative of a negative status , whilst +2 and +3 are HER-2 positive . There is no in-between state.
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What Is Triple Negative Breast Cancer
In addition to being negative for estrogen and progesterone receptors, triple negative breast cancer cells also lack a protein known as HER2. Human epidermal growth factor receptor-2 is a protein that promotes cell growth and HER2 positive breast cancers have a higher than normal presence of these proteins, because of mutations in HER2 gene.
Triple negative cancers account for approximately 15% of breast cancers. Triple negative breast cancer more often occurs in African-American women younger than 40, or women who have an inherited mutation in BRCA1 gene, which normally is a tumor suppressor gene, which suppresses cell growth.
How Long Will It Take For Results
Hormone receptor status testing is not available in every laboratory. It requires experience and special training to perform and interpret. A healthcare practitioner will often send a sample to a reference laboratory and it may take several days to weeks before the results are available. It is recommended that testing be done by a lab that follows the American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations to avoid inaccurate results.
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What Are Estrogen Receptor/progesterone Receptor Tests
Estrogen receptor/progesterone receptor tests are used to help guide breast cancer treatment. Receptors are proteins that attach to certain substances. ER/PR tests look for receptors that attach to the hormones estrogen and progesterone in a sample of breast cancer tissue. Estrogen and progesterone play key roles in a woman’s sexual development and reproductive functions. Men also have these hormones, but in much smaller amounts.
About 70 percent of all breast cancers in women have receptors that attach to estrogen and/or progesterone. About 80 percent to 90 percent of breast cancers in men have these receptors. Breast cancers with estrogen and/or progesterone receptors include the following types:
- ER-positive : Cancers that have estrogen receptors
- PR-positive : Cancers that have progesterone receptors
- Hormone receptor-positive : Cancers that have one or both types of these receptors.
Breast cancers without ER or PR receptors are known as HR-negative .
ER/PR tests will show whether there are ER and/or PR receptors on your breast cancer cells. Test results are frequently referred to as the hormone receptor status. If your hormone receptor status shows you have one or both of these receptors on your cancer cells, you may respond well to certain types of treatments.
Other names: ER/PR IHC testing, hormone receptor status