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Advice please- change in ER after chemo

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Trip bc View Drop Down
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    Posted: Oct 10 2013 at 7:03pm
Hi ladies

I know we all have had a diagnosis of TNBC but ..... Has anyone had a change from ER negative to positive on their pathology after neoadjuvant chemo??

Saw a report suggesting 1 in 4 go from ER negative to some ER positivity after neoadjuvant chemo. Wondered if anyone had had this and so is now on tamoxifen or other hormonal treatment.
Thanks for your time, and wishing you all the very best,

Rupa
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Post Options Post Options   Thanks (0) Thanks(0)   Quote SagePatientAdvocates Quote  Post ReplyReply Direct Link To This Post Posted: Oct 10 2013 at 8:08pm
Dear Rupa,

can you post the link to the study you saw, please?

the main changes I have seen are changes in a new tumor that at times changes characteristics. Rupa, not saying it doesn't happen..just that 25% sounds high to me...so would like to see the study. 

I also always suggest patients get a 'second opinion' on their pathology report from a major cancer center as often(maybe as much as 15-20% of the time) e.g. FISH testing for HER2/neu yields a different result
and if you have HER2/neu+ disease your treatment plan will change and Herceptin (plus possibly another agent) will most likely be suggested. 

There is a controversy about ER+ disease with some oncologists evaluating 'mildly positive' disease as not affecting treatment while others prescribe Aromatase Inhibitors or Tamoxifen.

warmly,

Steve


Edited by steve - Oct 10 2013 at 8:19pm
I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Trip bc Quote  Post ReplyReply Direct Link To This Post Posted: Oct 11 2013 at 3:55am
Hi Steve
Thanks for your response. I know, it's 1 in 5 according to their data.....I also though that sounds rather high. This is the abstract:

Receptor status change from primary to residual breast cancer after neoadjuvant chemotherapy (NCT) and analysis of survival outcome.

Meeting:
2013 Breast Cancer Symposium
Session Type and Session Title:
General Session II: Biologic Subtyping in Early-Stage Disease
General Poster Session A
Abstract Number:
48
Citation:
J Clin Oncol 31, 2013 (suppl 26; abstr 48)
Author(s):
Napa Parinyanitikul, Xiudong Lei, Mariana Chavez-Mac Gregor, Elizabeth Ann Mittendorf, Jennifer Keating Litton, Wendy A. Woodward, Hong Zhang, Gabriel N. Hortobagyi, Ana M. Gonzalez-Angulo; The University of Texas MD Anderson Cancer Center, Houston, TX

Background: Treatment and prognosis of breast cancer is determined by tumor subtype. Tumor heterogeneity and lack of stability in ER, PR and HER2 has been described. We evaluated the changes receptor status between primary and residual disease after NCT and its association with outcome. Methods: 398 women with known ER, PR and HER2 status in primary and residual disease were identified. Patients were classified as no receptor change vs. any receptor change. For ER and PR we explored absolute percent changes. Descriptive statistics were used. Kaplan-Meier method was used to estimate overall (OS) and recurrence-free (RFS) survival. Cox proportional models were fit to determine the association of receptor status changes with outcomes after adjustment for patient and disease characteristics. Results: From the 398 patients, 162 (40.7%) had a change in at least one biomarker. Twenty-three (10.9%) of the 211 ER-positive tumors changed to ER-negative and 39 (20.8%) of the 187 ER-negative tumors changed to ER-positive. Fifty-seven (35.2%) of the 162 PR-positive tumors changed to PR-negative and 28 (11.9%) of the 235 PR-negative tumors changed to PR-positive. Lastly, 29 (40%) of the 72 HER2-positive tumors changed to HER2-negative and among the 35 trastuzumab-treated patients, 16 (45.7%) had HER2 status changed. At a median follow up of 40 months, 128 women (32%) had died, and 167 (41.8%) had experienced a recurrence. Five-year OS estimates were 73% and 63% for patients with or without any receptor change, (P=0.07); 5-year RFS estimates were 63% and 48% for patients with or without any receptor change, (P=0.003). Among patients with baseline ER-positive tumors, 5-year OS estimates was 73% and 87% (P=0.03), and the 5-year RFS estimates was 59% and 71% (P=0.03) for those whose absolute ER percent decrease was less than 20% or more than 20%, respectively. A change in any receptor was associated with better RFS (HR: 0.63, 95% CI 0.44-0.9) but not with OS, (HR: 0.79, 95% CI 0.53-1.18). Conclusions: Changes in ER, PR and HER2 status between the primary and the residual disease after neoadjuvant chemotherapy are frequent. In this study, a change in biomarker status was associated with significant improved RFS.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Noodlegirl Quote  Post ReplyReply Direct Link To This Post Posted: Oct 15 2013 at 3:22pm
Hi Rupa,
 
I just posted the same question before I thought to search for it. 
 
Yes, I was just told after my mastectomy that the "residual" cancer was ER+.  The Dr could not say whether they missed the receptors at biopsy (they took 6 samples of tissue from different locations of my very large tumor), if the receptor had changed due to chemo, or if I had in fact had two types of cancer.
 
I am doing whatever the Drs tell me to do. TNBC diagnosis was too scary for me to push for alternative treatments, especially with reoccurence rates; so I have agreed to start Tamoxifen after radiation. 
 
43YO @ diagnosis; 3/5/13 IDC, TNBC, stage 2, grade 3, 2 nodes (only 2 biopsied); 4/4/13 Neoadjuvant 12 taxol & 4 FAC; 9/25/13 MX;
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Trip bc Quote  Post ReplyReply Direct Link To This Post Posted: Oct 15 2013 at 5:04pm
Hi Holly

Thanks for your post. I don't know your situation but for me my receptors were all properly negative at initial biopsy before neoadjuvant chemo. In the UK where I am it doesn't seem to be routine practice to retest the receptor status after neoadjuvant on the pathology specimen. In fact my initial pathology was reported as a complete response and then after further immunostaining at another reputable centre they found some residual cancer. It was only after I saw the abstract above that we discussed testing the markers again and I was found to have a low/ borderline ER score of 4 / 8 so am now starting tamoxifen. Do you know how strongly ER positive your tumour was after chemo? To me it would sound from your description we are amongst those who have a receptor change after neoadjuvant chemo.
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