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KK1722 View Drop Down
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    Posted: May 31 2016 at 6:25pm
Hi again to fellow fighters,

Anyone else on here "weakly hormone positive"? My pathology report actually reads: ER+ 20%, PR 5%, HER2- negative (2+ but negative FISH).

My doctors have always advised I'm a "Triple Negative" despite my weakly estrogen positive level. Also, I'm Grade 3, Ki-67 99%. I believe my slightly-ER-positive status is negatively affecting my response to chemo and post-surgery treatment plans. Just wanted to hear the stories, successes and failures of those similarly situated.

Tomorrow, I have my last round of NAC (Taxol dose 4). While scans revealed I did pretty well in response to 4 doses of A/C, it looks as though 3 doses of Taxol thus far have not shrunken the tumor any further (current cellularity unknown).

Wondering what other neoadjuvant and adjuvant therapies have been administered to others who are weakly hormone positive. Feel free to private message me or just reply. I posted the same thing on another thread, but then decided to start a new topic with it, too. Sorry for being redundant.

Thanks and best wishes to all of you!

Kelly

Edited by KK1722 - May 31 2016 at 6:31pm
Dx 1/16: IDC TNBC stage IIB, 5.1cm, 0/3 nodes, Gr3, Ki67- 99%.
37 years old. BRCA neg.
NAC - AC/T
Dbl MX June 2016. RCB II.
1.2cm residual high grade tumor.
RADs 9/16-11/16
Adj. Tx - Unknown
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Maria1975 View Drop Down
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Hi there,

I was PR 20% pre chemo and PR 5% post chemo. Had lumpectomy and 25 rads and 8 boosts of electrons. I did not get a pcr... Tumour was 2.5 and reduced to 1.6cm. My onc is now starting me on xeloda for 8 three week cycles as a chemo preventative measure to avoid reoccurrence. He ssys I am Hormone positive as anything greater than 1% is hormone positive. Some oncologists say anything under 10% is hormone negative. After xeloda, my onc is suggesting tamoxifen as by definition you and I are hormone positive.

Maria
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123Donna View Drop Down
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I think anything over 10% is considered ER Positive and can benefit from hormonal therapy.

Marisa Weiss, M.D. If your hormone receptor status is positive, that predicts two things—first, a better overall outcome, and second, a good response to hormonal therapy. The difference in outcome between positive and negative test results is only moderate. The meaning of the test in terms of choosing treatment options is much more important. The higher the percentage of estrogen receptors positive, the greater your chance of responding well to hormonal therapy. The lower the hormone receptor positivity, the better response you'll have to chemotherapy. 

Some centers will say the cancer is hormone receptor negative if 10 percent or less of the cells shows receptors. Some centers will use a 5 percent cut-off. Still, cancer with this level of estrogen- receptor positive energy can still have a good response to hormonal therapy. 

The important take-home message here is, find out if your estrogen receptor negative result is 0 percent, 5 percent, or 10 percent. If it's 5 to 10 percent, you might want to be able to take advantage of an important type of treatment that could make a difference to you.
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15
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KK1722 View Drop Down
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Points: 18 		Post Options Post Options   Thanks (0) Thanks(0)   Quote KK1722 Quote  Post ReplyReply Direct Link To This Post Posted: Jun 02 2016 at 12:57am
Thank you both for the thoughtful replies!

Maria - I'm intrigued by your notes. From what my MO and I discussed today at my consultation before my final dose of NAC, he seemed to predict that the live cancer detected during my post-surgical pathology would remain at 20% or maybe even higher, since these cells tend to be less responsive to chemo. I had not really anticipated the outcome you described where the ER-positive status was reduced after NAC. (I also have no idea what the effect/impact is of this since I haven't researched that or discussed it with the MO at all.... it's just something I'm completely uninformed about.) Did your doc offer you any insight on the post-chemo lower ER score? Just curious in case I have a similar result.

Donna - Thank you for the information. This is consistent with my research and I think you're completely right. Many articles say to provide Tamoxifen if the patient is even 1% hormone positive because, basically, "it won't hurt" and could provide some benefit. So I have agreed whole-heartedly with my MO's suggestion that I take Tamoxifen following surgery. That said, having researched and reviewed articles stating that those classified as "weakly ER positive", like myself, may not be responsive to Tamoxifen, I wanted to explore additional therapy options explored by other weakly ER positives (to be given in addition to Tamoxifen). I think we may be considering inclusion of Xeloda, but have to perform and consider the post-surgery pathology first.

Thanks for taking the time to respond. It's always good to hear from fellow fighters with different information and experiences! Wishing you both the best!


Kelly
Dx 1/16: IDC TNBC stage IIB, 5.1cm, 0/3 nodes, Gr3, Ki67- 99%.
37 years old. BRCA neg.
NAC - AC/T
Dbl MX June 2016. RCB II.
1.2cm residual high grade tumor.
RADs 9/16-11/16
Adj. Tx - Unknown
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123Donna View Drop Down
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Points: 13510 		Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jun 02 2016 at 8:11am
Kelly,

I found a couple of older threads from ladies who were also weakly ER positive and thought you might like to read them.





Originally posted by Lee21 Lee21 wrote:

 Low (1-9%) Hormone receptor expression

Estrogen Receptor (ER) mRNA and ER-Related Gene Expression in Breast Cancers That Are 1% to 10% ER-Positive by Immunohistochemistry 
http://www.ncbi.nlm.nih.gov/pubmed/22291085
CONCLUSIONS: minority of the 1% to 9% IHC ER-positive tumors show molecular features similar to those of ER-positive, potentially endocrine-sensitive tumors, whereas most show ER-negative, basal-like molecular characteristics. The safest clinical approach may be to use both adjuvant endocrine therapy and chemotherapy in this rare subset of patients.
NOTE: The overall survival rate of 1%-9% ER+ patients was between those of patients in the >=10% ER+ and ER- (<1%) groups.

Impact of low estrogen/progesterone receptor expression on survival outcomes in breast cancers previously classified as triple negative breast cancers 
http://onlinelibrary.wiley.com/doi/10.1002/cncr.26431/abstract
CONCLUSIONS: In this cohort, a low ER/PR level (1%-5%) does not appear to have any significant impact on survival outcomes. There was a tendency for survival advantages in the ER/PR 6% to 10% is seen. Benefit of endocrine therapy in these patients is unclear.

4-1-12 entry
Recommendations for ER positivity cutoff to be 1% (OPEN ACCESS)
http://www.archivesofpathology.org/doi/full/10.1043/1543-2165-134.7.e48
Scroll down to "What Are the Clinically Validated Methods That Can Be Used in This Assessment?" where the article discusses the basis for the recommendation (survival data)
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15
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