Changes in metastatic Hormone status after chemo

HI

Wonder if anyone can help… When I found that my bone mets had progressed a short while ago I was researching my options and I found an number of papers/research that reported breast tumours ER/PR status can change after chemo &/or after secondary spread… the percentages reported were between 20-30%. I’m ER/PR -itive and consequently likely a worse prognosis than if ER/PR +itive. If my markers have altered to be +itive then obviously I’m in a better positio as long as its acted on, but worse if its ignored… Has anyone had their receptors checked and have they altered at all? I’ve been asking my onc about this as my secondaries & then progression have coincided with my cycle restarting after chemo… However, as my secondaries are presently limited to my bones the answer I keep getting is that bone marrow biopsy’s are inconclusive as it calcifies … Really appreciate anyones experiences with tumour changes… X Jane

Hi Jane

I don’t know which research papers you have read but my oncologist told me that er and pr negative tumours were very unlikely to change after recurrence. Higher chance of er+ and pr+ changing apparently.

I have a regional recurrence in chest wall/supraclavicular nodes and did have a biospy after diagnosis which checked my status and I was still triple negative.

best wishes

Jane

Hi Jane

Thanks for your message… I’ve seen about 4 papers… I’ve copied one below as this shows the % changes in ER/PR -itive to +itive after chemo… however there are others showing changes after metastasis …out of the 145 patients that were ER/PR -itive… 61 became ER/PR +itive (so 42% of this sub group)… whilst out of 275 ER/PR +itive patients 37 became -itive ( 13%)… so in this research paper its the -itive tumours mutated/altered the most. Think its just the individual oncologists view or the fact that they are so busy they don’t necessarily look at all possibilities.

x Jane

theoncologist.alphamedpress.org/cgi/content/abstract/12/6/636

Changes in and Prognostic Value of Hormone Receptor Status in a Series of Operable Breast Cancer Patients Treated with Neoadjuvant Chemotherapy

Olivier Taccaa,b, Frédérique Penault-Llorcaa,c, Catherine Abriala,b, Marie-Ange Mouret-Reyniera, Inès Raoelfilsa, Xavier Durandoa,b, Jean-Louis Acharda, Pierre Gimberguesa, Hervé Curéb,e, Philippe Cholleta,d
aCentre Jean Perrin, Clermont-Ferrand, France; bINSERM U484, Clermont-Ferrand, France; cUniversité d’Auvergne, Clermont-Ferrand, France; dCentre d’Investigation Clinique, Clermont-Ferrand, France; eInstitut Jean Godinot, Reims, France
Key Words. Hormone receptor status • Neoadjuvant chemotherapy • Breast cancer • Allred score
Correspondence: Olivier Tacca, Ph.D., Bureau de Recherche Clinique, Centre Jean Perrin 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand Cedex 1, France. Telephone: 33-473278005; Fax: 33-473278029; e-mail: <script type=“text/javascript”>eval(unescape(‘%64%6f%63%75%6d%65%6e%74%2e%77%72%69%74%65%28%27%3c%61%20%68%72%65%66%3d%22%6d%61%69%6c%74%6f%3a%72%65%63%68%65%72%63%68%65%2e%63%6c%69%6e%69%71%75%65%40%63%6a%70%2e%66%72%22%3e%72%65%63%68%65%72%63%68%65%2e%63%6c%69%6e%69%71%75%65%40%63%6a%70%2e%66%72%3c%2f%61%3e%27%29%3b’))</script>

The aim of this study was to detect and analyze changes in hormone receptor (HR) status after treatment of operable breast cancer with neoadjuvant chemotherapy (NCT). Patients were treated from 1982 to 2004 with different NCT combinations, mainly in successive prospective phase II trials. HR status before and after NCT was retested and reviewed in a blinded fashion by two pathologists, for 420 patients from a database of 710 patients. Among these 420 tumors, 145 (35%) were HR negative and 275 (65%) were HR positive before NCT. The HR status had changed after treatment in 98 patients (23%): 61 patients (42%) initially HR negative became HR positive. This HR-positive switch was significantly correlated with better overall survival (OS), compared with patients with unchanged HR-negative tumors. Moreover, this HR-positive switch also had an effect on disease-free survival (DFS). Conversely, 37 patients (13%) initially HR positive became HR negative after NCT. However, this group of previously positive patients still had a survival advantage for OS, but not for DFS. The Allred score was evaluated before and after chemotherapy. An increase in Allred score after NCT was significantly correlated with better DFS but not OS. It was previously shown, for other tumor parameters, that residual disease after NCT, rather than parameters evaluated on the initial biopsy, must be considered for patient prognosis. In this work, NCT induced variations in HR status in 23% of patients. A positive switch in HR status after NCT could be an indicator of better prognosis for patient outcome.

-Thanks Jane…just goes to show we should be vigilant of our oncs views!

Jane

Hi Jane

I have been following your progress as I had a similar regional recurrence to you last year. Spread to supraclavicle nodes treated with surgery, Taxol, Herceptin and radiotherapy. I have now had spread to the brain and just had a craniotomy from which I’m recovering and will then have radiotherapy and chemotherapy. Of course in the last couple of weeks I now feel that I should have had a brain scan last year when I had bones, liver and lungs checked but I didn’t have any symptoms so didn’t ask. My onc feels the tumours have been there for some months but I only had headache annd sickness recently. I hope you don’t mind me contacting you but I wonder if you’ve had a brain scan as part of your checks … just something i’ve been pondering lately. I know it probably wouldn’t have changed my situation now but it’s just a thought. Anyway I hope you’re bearing up with your treatment at the moment, bye for now Gemini.

Hi Gemini

Thanks ever so for your thoughts. No I haven’t had a brain scan and have no intention of having one unless I get symptoms to suggest brain mets. I’m firmly of the view that I’d rather not know until I have to and waiting for test results is awful. Actually I was worried when I did get headaches during one cycle of chemo a couple of months back and duly reported them but they disappeared. Onc thought it was anti sick meds and tweaked those.

I’ll have another CT scan either in the next couple of weeks or after two more cycles of gemcarbo, but no I’ll save the brain scan until/unless I get symptoms.

Hope your treatment goes well.

Thanks again for thinking of me.

Jane

Hi JaneRA

Thanks for your message. I understand how you feel about scans and when to have them. I suppose we are where we are at the moment and wondering if an earlier scan would have made a difference isn’t so important. I hope your next scan shows some encouraging news. Take care, Gemini.