FEC reduces 10-year death risk of her2Neu positive patients

FEC reduces 10-year death risk of her2Neu positive patients

FEC reduces 10-year death risk of her2Neu positive patients I know that there has been general concern in the past about figures concerning the rate at which her2 cancers come back in the UK (the figure of 50% has been bandied about for all her2 cancers). I found the story at the URL below interesting because it implies that CMF chemo, which was standard not long ago in the UK and commonly used by itself as little as three years ago, is much less beneficial than FEC for her2 positive cancers. If it is anthracyclines that are so important to her2 node-positive survival, something like E-CMF, which is still used, should be o.k.

nlm.nih.gov/medlineplus/news/fullstory_33672.html

“Canadian researchers looked at 639 preserved specimens from pre-menopausal women and found that it may be primarily her2 positive women who benefit from anthracycline containing regimes. 'In the study, the CEF regimen reduced the 10-year risk of death for patients with HER2-positive cancers by 48 percent, compared to similar patients placed on another regimen, called CMF (cyclophosphamide, methotrexate and fluorouracil).”

Also interesting… I read the abstract of this study as well. Another interesting suggestion the authors make is that the improvement in outcome with anthracyclines is almost entirely due to their effect on Her2 + cancers. Therefore, anthracycline based chemo regimens may not be any more beneficial than CMF in Her2 - cancers.
Certainly one to think about

Well AC didn’t work for me I’m triple negative and know AC didn’t work on my cancer.still active cancer tunour after 6 cycles and lots of cancerous nodes…still hoping with fingers crossed that taxotere was my miracle drug…

Jane

Recurrence Christine

My oncologist keeps telling my that because my prognosis is good my chance of recurrence even though I am probably HER2 positive is small - I can’t say that I totally believe her!

In your posting you mentioned that a figure of 50% had been bandied about for all HER2 positive cancers. Could you point me in the right direction to find out more please.

Thanks

bjj

Different subgroups Thanks for posting this Christine

I’ve seen reference to commentds from Dr Piccart (which I assume were published in the same NEJM issue???) saying that she thought it was now appropriate to divide breast cancer into clinically relevant molecular subgroups in order to answer/prioritize the clinical questions applicable to each subgroup,… So being node positive is not simply enough… essential to add in HER2, homones etc etc to determine the best treatment plan. Often say BC isn’t maganged by a simple “one size fits all” - it is a multiheaded beast and this nedds recognising in its management (the current NICE appraisal plans to turn down the taxanes springs rapidly to mind here).

For bjj Have sent you a PM on the HER2 site, bjj.

Hope things are better for you now, and that I will hear from you soon.

Mcgle

Hello everyone Whoa, so many responses.

Yes, Danan, there is some suspicion that the benefit of anthracyclines may be to her2neu positive patients, although it is also possible that it is not so much being her2 positive and being positive for another trait, topo alpha IIa, that matters. Her2 positive tumours are disproportionately topo alpha IIa positive. Doctors are interested in reducing the use of anthracyclines because of the potential for long-term heart damage (although a more targeted version of adriamycin, doxil, may solve this problem by being a safer alternative to something like adriamycin). The problem is that reducing the amount of treatment patients receive has to be done very carefully or doctors will seem negligent.

I know, Jane, that the FEC news does not apply to you, but I think I should mention that her2neu did worse than her2neu negative, even with FEC. It’s not so much that FEC was bad, but that it many only be better than CMF for her2 positive patients. However, many of the other breakthroughs in breast cancer, such as taxanes and dose-dense chemo, seem to disproportionately benefit her2 positive patients, not to mention herceptin. Based on recent trial results, I think it probable that there will be highly effective curative treatments for primary her2positive BC within the decade and that the emphasis of long-term research should shift over more to triple negatives and more tolerable treatments for hormonally-driven cancers.

Hi BJJ. I think that I read the 50% figure in a newspaper article. Part of the reason I posted this article is that I know that some people have been told by their oncologists that node-positive her2 positive breast cancer always comes back and that her2 positive patients often come across older bits of info that make it seem like a death sentence.

As you are all too aware, you are unfortunately in a grey area. It is fairly clear that node-positive or hormone-receptor negative breast cancer merit herceptin after chemo, but it is not clear now whether chemo on balance benefits patients with hormonally-driven node-negative cancers and no research on how herceptin alone affects survival. Try not to be alarmed. Keep in mind that recurrences are disproportionately likely in node-positive and hormone-receptor negative her2 positive cancers and alot of her2 positive cancers fall into those categories. The 50% figure, as such, probably does not apply to you.

Thanks Christine Hi Christine

Thanks for the extra info - very much appreciated.

I think you are right - with all the “scare” type stories in the paper connected with Herceptin the media often portray it as almost inevitable that the cancer will recur for all HER2 positive patients - in light of that I think it is reassuring to know that it is not the case and the percentage in reality could be 50%.

Thank you for your reassurance - I am not over alarmed - just always keeping my eyes open for further information. You are so right - I seem to be in a grey area - not helped by being diagnosed before HERA trial results and having to push my onc for a test anyway.

I noticed on the HER2 american site that at ASCO there is going to be a presentation (on 2nd June) on new guidelines for treating HER2 positive patients. I think it could be quite interesting and I am hoping it will cover some of the previously grey areas.

Thanks

bjj

Her positive cancer Hi ladies,
Please tell me where I can find out statistics on Her + cancers.
I am Er Pr neg and Her +++.
I am fed up with friends and family telling me that this is fine and is not a potential problem and I should be grateful for going on Herceptin as this will make me be better for life.
I started Herceptin last week for Grade 3 stage 1.
Whilst we try so hard to be positive I would like to be aware of the prognosis.
Thanks
Sue x

Ask the nurse e- mail Hi Sue

Ask the Nurse service via the link below:

breastcancercare.org.uk/content.php?page_id=444

may be of help with your query.

Kind regards

Host
Breast Cancer Care

No one really knows Hi Sue,

The thing to keep in mind is that the research on herceptin is on-going. It was only a few weeks ago that the researchers announced that herceptin definitely increases overall survival. Nobody knows whether it is a lifetime benefit or not.

In the HERA trial as of December, about 18% of ER-,PR-,her2+++ women had recurred if they did NOT get herceptin. I don’t think that they said how similar women had done on herceptin, although the earlier results were that the benefit for er-,pr- was even higher than for er+,pr+.

And, as for a prognosis, who knows? A Harvard oncologist has recently said that he thinks that death from her2+ breast cancer will be eliminated in 5-10 years. I find that highly optimistic, but who knows? I am sure that he knows much more than I do about what is in development. I know that there are all kinds of new drugs and vaccines in the pipeline, so perhaps his optimism is warranted.

After all, the purpose of this thread was to point out that scientists have only recently discovered that FEC seems to be particularly good.