30 september 2011: Bron: 2011 European Multidisciplinary Cancer Congress (EMCC)

Bij 1 op de 3 vrouwen met borstkanker verandert de status van hun tumor tijdens de behandelperiode met bv. herceptin of hormoonbehandelingen. Dit heeft grote gevolgen voor de behandeling van borstkanker want als de status veranderd moet ook de aanpak veranderd worden. Dit zijn de conclusies uit een niewus gepresenteerde studie op het Europese congres over kanker, Er wordt voorgesteld naar aanleiding van deze studie en eerdere studies , zie o.a. hieronder om bij vrouwen met borstkanker regelmatig nieuwe biopsies uti te voeren. Het is eigenlijk ongelooflijk dat al jaren hiervoor wordt gewaarschuwd en er in de praktijk bijna niets mee wordt gedaan. Als ik soms dit aan vrouwen vertel en zij dit aan hun oncoloog voorleggen wordt dit altijd afgedaan als ja heel soms verandert die status maar bij jou is dat denk ik niet het geval. En er wordt dan verder niets mee gedaan.  Hier enkele citaten uit een groot artikel bij Medscape waar als u hier klikt het hele artikel kunt lezen. Lees dat aub het is zo belangrijk dit.

September 29, 2011 (Stockholm, Sweden) — Tumor hormone-receptor and HER2 status can change in breast cancer patients during the course of their disease. Because these changes can significantly influence survival and can completely change the patient's clinical management, these patients should undergo regular biopsies, according to a new study.

"For example, we saw that 1 in 3 breast cancer patients alter estrogen or progesterone hormone-receptor status, and 15% of patients change human epidermal growth-factor receptor 2, or HER2, status during the course of disease," explained lead author Linda Lindström, PhD, a postdoctoral fellow from the Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.

Estrogen-receptor (ER) status, which was assessed in the primary tumor and after the first relapse, showed a change in 32.4% of patients. Similar results were observed for progesterone-receptor (PR) status, and tumor changes were noted 40.7% of patients.

The researchers observed a change in HER2 status from the primary tumor to the first relapse in 14.5% of patients.

These data emphasize the importance of regular biopsies in patients who relapse, she told Medscape Medical News.

A similar pattern was seen in patients who experienced multiple consecutive relapses. In this group, ER, PR, and HER2 status changed in 33.6%, 30.2%, and 15.7% of patients, respectively.

12 mei 2010: Bron: Ann Oncol. 2009 Nov 3.

De status van de oestrogeen receptor (ER), progesteron receptor (PR) en human epidermal growth factor receptor 2 (HER2) van borstkanker wordt standaard gebruikt voor het bepalen van een behandelingsstrategie. Nu blijkt dat bij vrouwen met uitgezaaide borstkanker de status van deze receptoren voor hun primaire tumor vaak anders ligt dan voor de uitzaaiingen. En ook blijkt dat de status van deze receptoren zich snel en vaker dan gedacht aanpassen en veranderen door de behandelingen. Dit blijkt uit een gerandomiseerde studie bij 385 vrouwen met invasieve borstkanker. 211 van die vrouwen hadden ook uitzaaiingen. Maar liefst 46,9 % van de vrouwen hadden een verschillende status tussen primaire tumor en uitzaaiingen.

Het onderzoeksteam analyseerde de expressie van 3 receptoren: oestrogeenreceptor (ER), progesteron receptor, en humane epidermale groei factor receptor 2 (HER2). De expressie van deze worden gebruikt om beslissingen te nemen over adjuvante therapie bij borstkanker; ER-positieve patiënten word meestal  hormonale therapie (tamoxifen en / of aromataseremmers) aangeboden en HER2-positieve patiënten worden trastuzumab (Herceptin) aangeboden.

Deze behandelings beslissingen worden genomen op basis van de receptor status in de primaire tumor, verkregen uit een diagnostische rechtstreekse biopsie of uit weefsel dat chirurgisch is verwijderd. Maar als de borstkanker al is uitgezaaid of zich nog verder verspreidt, kunnen de kenmerken van de receptoren ervan wijzigen. Verschillende studies hebben dit verschil in status onderzocht en aangetoond. 


In deze laatste studie wordt een verandering in bijna de helft van de onderzochte patiënten (46,9%) aangetoond. En blijken nogal wat vrouwen emt borstkanker dus verkeerd te worden behandeld. Of heeft de eerste behandeling een dusdanig effect dat de receptorstatus verandert.

Lees hier een artikel in Medscape over deze studie.

Ann Oncol. 2009 Nov 3. [Epub ahead of print]

Quantitative analysis of changes in ER, PR and HER2 expression in primary breast cancer and paired nodal metastases.

Aitken SJ, Thomas JS, Langdon SP, Harrison DJ, Faratian D.

Edinburgh Breakthrough Research Unit and Division of Pathology, University of Edinburgh, Edinburgh, UK.

Abstract

BACKGROUND: Assessment of receptors [estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2)] is routinely carried out on primary tumour in order to select appropriate adjuvant therapy; the same analysis is not carried out on nodal metastases. Since de novo resistance to therapy is common, we quantified differences in receptor expression between primary and nodal disease in order to assess whether this might contribute to therapeutic resistance.

PATIENTS AND METHODS: A total of 385 patients with invasive primary breast carcinomas and paired lymph nodes (n = 211) were assessed for ER, PR and HER2 expression using quantitative immunofluorescence. Cut-points were defined by comparison with tumours scored by immunohistochemistry (IHC) and FISH. Differences in expression for each of the markers and molecular phenotype were analysed.

RESULTS: Quantitative receptor expression shows a wide dynamic range compared with IHC. Overall, 46.9% cases had disparate breast/node receptor status of at least one receptor. Many of the differences in expression between primary tumour and node are large magnitude (greater than fivefold) changes. Triple-negative phenotype changes in 23.1% of cases.

CONCLUSIONS: A significant number of patients show discordant quantitative expression of molecular markers between primary and nodal disease. Appropriately measured, lymph node receptor status could be a more accurate measurement for guiding adjuvant therapy, which requires testing in a clinical trial.

PMID: 19858088 [PubMed - as supplied by publisher]

 

Ann Oncol. 2009 Nov 3. [Epub ahead of print]

Quantitative analysis of changes in ER, PR and HER2 expression in primary breast cancer and paired nodal metastases.

Aitken SJ, Thomas JS, Langdon SP, Harrison DJ, Faratian D.

Edinburgh Breakthrough Research Unit and Division of Pathology, University of Edinburgh, Edinburgh, UK.

Abstract

BACKGROUND: Assessment of receptors [estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2)] is routinely carried out on primary tumour in order to select appropriate adjuvant therapy; the same analysis is not carried out on nodal metastases. Since de novo resistance to therapy is common, we quantified differences in receptor expression between primary and nodal disease in order to assess whether this might contribute to therapeutic resistance.

PATIENTS AND METHODS: A total of 385 patients with invasive primary breast carcinomas and paired lymph nodes (n = 211) were assessed for ER, PR and HER2 expression using quantitative immunofluorescence. Cut-points were defined by comparison with tumours scored by immunohistochemistry (IHC) and FISH. Differences in expression for each of the markers and molecular phenotype were analysed.

RESULTS: Quantitative receptor expression shows a wide dynamic range compared with IHC. Overall, 46.9% cases had disparate breast/node receptor status of at least one receptor. Many of the differences in expression between primary tumour and node are large magnitude (greater than fivefold) changes. Triple-negative phenotype changes in 23.1% of cases.

CONCLUSIONS: A significant number of patients show discordant quantitative expression of molecular markers between primary and nodal disease. Appropriately measured, lymph node receptor status could be a more accurate measurement for guiding adjuvant therapy, which requires testing in a clinical trial.

PMID: 19858088 [PubMed - as supplied by publisher]

Tumor hormone-receptor and HER2 status can change in breast cancer patients during the course of their disease. Because these changes can significantly influence survival and can completely change the patient's clinical management, these patients should undergo regular biopsies, according to a new study.

Source: Medscape

The researchers evaluated breast cancer patients in the Stockholm healthcare region who experienced a disease recurrence from January 1, 1997 to December 31, 2007.

In 459, 430, and 104 patients, ER, PR, and HER2 status, respectively, was assessed in the primary tumor and after first relapse. Information on ER, PR, and HER2 status in multiple consecutive relapses was evaluated in 119, 116, and 32 patients, respectively.

ER status changed in almost 34% of a cohort of 119 women, and between the different sites of relapse (local, loco-regional, and metastases). ER-positive status remained stable in 36.1% of patients, and ER-negative status remained stable in 30.3%. However, ER status changed from positive to negative in 16.0% during the course of their disease, changed from negative to positive in 12.6%, and alternated between positive and negative in 5%.

"In the clinical setting, the implication of estrogen-receptor instability is important," said Dr. Lindström. "The loss of estrogen receptor generally means resistance to hormonal therapy; these patients would benefit from a change in therapy."

"An estrogen-receptor gain would introduce an additional choice of therapy, which in some patients could lead to tumor response and improved survival in the metastatic setting," she explained.

Changes in receptor status appeared to adversely affect outcome, Dr. Lindström pointed out. Women with ER-positive primary tumors that switched to ER-negative status had an approximately 2-fold increased risk of dying, compared with those with stable ER-positive tumors.

The data suggest that hormonal therapy promotes changes in ER status during disease progression. The researchers stratified the intrapatient ER status in primary tumor and relapse according to the treatment they received: none, adjuvant hormonal therapy or chemotherapy, or a combination of both. One third of patients who received hormonal therapy lost ER expression when their disease relapsed, whereas only 1 of 10 untreated patients experienced altered ER status.

In addition, only a few patients who gained ER had received hormonal therapy. Conversely, in the those who received chemotherapy alone or no treatment, the proportion who gained ER status was 3 times greater.


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