Future test for node-negative prediction for mets

AlaskaAngel

Gene expression profile predicts breast cancer metastases

Reuters Health
Posting Date: February 17, 2005

Last Updated: 2005-02-17 18:30:23 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Researchers have identified a gene expression signature that is a powerful predictor of distant metastases in patients with lymph node-negative breast cancer.

"Since only 30% to 40% of untreated lymph node-negative patients develop tumor recurrence, our prognostic signature could provide a powerful tool to identify those patients at low risk, preventing overtreatment in substantial numbers of patients," senior author Dr. John Foekens, from Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues note.

As reported in the February 19th issue of The Lancet, the researchers analyzed 22,000 RNA transcripts from breast cancer samples to identify an expression profile that predicted metastases. The samples came from 286 patients with node-negative disease.

Using a training set of 115 tumor specimens, the authors identified a 76-gene signature that predicted distant metastases. Subsequent testing of this signature in a set of 171 lymph node-negative patients yielded a sensitivity and specificity of 93% and 48%, respectively.

The profile was found to be useful in predicting metastatic disease even after adjusting for traditional prognostic factors. Moreover, the signature was particularly good at predicting metastases within 5 years; patients with the signature were nearly six times more likely to develop metastases than patients lacking this profile.

The investigators found that the signature was a strong predictor of metastases regardless of menopausal status and also performed well in patients with tumors between 10 to 20 mm, a group that has traditionally proved to be a prognostic challenge.

In a related editorial, Dr. Tor-Kristian Jenssen, from PubGene AS in Vinderen, Norway, and Dr. Eivind Hovig, from the Norwegian Radium Hospital in Montebello, note that although the current study represents the largest of its kind to date, "it may still be too small to provide a final selection of genes for signature inclusion. Thus, the signature is there, but it is still necessary to read the fine print."

Lancet 2005;365:634-635,671-679.

penelopez · Senior User Joined: 11 Oct 2004 Posts: 165

AA ~ Thanks for sharing this interesting information. I do fall into that category.

Hugs,

Margie

leo · Site Admin Joined: 23 Sep 2004 Posts: 1574

Hello

Studies of this kind have been done before, and they have been useful. But it is only a "likelihood" thing, so still the usual follow-up is done.

regards,
Leo
_________________
Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

AlaskaAngel · Posted: Fri Feb 18, 2005 3:10 pm Post subject: Making choices

The future looks so promising. I do have to recognize and admit that as a stage 1 node-negative who has had chemo, rads and some tamoxifen, today instead I would look to the future and skip the chemo in hope that the future test is not far away, since my benefit is only a few percentage points.

A.A.
_________________
Dx Dec 2001 at age 50
Lumpectomy Jan 2002, 1.6 cm IDC plus some DCIS
Node neg
ER+, PR+, HER2+++
CAF x 6, 35 rads+boost
NED
Tamoxfen 1 3/4 yrs
In 2 clinical trials
bc for mom and 1 sis and 1 aunt and 1 granny
ovarian cancer for 1 aunt

hhmv73a · Experienced user Joined: 16 Jan 2005 Posts: 95

I cannot agree more with Leo. This type of result needs to be interpreted with great caution, especially by a lay person. Usually the news reporter does not really understand what is the difference between a pilot study, basic science study, and a clinical trial. Before deciding one starting a test or stopping a medication, a patient really should talk to the oncologist.

Regards,

J. Jay Lu, M.D.
Diplomate, American Board of Radiology (Radiation Oncology)

hhmv73a · Experienced user Joined: 16 Jan 2005 Posts: 95

I cannot agree more with Leo. This type of result needs to be interpreted with great caution, especially by a lay person. Usually the news reporter does not really understand what is the difference between a pilot study, basic science study, and a clinical trial. Before deciding one starting a test or stopping a medication, a patient really should talk to the oncologist.

Regards,

J. Jay Lu, M.D.
Diplomate, American Board of Radiology (Radiation Oncology)

AlaskaAngel · Posted: Sat Feb 19, 2005 2:05 pm Post subject: Choices

Absolutely, Drs. Leo and Lu. I am not ungrateful for the expertise both of you have or that my oncologist has. You see patients from one end of the spectrum of cancer to the other, and I don't.

However, in the entire course of just my personal experience with cancer I have yet to meet a single health care provider who has personally had cancer, much less chemotherapy. I think that is why not a single one of them has ever taken the time to provide even a brief, perfunctory description of what it is like to be neuter as a direct result of choosing therapy. Maybe they genuinely don't have the time; but neither did they provide me with any reading material about it, or any referral to any other entity that would provide counseling for the impacts from chemotherapy that are outside their area of specialization.

I do not think it is legitimate for medical people to act "in my best interests" in this regard. I would bet that you don't either, or you would not be kind enough to allow this discussion here.

I am appreciative of this forum and dialogue if in any way it ends up meaning that even just one person who is diagnosed has a genuine opportunity to make a more informed decision than I had, no matter what choice they make in the end. And they certainly shouldn't put much credibility in a very preliminary report about a test that might be available somewhere off in the future.

Respectfully,

AlaskaAngel
_________________
Dx Dec 2001 at age 50
Lumpectomy Jan 2002, 1.6 cm IDC plus some DCIS
Node neg
ER+, PR+, HER2+++
CAF x 6, 35 rads+boost
NED
Tamoxfen 1 3/4 yrs
In 2 clinical trials
bc for mom and 1 sis and 1 aunt and 1 granny
ovarian cancer for 1 aunt

Muttsmom

I was thinking the same thing about oncos or surgeons who have never gone through chemo and obviously have the medical knowledge of what works best and lay out a treatment plan that's best for the individual. There are 5 or 6, can't remember, at the cancer institute I do to and when there is a new patient, they all sit down and go over all the info from the path report, age, etc. and decide what the best treatment plan is, which I think is great, even though I have total faith in mine and he's head of oncology there. The ironic thing is both of the rads oncos at the cancer institute I go to have both had cancer. One was a childhood cancer and can't remember what kind, but he wasn't expected to make it and here, 20 years later he's helping others. The weird thing is, as he's proof that stats don't mean squat and everyone is different, he has a gloom and doom attitude if, in my case Stage III. You'd think that he'd be more encouraging considering his past. I don't want or expect someone to lie to me about prognosis, but the way he put it, I wasn't going to be around long. That isn't what I needed at the time, so I switched. The other rads onco was dx with prostate cancer after I had gone through treatment and he got radiation, that capsule thing. Before and after that, he was the same, honest but encouraging and I only see him once a year now, but each year I make it without a reoccurence, he sincerely is so pleased and once again, says the longer you go without one, the better your chances of not having one, even though as we've discussed, all the written material says our chances go up between 5 and 10 years and that has yet to make sense to me, but no one can explain why the articles say it.
_________________
Nancy
2/14/02 ILC 43 - 5.5 cm 9+/16 nodes
Stage IIIA er/pr+ Her2-
2/02 MRM
FECx6 radsx33
Tamoxifen - Arimidex (chemo induced menopause)
4/03 SM w/bilat. recon.
9/03 expanders removed
5/04 repair reconst. disaster
10/04 Actonel for bone/joint pain from Arimidex
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

AlaskaAngel · Posted: Sat Feb 19, 2005 10:46 pm Post subject: Mutual Understanding

Oncologists are the ones who have to open the door to things we would rather not experience, so being mad at them for it is real.

I felt closest to my onc when I read about some of the things he has done in his field that showed real professional integrity. I also found the book, The Anatomy of Hope, by Jerome Groupman, took away a lot of the hard feelings for me. I'm going to have to read it again.

I know each "case" of breast cancer is presented at tumor board where it gets discussed and a treatment plan is developed, but without somone there like an endocrinologist and a psychiatrist/psychologist how can they possibly make an educated plan?

A.A.

Muttsmom

I may be misunderstanding what you're saying.

I was never mad at my oncologist, he was there to do everything possible to save my life. He came highly recommended, is the head of oncology and goes all over the U.S. giving lectures and has alot of articles in medical journals etc.

If they have been practicing long at all, they can see the devistation and fear in all of us that are dx. They don't know how it feels because they haven't walked in our shoes, but they have seen it enough. My PCP never suggested an anti-depressant or meds for anxiety. It was my onco who saw me get to a point that he knew I needed something. He was aware of the divorce mess that started right before my dx, well right before my biopsy and knew both that and the dx were taking it's toll. He put me on Paxil and it helped more then words can say.

If I don't make it to a ripe old age because this mess comes back, it won't be for his lack of trying and his knowledge and determination to save as many as he possibly can. He wanted the divorce over before I started treatment because the extra stress of a court battle would only hinder my health and chances and was willing to treat me without me having insurance (I would have lost it or had to pay for COBRA and I wasn't able to work) and it not costing me anything. I would have gotten the exact treatment I got, but the divorce drug on and it's still going on 3 years later, but that's another story. His primary concern was me and kicking some cancer butt.
_________________
Nancy
2/14/02 ILC 43 - 5.5 cm 9+/16 nodes
Stage IIIA er/pr+ Her2-
2/02 MRM
FECx6 radsx33
Tamoxifen - Arimidex (chemo induced menopause)
4/03 SM w/bilat. recon.
9/03 expanders removed
5/04 repair reconst. disaster
10/04 Actonel for bone/joint pain from Arimidex
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

AlaskaAngel · Posted: Sun Feb 20, 2005 2:33 am Post subject: Trust

Hi Muttsmom. I'm glad you have a strong trust in your oncologist and that it got you through some very hard times.

I am trying to understand the lack of communication that I have with my onc, as I know that most patients and all the docs like him a lot. Some of it has to do with the difference between talking to patients who believe in targeting cancer with the most toxic treatment ever invented and talking to patients like me who do not. Some of it might even have to do with oncs getting tired of explaining things to patients who are not gung-ho, although that is definitely part of the job.

A.A.

Muttsmom

Hi,
You know me and my memory, I don't have much of one anymore. I can't remember your stage, but am thinking it was caught early? Mine had no choice but to treat me very aggressively because of my stage and age. I think it's very common practice now to treat even stage I with 4 rounds of AC just to be sure that one or a few cancer cells didn't get outside the tissue that was removed even if it wasn't in your nodes.

Just because most like your onco, doesn't mean that ya'll can't have a problem. I'm sure there are some that don't like mine, just human nature. If you don't feel like you can openly talk to your onco or that he is getting frustrated with questions, then I'd check into a 2nd opinion. You've got to feel comfortable not only with talking to the onco but in the way he wants to treat you for the BC.

I changed rads onco as I said because of the personality differences and I felt like I was just one more person added to his list. I wanted to truth about everything, but there are 2 ways to tell the truth to someone. Share the crap out of them or be honest but in a calming and compassionate way.

Best of luck to you and I hope you can find one you're comfortable with, that is so important.

Nancy
_________________
Nancy
2/14/02 ILC 43 - 5.5 cm 9+/16 nodes
Stage IIIA er/pr+ Her2-
2/02 MRM
FECx6 radsx33
Tamoxifen - Arimidex (chemo induced menopause)
4/03 SM w/bilat. recon.
9/03 expanders removed
5/04 repair reconst. disaster
10/04 Actonel for bone/joint pain from Arimidex
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

Madge · Regular Joined: 27 Dec 2004 Posts: 27

OOOOPPPPPPSSSS SORRY I POSTED MY COMMENTS TWICE AND CAN'T FIGURE OUT HOW TO DELETE THIS ONE. Confused

_________________
Madge
61-years young
Dx - 7/04
Bilateral Mastectomy (skin sparing) 8/19/04
Negative nodes
Micro-invasive DCIS, DCIS, LCIS
Stage T1a
ER/PR -
Her2 3+
No chemo, no radiation
Waiting for reconstruction

Madge · Regular Joined: 27 Dec 2004 Posts: 27

Thank you one and all for sharing your opinions and experience. I am a pretty positive minded person and feel I have been given a "second chance" at living my life. I will also say, being staged a T1a, ER/PR- and HER2 +++ I am "scared" as I approach my 6M visit to my oncologist. I was fortunate to not have required chemo or radiation after my bilateral. I am worried though, not having had any treatment other than surgery, that there is no way to monitor what those #$%^& cancer cells might be doing in my body. I had a pre-cancerious colon polyp five years ago and have a coloonoscopy every three years now, before I had BC I had an annual mammogram. Now I feel I am "out in the middle of the ocean" with no way to monitor what is going on in my body .... that is until it gets out of hand. This article is unsettling to say the least. On the one hand my oncologist and oncology surgeon said "consider yourself cured" but on the other hand this article indicated that 30 - 40 % of lymph node negative patients develop tumor recurrence .... how does one monitor for recurrence? Any suggestions for my 6M oncology visit would be greatly appreciated. I don't want to "buy trouble" but at the same time I don't want to be nieve and not do something or monitor something along the way that would prevent a early detection of a recurrence.
_________________
Madge
61-years young
Dx - 7/04
Bilateral Mastectomy (skin sparing) 8/19/04
Negative nodes
Micro-invasive DCIS, DCIS, LCIS
Stage T1a
ER/PR -
Her2 3+
No chemo, no radiation
Waiting for reconstruction

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