• HER2, etc

    Asked by nonnie917 on Saturday, February 23, 2013

    HER2, etc

    Could someone please explain to me in layman's terms what triple positive on HER2/neu, PR and ER means? I am very confused by the discussions and am not sure what to think. Am I going to get cancer again. That is the impression I am getting from some of the discussions I read. I would really like to know because I have a daughter and 4 granddaughters this might affect in the future. Thank you for your help.

    7 Answers from the Community

    7 answers
    • Nomadicme's Avatar
      Nomadicme

      Given you're Stage 0, you're at a very low risk of recurrence.

      ER/PR indicate that the breast cancer cells (a tumor is a bundle of cells growing out of control) grow with the help of estrogen (the ER) and progesterone (PR) supplied by the body. This is why pills like Tamoxifen and Aromatase Inhibitors (AIs) are given, to deprive potential or existing cancer cells of the "food" hormones represent.

      Her2/neu sits on the surface of breast cancer cells, also helping them to grow. Her2 is present in normal cells, but a biological mechanism (mutation, the neu part) has caused a high amount of these receptors in the surface of breast cancer cells. Herceptin is a drug that targets cancer cells that have Her2/neu, the Herceptin works like a key to the lock that's the her2/neu. Then the body's immune system destroys the cells that have been tagged by the Herceptin.

      Triple positive is when a breast cancer has all of the above, ER, PR, and Her2. It's better to be triple positive than negative, as there are more drugs with which to slow/kill these cancer cells. I recently read some other "things" were being identified on triple negative cells,,which now can split those cancers into 3 types (so for now a diagnostic tool which hopefully soon will lead to medicine against them)

      almost 4 years ago
    • nancyjac's Avatar
      nancyjac

      Progesterone and Estrogen are hormones. HER2 is a protein enzyme. All occur naturally in our bodies. Cancer cells can have what are called receptors that these hormones or enzyme attach to. When there is a high ratio of cancer cells with these receptors, the cancer is said to be PR (progesterone receptor), ER (estrogen receptor) or HER2 (HER2 enzyme positive. When positive it means those excess receptors have contributed to the growth of the cancer cells. Knowing whether a cancer is positive or negative for these is part of the information used to develop a treatment plan. There are hormone therapeis (tamoxifen or aromatase inhibitors) thaqt block or deplete estrogen and progesterone and targeted therapies (Herceptin) that do the same with HER2.

      Whether a cancer is positive or negative is not a direct factor in the risk of recurrence. Some would argue that because there are additional treatments available for those who are positive that they have a lower risk of recurrence by using those therapies. But on the other hand, those that are negative don't need those therapies and didn't have those hormones and/or enzyme contribute to their cancer growth in the first place.

      To the best of my knowledge there is no genetic component to this. Your daughter and granddaughters may or may not develop cancer at some point, but whether you are hormone/enzyme positive or negative is not a factor in their risk.

      almost 4 years ago
    • karen1956's Avatar
      karen1956

      Triple positive...means you carry the "gene' (I can't think of the correct word) HER2....your cancer is fueled by estsrogen (ER) and progeserin (PR)...that means that you will most likely take Herception for a year ( a targeted therapy) and you are a candidate for either Tamoxifen (for both pre and postmenopausal women) or AI's (for post menopausal women).
      If you don't carry the BRCA gene, then your daughters and granddaughters are only at a slightly higher risk for getting BC than you were before you were Dx......
      Stage and grade of cancer are more of an indicator of the aggressiveness of the cancer, but even that doesn't mean that you will get cancer again!!!

      almost 4 years ago
    • carm's Avatar
      carm

      Nonnie917, hello, I am an oncology nurse and let me clarify some points. First, HER-2 is Human Epidermal Growth Factor 2 and this is a mutation that causes your cancer cells to proliferate. It is considered one of the harder to treat breast cancers and you cannot get it from a parent. There are some drugs on the market for it but one drug mentioned, Herceptin is not approved for first line treatment of HER-2, only for recurrent HER-2 and has a cautious adverse event in that it tends to cause cardiovascular issues with extended use. Estrogen and progesterone positive cancers are hormone driven and so those are treated with drugs that inhibit a hormone. All cells in the human body have receptors that is how they signal and communicate the needs of the nucleus. The genetic component for the ER+ & PR+ is the BRCA2 gene and that is a genetic trait located on the short arm of the 13 chromosome. If there is a history of breast, ovarian, or even pancreatic cancer in your lineage, then it would be a good idea to be BRCA tested to see whether your daughter or granddaughters have that risk. I think it is considerate and so responsible of you to ask these questions in an effort to protect those most precious to you. Whether you have recurrence again, no one can predict. If you are a stage 0 then your outlook is indeed very promising. Best of luck to you and to your family as well. I should think they should be most grateful to have a matriarch who has their best interests at heart. They are very lucky indeed, Carm RN.

      almost 4 years ago
    • Nomadicme's Avatar
      Nomadicme

      @carm
      I received Herceptin adjuvant to surgery for the first line treatment of my stage IIb breast cancer (unless you're referring to first line as Stage 0?).

      Also, my BC is ER+PR+ and I tested negative for the BRCA genes (so not a genetic correlation).

      i am not an oncology nurse, but I do hold a BS in Biochemistry and a MS in Immunology and can/have read PIs (product inserts for pharmaceutical products which state which line a product can be given), have read/read JCO, as well as clinical trial data as published in scientific meetings such as ASCO.

      almost 4 years ago
    • carm's Avatar
      carm

      @Nomadicme
      Perhaps I should clarify. I have never seen it given to a stage 0 HER-2+ and as I am sure you know as a Biochemist major that pharm houses do not have to disclose all trials with every drug and so the info out there is carefully selected. In Europe it is a bit more stringent and perhaps because they have nationalized medicine. They uncovered the CV risks and the drug origionally approved for recurrent in 2006 I believe was later modified in 2008 to include first line in combination with cyclophosphamide or other class compounds but it was recommended for 9 time cycles but was approved for 12 and to be used cautiously as a monotherapy. It does however carry the risk much like Doxorubicin Liposomal.

      almost 4 years ago
    • Nomadicme's Avatar
      Nomadicme

      @carm. I know there are now trials in DCIS patients. In pharma talk, first line refers to the first treatment given, as in 2nd line would be given upon recurrence, not the first time around.

      almost 4 years ago

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