If you've been diagnosed with recurrent breast cancer (cancer that has come back) that is metastatic (cancer that has spread beyond the breast area and surrounding lymph nodes), you may want to discuss the results of this study with your doctor. In some cases, certain "personality" factors of recurrent metastatic breast cancer -- hormone-receptor status and HER2 status -- can be different from the original breast cancer. If the hormone-receptor status or HER2 status of the recurrent metastatic cancer has changed, it can affect the treatment plan you and your doctor develop.
The researchers looked at biopsies of cancers from 29 women. The women were thought to have metastatic disease that was a recurrence of previously diagnosed early-stage breast cancer. For each woman, the biopsy of the metastatic cancer was compared to the biopsy of the original cancer.
The biopsies showed that:
A breast cancer's hormone-receptor status helps doctors figure out if hormonal therapy medicine would help treat the cancer. Hormonal therapy can be an effective way to treat hormone-receptor-positive breast cancer. Hormonal therapy medicines work by blocking estrogen's effects on the receptors, or by lowering the amount of estrogen produced by the body. Hormonal therapy medicines used to treat metastatic breast cancer include:
Hormonal therapy medicines don't work on hormone-receptor-negative breast cancers.
A breast cancer's HER2 status helps doctors figure out if the targeted therapies Herceptin (chemical name: trastuzumab) or Tykerb (chemical name: lapatinib) will help treat the cancer. Herceptin and Tykerb can be effective treatments for HER2-positive breast cancers. HER2-positive breast cancers make too many copies of the HER2 gene or have too many HER2 receptors. Herceptin and Tykerb don't work on HER2-negative cancers.
Assuming that metastatic recurrent breast cancer has the same hormone-receptor status and HER2 status as the original cancer may seem logical. Still, this study suggests that these "personality" factors can sometimes change when the cancer comes back as metastatic disease. So assuming that a metastatic breast cancer's hormone-receptor status and HER2 status have stayed the same may cause a woman to get treatment that isn't the best for her situation. This study also suggests that assuming an abnormal area is definitely metastatic breast cancer without a doing biopsy also may not be correct.
If you've been diagnosed with recurrent metastatic breast cancer, you may want to ask your doctor about the hormone-receptor status and HER2 status of the recurrent cancer and how these two factors were determined. Is your treatment plan based on the hormone-receptor status and HER2 status of the original cancer? You also may want to ask whether a biopsy of the recurrent metastatic cancer should be done. Based on this study, a new biopsy might show changes in the cancer's personality that may affect treatment decisions. When you have the best and most accurate information, you and your doctor can decide on a treatment plan that's best for your unique situation.
TORONTO, March 18 (MedPage Today) -- Biopsies of suspected metastatic breast cancer revealed a different hormone receptor status from the primary tumor in 40% of patients and changed clinical management in 20%, according to data from a small clinical series.
Her2 status differed between primary and metastatic lesions in 8% of cases, the disease proved to be benign in 10%, Mark J. Clemons, M.D., of Princess Margaret Hospital, and colleagues reported online in Annals of Oncology.
The findings are potentially practice changing, Dr. Clemons said in an interview, because biopsy is not standard practice for metastatic breast cancer.
"In order to allow this to become a standard of care for patients with breast cancer worldwide, we are going to need more studies, but we also need physicians to begin to think about the fact that tumors can indeed change with time," said Dr. Clemons.
Preliminary results from an ongoing confirmatory study have been virtually identical to those of the initial study, he added.
Several retrospective studies have demonstrated discordant hormone-receptor status between primary and metastatic tumors in 15% to 40% of breast cancer patients. Her2 discordance has been reported in 7% to 26% of patients.
The discordance raises the possibility that some patients with metastatic breast cancer might receive suboptimal therapy in the absence of biopsy, Dr. Clemons and co-authors said.
To examine the issue prospectively, investigators performed biopsies of suspected metastatic breast lesions in 35 women, yielding 29 samples sufficient for analysis. Women with local recurrence were excluded from the study.
All samples were analyzed with respect to receptor status (estrogen/progesterone) and Her2 status and were compared with biopsy results from the patients' primary tumors.
Analysis of the 29 specimens showed that:
Six of the 29 patients with adequate biopsy specimens had changes in clinical management as a result of biopsy. The two patients who gained Her2 overexpression qualified for trastuzumab (Herceptin) or a clinical trial.
"For the four patients who had no evidence of metastatic breast cancer on biopsy, not only did their treatment plan change but also the biopsy results drastically changed their prognosis," the authors said.
The researchers acknowledged that their study was limited by its size, which would have made any subgroup analysis -- for type of adjuvant treatment, location of metastases, or disease-free interval -- unreliable.
However, they concluded, "tissue confirmation should be considered standard of care in patients with clinical and/or radiological suspicion of metastatic recurrence and lesions amenable to biopsy," they concluded.
The Ontario chapter of the Canadian Breast Cancer Foundation provided funding for the study.
The authors made no declarations as to conflicts of interest.
Primary source: Annals of Oncology Source reference: Simmons C et al. "Does confirmatory tumor biopsy alter the management of breast cancer patients with distant metastases?" Ann Oncol. 2009; DOI:10.1093/annonc/mdp028.
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