Who is cured of her2 neu 3 cancer. Her2 positive breast cancer. What is Negative Breast Cancer

Breast cancer is not just one disease. This is actually a group of diseases. When diagnosing breast cancer, one of the first steps is to determine what type you have. how cancer behaves.

When you have a breast biopsy, the tissue is tested for hormone receptors (HR). It is also tested for something called human epidermal growth factor receptor 2 (HER2). Each of them can be involved in the development of breast cancer.

Some pathology reports refer to HER2 as HER2/neu or ERBB2 (Erb-B2 receptor tyrosine kinase 2). rs are identified as estrogen (ER) and progesterone (PR).

HER2 is the gene that creates the HER2 proteins or receptors. These receptors help control the growth and repair of breast cells. Overexpression of the HER2 protein causes uncontrolled proliferation of mammary cells.

HER2 positive breast cancers tend to be more aggressive than HER2 negative breast cancers. Along with cancer stage and cancer, HR and HER2 status helps determine your treatment options.

Continue reading to learn more about HER2 positive breast cancer and what you can expect.

Survival. What are the survival rates?

There are currently no specific survival studies for HER2-positive breast cancer alone. Current studies on breast cancer survival apply to all types.

According to the American Cancer Society, this is the five-year relative survival rate for women with all types of breast cancer:

Stage 0 or Stage 1 (also known as localized or non-metastatic): Nearly 100 percent

• stage 2: 93 percent
• stage 3: 72 percent
• stage 4 (also known as metastatic): 22%
• It is important to remember that these are only general statistics. Long-term survival statistics are based on people who were diagnosed several years ago, but treatment is changing rapidly.

When considering your look, your doctor will need to analyze many factors. Among them:

stage of diagnosis

• : The outlook is better when breast cancer has not spread beyond the breast or has only spread regionally at the start of treatment. Metastatic breast cancer, which is cancer that has spread to distant sites, is difficult to treat. size and grade of the primary tumor
• : This indicates how aggressive she is. Involvement of lymph nodes
• : Cancer can spread from lymph nodes to distant organs and tissues. HR and HER2 status
• : Targeted therapy can be used for HR-positive and HER2-positive breast cancer. general health
• : Other health problems may complicate treatment. response to therapy
• : It is difficult to predict whether a particular therapy will be effective or cause intolerable side effects. age
• : Younger women and those over 60 have a worse prognosis than middle-aged women, except in patients with stage 3 breast cancer. In the United States, more than 40,000 women are estimated to die from breast cancer in 2017.

Prevalence What is the prevalence of HER2 positive breast cancer?

Approximately 12 percent of women in the United States will develop invasive breast cancer at some point. Anyone, even men, can develop HER2-positive breast cancer. But it is more likely to affect young women. HER2-positive represents about 20 percent of all breast cancers.

RecurrenceCan HER2-positive breast cancer recur?

HER2-positive breast cancer is more aggressive and more likely to recur than HER2-negative breast cancer. Recurrence can happen at any time. But this usually happens within five years of treatment.

The good news is that relapse is less likely today than ever before. This is largely due to recent targeted treatments. In fact, most people treated for early-stage HER2-positive breast cancer do not recur.

If your breast cancer is HR-positive, hormone therapy may help reduce the risk of recurrence.

HR status and HER2 status may change. If breast cancer recurs, a new tumor must be tested so that treatment can be reevaluated.

TreatmentWhat treatment is available?

Your treatment plan will likely include a combination of treatments such as:

surgery

• chemotherapy
• radiation
• targeted therapies
• The size, location, and number of tumors help determine the need for breast surgery or mastectomy, as well as the removal of lymph nodes.

Radiation therapy can target any cancer cells that may be left behind after surgery. It can also be used to shrink tumors.

Chemotherapy is a systemic treatment. Powerful drugs can seek out and destroy cancer cells anywhere in the body. HER2-positive breast cancer usually responds well to chemotherapy.

HER2 positive breast cancer can also be HR positive. If yes, then hormonal treatments may be an option.

Targeted treatments for HER2-positive breast cancer include:

Trastuzumab

• (Herceptin) helps block cancer cells from receiving chemical signals that stimulate growth. A 2014 study of over 4,000 women showed that when added to chemotherapy (paclitaxel after doxorubicin and cyclophosphamide) in early-stage HER2-positive breast cancer, trastuzumab resulted in a significant reduction in recurrence and improved survival. The 10-year survival improved from 75.2% with chemotherapy alone to 84% with the addition of trastuzumab. The results also demonstrated a permanent improvement in relapse-free survival. The 10-year disease-free survival increased from 62.2% to 73.7%. Ado-trastuzumab-emtansine
• (Kadcyla) combines trastuzumab with a chemotherapy drug called emmansine. Trastuzumab delivers emtansine directly to HER2-positive cancer cells. It can be used to shrink tumors and increase survival in women with metastatic breast cancer. Pertuzumab
• (Perjeta)is a drug that works in the same way as trastuzumab. However, it attaches to a different part of the HER2 protein. lapatinib
• (Tykerb) blocks proteins that cause uncontrolled cell growth. This may help slow disease progression when metastatic breast cancer becomes resistant to trastuzumab. OutlookWhat is the outlook?

Once treatment for non-metastatic breast cancer is over, you will still need periodic testing for signs of recurrence. Most treatment side effects will improve over time, but some may be permanent.

Metastatic breast cancer is not considered curable. Treatment can continue as long as it works. If any treatment stops working, you can switch to another one.

It is estimated that over 3.1 million women in the United States have a history of breast cancer.

The outlook for HER2 positive breast cancer varies from person to person. Progress in targeted therapy continues to improve the outlook for both early stage and metastatic disease.

Editor's Choice

health line

Overview Avascular necrosis (AVN) is a bone disease. Necrosis is a general term which means that the cell has died. AVN is also called: osteonecrosis aseptic necrosis ischemic bone necrosis AVN bone infarction can lead to joint pain, especially in the hip area. Bone damage occurs due to lack of blood flow to the bone cells.

Her2(short for Human Epidermal Growth Factor Receptor 2) is the human epidermal growth factor 2 receptor. Her 2 is a transmembrane protein that plays a key role in growth factor signaling at the cellular level. Her2 is a member of the HER protein family, which includes four types of growth factor receptors: HER1 (also known as the epidermal growth factor receptor EGFR), HER2, HER3, HER4.

Features of Her2 positive breast cancer

1. Low sensitivity to hormones(ER-estrogen, PR-progesterone),
2. Positive overexpression of Her2neu,
3. Average Ki-67.

• Insensitivity Her2neu positive breast cancer to hormones suggests that the tumor will not respond to hormone therapy.

• Positive Her2 status indicates a high level of tumor aggressiveness and allows the use of targeted therapy with such drugs as: Herceptin (trastuzumab), Kadcyla (trastuzumab-emtansine), Perjeta (Pertuzumab) and Lapatinib.

• The average Ki-67 index at indicates the rapid growth of the tumor, a fairly high probability of its metastasis to various organs, as well as its good sensitivity to chemotherapy.

Treatment for Her2neu positive breast cancer

Hormone therapy for treatment Her2 positive breast cancer not used due to tumor insensitivity to this type of treatment.

Chemotherapy and targeted therapy for Her2 positive breast cancer applied at all stages of treatment. Chemotherapy and targeted therapy for Her2 positive breast cancer can be prescribed in the preoperative period (in order to reduce the tumor before surgery) and in the postoperative period (in order to destroy the tumor cells remaining after the operation).

Radiation therapy in treatment Her2 positive breast cancer it is used only in cases of non-radical surgery and / and in the presence of metastases in the peripheral lymph nodes.

After adequate treatment, Her2neu positive breast cancer has a good prognosis, but is prone to early relapses. Therefore, after successful completion of treatment, women with positive Her2 status with breast cancer, you should pay close attention to control examinations and not skip them.

Recurrence of Her2neu-positive breast cancer detected at an early stage makes it possible to start therapy on time and improve the prognosis of the disease.

Breast cancer is the most common form of cancer in women. The incidence of breast cancer in Russia at the end of 2011 was 45.2 cases per 100,000 women, accounting for 20.4% of the total oncological incidence. More than 57,000 new cases of breast cancer are diagnosed annually in Russia. The correct choice of pre- and postoperative therapy, the prognosis of tumor development, and the assessment of the likelihood of recurrence are largely based on the study of prognostic and predictive markers.

20.4% in the structure of general oncological morbidity is cancer, 20.4% in the structure of general oncological morbidity is breast cancer.

What is HER2?

The HER2 receptor is one of the most significant molecular markers in breast cancer (BC). Normally, the HER2 receptor is located on the surface of many cells in the body. Approximately in every fourth woman with breast cancer, the amount of this protein in the tumor cells is increased compared to the norm. The increased expression is based on the amplification of the HER2/neu gene. An excess of this receptor on the surface of cancer cells indicates a highly aggressive form of breast cancer.

What is a highly aggressive form of breast cancer?

Malignant neoplasm in the breast with amplification and increased expression of the HER2/neu gene. A tumor of this type behaves extremely aggressively and quickly metastasizes to other organs. HER2-positive breast cancer patients have a poor prognosis and low survival (1-2 years from the time of diagnosis). The disease affects women of reproductive age. A HER2-positive tumor does not respond to conventional lines of chemotherapy.
Number of HER2-positive breast cancer patients: HER2-positive tumor status is detected in 25-30% of all patients with breast cancer (about 15,000 new cases per year). In Russia, there are about 90,000 women with breast cancer with a positive HER2 status. Of these, only 3,425 patients have been identified and are registered.

Who should be screened?

All women diagnosed with breast cancer should be tested to determine the HER2 status in the tumor cells, since this status is extremely important both for prognosis and for the selection of adequate treatment. Checking the status allows the doctor to more accurately determine which type of cancer this particular tumor belongs to, clarify the diagnosis and choose the most appropriate treatment on an individual basis. To date, the analysis of the dose of the HER2/neu gene in metastatic breast cancer is recommended by the European Society of Oncology as a necessary element of the study of the patient.

Why is it important to know the HER2 status of a breast cancer tumor?

A positive HER2 tumor status is important from several points of view:
Allows the doctor to assess the propensity of the tumor to progress;
Determine the body's response to the proposed treatment.

It has been shown that for patients with a positive HER2-status of tumors during chemotherapy, the use of Metatrexate and Tamoxifen is ineffective, and the use of anthracyclines and platinum-containing drugs, on the contrary, is more effective, taxanes and aromatase inhibitors are equally effective, regardless of the HER2-status of the tumor. Analysis of the dose of the HER2 gene allows you to know whether it makes sense to prescribe treatment with Herceptin.

What is Herceptin?

Herceptin (Roche, Switzerland) is a prominent representative of the class of targeted drugs based on monoclonal antibodies that bind with a high degree of selectivity to the extracellular part of the HER2 receptor. Thanks to this action, the defeat of cancer cells becomes more directed, targeted and sparing in relation to healthy cells of the body. After Herceptin blocks HER2 receptors on the surface of a cancer cell, its further growth stops and, in some cases, tumor shrinkage is observed. In addition to the direct antiproliferative action, Herceptin is able to cause the destruction of tumor cells due to the reaction of antibody-dependent cellular cytotoxicity. The use of Herceptin allows to increase the time to progression and overall survival of patients with HER2/neu overexpression, overcome tumor resistance to cytostatic drugs and reduce the dose of chemotherapy, and, as a result, gives a chance to prolong the years of life allotted by the disease.

Establishing HER2 status

In the vast majority of cases, increased expression is based on amplification of the HER2/neu gene; to determine the HER2 status of a tumor, we propose an analysis of the dose of the HER2/neu gene in tumor cells using real-time PCR. This technology has a good correlation with the immunohistochemical (IHC) method for diagnosing the HER2 status of tumors (1). In addition, real-time PCR is an excellent alternative to the fluorescence in situ hybridization (FISH) test system, which has been recommended by the Food and Drug Administration (USA) as a standard method for diagnosing the HER2 status of tumors in predicting the course breast cancer (2, 3).

Research material

For analysis, DNA from breast cancer tissue obtained during a biopsy or surgery is used. In addition, DNA isolated from archival samples of breast cancer tumor tissue enclosed in paraffin blocks can be used for analysis.

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In the archive of medical consultations for 13 years, there are a large number of prepared materials that you can use. best regards, editorial

Galina asks:

Hello! I would like to know how to understand this "final clinic. dz at discharge: Ca mammae sin pT1pNOMO G2 st I Er-100% Pr-60% HER2\neu-0 Ki-67-42% p53-0%". Have attributed to drink aksastrol.

Responsible Filonenko Andrey Grigorievich:

Good afternoon, Galina. This should be understood as "a malignant tumor of the left breast of small size without changes in the lymph nodes." It also says that the operation was performed and the tumor was completely removed. It also says here that tumor cells have receptors. Estrogen (100% of all cells), progesterone (60% of all cells), Ki-67 (42%). And they do not have receptors like HER2-new and p-53. The presence of receptors on tumor cells makes it possible to additionally influence the tumor. In particular, the presence of receptors for female hormones (estrogen and progesterone) allows the use of hormone therapy. Axastrol (anastrozole), which was attributed, this is such a treatment. Axatrol should be taken for 5 years.

Oksana asks:

Hello, Doctor. I am 43, breast cancer 2B on ultrasound before biopsy 35x15mm, lu without changes, on mamography after biopsy 65x30mm accumulation of microcalcifications, CT up to 45mm in diameter, multiple LU 5-10mm, signs of distant metastasis are not visible. 1 lu is palpated. Constant aching pain and not much swelling of the chest.
Biopsy showed G-2,
HER 2new is not harmonically dependent. Treatment suggest: 2 or more chemotherapy before surgery Doxorubicin, Docetaxel. Herceptin after surgery.
I'd like to know your opinion about the treatment.
Is Heptral needed right away, and what are the forecasts in my situation.

Responsible Filonenko Andrey Grigorievich:

Good afternoon, Oksana.
Quite a large tumor with the presence of lymph nodes in the armpit. HER 2new is positive. The age is young.
All these points negatively affect the prognosis. Nevertheless, successful treatment and lasting recovery are possible. Treatment will be long and rather complicated. You only need to carefully follow the recommendations of the attending physician.
In such a situation, it really makes sense to conduct several courses of chemotherapy before the operation. Subsequently - surgery, after surgery - Herceptin and continued chemotherapy. So everything is correct.
Heptral is a hepatoprotector. As far as it is shown now, I cannot determine without an examination, you will have to rely on the attending physician in this matter.

Hope asks:

Hello. My mother was diagnosed with T4 N1M1 breast cancer, they said that metastases went to the lungs and to the cervical vertebrae. She has a wound on her chest and it does not heal, tell me what can be done. Doctors in Tashkent said that nothing could be done, but at the last stage they don’t go, as far as I know, but she walks. The truth is that he coughs a lot (cough is wet) and I don’t know what to do, how to help, where to take? Tell me please. Thank you waiting for an answer.

Responsible Filonenko Andrey Grigorievich:

Good day, Nadiya. I have no doubts that the diagnosis was made correctly, and I can effectively have the remaining stage. To confirm this, there is a wound that that constant cough does not drag on. With whom, it doesn’t matter what your mother is doing on her own. Sorry, spent more than an hour. The plumpness is already large, rozpovsyudzhen, and anti-puffy exuberance is effectively impossibly. Necessary care for the wound (dressing, fight against bleeding, fight against infection and odor), symptomatic relief from cough and reduced breathing (like in the empty pleura, a streak - puncture), obov'yazykovo anesthetic treatment (tablets of tramadol, plastiril) . To take your mother anywhere is not the next thing, all the next thing is to work at home.

Xenia asks:

My mother has adnexal cancer....the tumor under the armpit is very dense...she has already had 4 chemotherapy...the tumor has not decreased..now they have prescribed radiation..2 months...is it not harmful for so long??? ?and another question, can metastases appear after chemistry? when we went to the doctor .. there was no metastasis

Responsible Heavenly Evgeny Vasilievich:

Hello! Maybe you mean cancer of the accessory lobe of the breast? Refine your question. Actually, if I understood you correctly, the mother should have felt better. Just now the views on the treatment of breast cancer have changed. The survival rate (sorry for the rude word) of patients after surgical treatment and after conservative treatment is almost the same. Therefore, it is now not customary to operate on breast cancer widely. Sometimes chemotherapy and radiation are used as the initial treatment before surgery. Metastases can also occur after chemotherapy. But sometimes the increase and swelling of the tissue around the tumor is just the body's reaction to treatment. If I explained something wrong, please repeat the question more specifically.

Anastasia asks:

Good evening! On 30,07,13 I had an operation. Radical resection of the lion, of the mammary gland with plastic surgery with an oncoming flap. Infiltrative ductal cancer of the 2nd stage, malignancy, tumor growth is not present and there is no cancer in the mts. Final diagnosis C50.2 C-h of the upper inner quadrant of the left mammary gland,
pT1 N0 M0 G2.1st.
Histological examination: ER-negative, HER-negative, PR-70% weak expression, KI-95%.
After the operation, I underwent 2 courses of chemotherapy (cyclophosphamide, fluorouracil, doxorubicin), now I am finishing the irradiation on a linear accelerator.
I have a few questions
1) what is the percentage of survival, can a relapse develop, do I have a chance for a full recovery?
2) At first, my chemotherapist said that he would do a course of 4 chemo, and then he said that 6, to the question why at the first stage there are so many courses and such strong drugs are dripping on me, he says so? Is it possible to change to other more generous ones and take only 4 courses, I am only 27 years old and I would like to give birth again !!!
3) Do I need hormonal treatment according to the results of histology?

Responsible Filonenko Andrey Grigorievich:

Good afternoon
1) The survival rate in your case is quite high. More than 90% of these patients live longer than 5 years. Of course, most likely you will be completely cured with proper treatment. Unfortunately, it is impossible to insure against relapse.
2) The FAC regimen is standard in this tumor. The doctor insists on 6 courses, most likely due to the fact that the tumor turned out to be very aggressive (KI-95%) and does not have estrogen receptors. I recommend that you agree to 6 courses.
3) Indications for hormone therapy in the case of the presence of receptors only for progesterone (your case) are not clearly defined. Perhaps it makes sense to redo the immunohistochemical study. I would prescribe hormone therapy.

Yana asks:

Please decipher the diagnosis: "Cr of the right mammary gland st III b. Mts in the bones (T4N1M1), lungs (Th 12), 2cl.gr"

Responsible Filonenko Andrey Grigorievich:

Good afternoon Yana. I decipher: There is a malignant neoplasm (cancer) of the right breast with metastases to the bones and lungs. Th 12 is the thoracic 12th vertebra. Obviously, it was there that a manifestation of tumor metastasis was found. You can read more about breast cancer here: http://www.cancer.ic.ck.ua/index_4_3.htm st III b and T4N1M1 - this is a characteristic of the prevalence of the process. You can read in detail about the classification of TNM and in general about the stages here: http://www.cancer.ic.ck.ua/index_2_8.htm 2 cells gr (clinical group) - means that a special antitumor treatment is indicated. More details about clinical groups can be found here: http://alloncology.com/enciclopedia/0/12/.

Natalia asks:

Good afternoon! Tell me please. In the city of Lutsk, my mother was diagnosed with breast cancer, grade 2 B, and uterine fibroids were found. They prescribed at least 4 or 6 chemotherapy and then surgery (the doctor said that the breast would be removed completely). They said they would prepare for chemotherapy for 4 days, pierce some injections. Why I didn’t understand for 4 days, I know that chemistry in Kyiv is done for 1 day. Maybe the doctor is missing something? Tell me, please, with such a degree, how much is the probability of curing my mother? What is the treatment method? Can I come to Kyiv for a consultation and treatment? Mom is 66 years old.
Thank you.

Responsible Titenko Eduard Vasilievich:

Good afternoon. Most likely, 4 days of preparation for chemotherapy, given the age of the mother, will include drugs to maintain the cardiovascular system and liver function, antiestrogen therapy can also be carried out, given the presence of uterine fibroids. Grade 2B gives a high percentage of cure. : 4 courses of preoperative chemotherapy (neoadjuvant), then surgery (unfortunately, complete removal of the breast is not enough, in order to avoid recurrence), then 6 courses of postoperative chemotherapy, treatment can be supplemented with radiation therapy, but this is all decided after surgery. Treatment standards are the same in all oncology dispensaries , so it's up to you to decide whether to go to Kyiv.

Nina asks:

Hello! Thank you very much for your useful site.
I would be grateful if you help me understand the problem more deeply.
I'm 55 years old.
An operation was performed a month ago to remove the right breast and lymph nodes.

Invasive lobular, partly ductal carcinoma (M8522/3)
solid structure G3 with metastasis in 1 lymph node.

ER - "+++" expressed positive reaction
PR - " - " backlash
С-erbB2(HER2/new) - "+" negative reaction
Ki67 - 40%

20 sessions of radiation therapy
but there are doubts about chemotherapy due to its toxicity

what treatment is usually indicated in such cases and what drugs can facilitate its passage (nausea, etc.)
are there any dietary recommendations?
Thank you for your reply.

Responsible Filonenko Andrey Grigorievich:

Nina, good afternoon. Regarding special (antitumor) treatment: if lymph nodes affected by a tumor (like yours) are detected during surgery, chemotherapy significantly improves the chances of a complete cure (about twice). In other words, the probability of continued tumor growth without chemotherapy in your case is twice as high as if chemotherapy was given. You decide. In your case, 4-6 courses of chemotherapy with anthracyclines are indicated. In the future - hormone therapy for five years. To reduce side effects, so-called accompanying drugs are used. The doctor who will treat you during the chemotherapy period will definitely prescribe them and tell you everything.

Svetlana asks:

In June 2011 I had an operation for ductal breast cancer (left),
RE-5%, RP-60%, HER2\Neu 1+. Before the operation, there were two red chemo, after - six yellow ones. I am currently taking tamoxifen. I don't feel bad, I'm examined every 3 months.
Questions: 1. Do I need to change to another medicine.
2. Why is HER2\Neu 1+ (weakly aggressive) worse than 3+.
2. What is the prognosis for survival. I read that even with a three-time negative after 3 years, the percentage of survival increases. Thanks

Responsible Filonenko Andrey Grigorievich:

Good afternoon, Svetlana.
1. The choice of medication for hormone therapy depends on the age (more precisely, on the presence of menopause) at the time of the start of treatment. Tamoxifen is used in cases where menopause has not occurred at the start of treatment. I think that your appointments took this moment into account, so there is no need to change anything. The best results of treatment are obtained when taking tamoxifen for 5 years.
2. With HER2\Neu 1+, the prognosis is not worse than 3+. At least I do not know such data.
3. Indeed, the more time has passed without a relapse since the end of treatment, the more likely it is that there will be no relapse at all. So your prognosis is good.

Elena asks:

My mother has stage 3 B left breast cancer, what does this mean and is there any hope for recovery after surgery or how can I support the body after surgery

Responsible Filonenko Andrey Grigorievich:

Good day, Elena. Stage 3B means that the tumor has existed in your mother for at least 10 years (most likely in reality - much longer), and at the time of treatment has reached a large size and / or spreads to structures adjacent to the mammary gland. Therefore, most likely, treatment will be started not with surgery, but with drug treatment (chemotherapy). The next task is to reduce the size of the tumor. The distant task is to facilitate (and perhaps even make possible) the operation. Recently, the concept of treating advanced breast cancer has been changing. Instead of the desire for a cure, the desire to prolong life and improve the quality of life for a patient with a tumor comes to the fore.

Nick asks:

Hello. Mom has RM. Complete mastectomy of the right breast was performed. The tumor is hormone dependent. Tamoxifen was prescribed, but after 3 months of taking the drug, endometrial hyperplasia of the uterus was determined. The doctor suggests replacing tamoxifen with farestan. But farestan has a contraindication - endometrial hyperplasia.
The following questions arise:
1. Is farestan prescribed correctly?
2. Is it possible to get rid of endometrial hyperplasia without curettage?
I would be very grateful for an answer, since my mother lives in a small town and it is not always possible to go to the region to consult a doctor all the time, and it is not so easy to find a farestan.

Responsible Babik Andrey Ivanovich:

Good afternoon. 1) fareston was prescribed correctly 2) in this case, you need to switch to the next line of hormone therapy - aromatase inhibitors 3) why don't you ask your doctor all these questions? In the offices, everyone is silent, as if they have taken water in their mouths, and then at home, at the computer keyboards, inspiration dawns on everyone, and they begin to write to "Internet" doctors!

Natalia asks:

Is there a disability for breast cancer if the breast is cut off?

Responsible Medical consultant of the portal "site":

Hello, Natalia! Disability is established not by a medical diagnosis, but by the changes that the disease has caused in the patient's body. You can count on disability if, as a result of an illness, surgery or subsequent treatment, you have partially or completely lost your ability to work, the ability to take care of yourself. Women after surgery for breast cancer are often given disability group 2 for 1 year - for the period of chemotherapy or radiation therapy (since these types of treatment seriously affect the patient's ability to work). At the end of this period, the group is removed (again, in the absence of indications for extension). Take care of your health!

Svetlana asks:

Please tell me if treatment with another aromatase inhibitor - axostrol - is contraindicated if I have metastases in the bone after treatment in 2006-2007 of ductal carcinoma (mastectomy of the left breast)? After all, axo strol destroys the bone tissue itself, and I already have severe problems with the bones - a compression fracture of the 3rd vertebra and osteolytic metastases in the hip joint. Metastases were discovered in 2012. She underwent chemo and radiation. The pain syndrome has decreased significantly. But about hormonal therapy, I asked the doctor myself recently and she wrote to you on the page. The tumor was extra gene dependent. For 4 years she drank Femara and, when the cycle was resumed, she was injected with Diphereline. Now I am 41 years old

Responsible Filonenko Andrey Grigorievich: Mariana :

Hello! It would be desirable to learn or find out your opinion in occasion of spent treatment.
In December, I was diagnosed with a lump in my chest,
On January 21, they operated on - Dz: moderately differential. ductal carcinoma with lymphoid infiltration of the stroma.
Т1N0М0, G2
IHC: triple negative (EP, PR, Her2 - negative), ki67-50%.
February 5 - quadrantectomy with removal of tissue and LU, histology-sections and LU are clean.
The glasses were reviewed in the regional clinic, the DZ was slightly clarified: medullary carcinoma

To date, 3 weeks have passed since the operation, our city doctor suggests starting Radiation therapy - 6 courses, then CT - doxorubicin + paclitastel - 6 courses.

In the regional antitumor center - another treatment option:
4 courses in 21 days CT: paclitastel 300m + carboplatin 450m, after that Radiation on the operated breast

in the first variant, it is embarrassing that radiation is prescribed before chemistry,
in the second option - the fact that the drug regimen is not the same as in many cases read on the Internet.

What is your opinion - what treatment will be the most effective and correct?
Thank you in advance for your advice and explanations, I really look forward to your answer, I need to start treatment, I want to make the right choice.

Responsible Filonenko Andrey Grigorievich:

Good afternoon Mariana. I believe that it is necessary to irradiate immediately. The ideal is a combination of radiation and chemotherapy, but this combination is usually poorly tolerated by patients.
As for the choice of chemotherapy regimens, the problem is that there is no single approach to the postoperative treatment of triple-negative breast cancer. The first option (taxane + anthracycline) is actually better known, because actively used in all types of breast cancer. The second option (the use of platinum + taxane preparations) is used only in the case of a triple-negative variant, but is also well known. Currently, research is ongoing, and it is not yet possible to say which option is better.

Lily asks:

Hello, 39 years old, on 10/17/12 I underwent Madden surgery, please decipher my diagnosis pT2N1M0, 2B st., in 3 out of 8 l. nodes mts c-r. ER-90%, PR-40%, HER +1, KT67- 40%. After the operation, a month later, l. therapy was prescribed for 18 sessions, after it, after 2 weeks. - 6 courses of "red" chemistry. After 9 days of irradiation, a ball similar to an inflammatory lymph node appeared on the neck closer to the collarbone, then two days later a similar "ball" appeared under the armpit. I show doctors, they touch and are silent ..... Thank you in advance for your answer. Children are small, they really want to live ....

Responsible Filonenko Andrey Grigorievich:

Good afternoon Lily. The "balls" you are talking about could be tumor foci. This means that even before the operation, there could be microscopic tumors in these areas, which are now growing. This information is just a guess. To clarify, a histological examination of the "balls" may be needed. Doctors are silent, because they are afraid that such “balls” may also be in other places, in other organs. I think for now the treatment should continue as planned. Changes will be made later. I recommend that you follow the instructions of your doctors as accurately as possible, this is the only way for you to do everything in your power so that your children have a mother.

16.01.2018

QUESTION: Dear Vitaly Aleksandrovich, please comment on the results of immunohistochemistry: ER 0 points, PR 6 points, ki 67 30%, her2neu+. Stage 2c, G3. I understand that the tumor is aggressive. Correctly? Is it very bad when estrogens are 0 points? And what treatment would you recommend? Right Madden mastectomy 4 weeks ago. Thank you so much.

ANSWER: Hello! Yes, it is considered that she is aggressive and she needs to be treated with chemotherapy 4 AS (doxorubicin and cyclophosphamide) + 4T (docetaxel), then prescribe tamoxifen 20 mg, since progesterone is 6 points - this is also considered sensitivity to endocrine therapy.

16.01.2018

QUESTION: Vitaly Alexandrovich, according to the results of immunohistochemistry, her2neu=0. What does this mean? Is this good or bad? Thank you.

ANSWER: Hello! This means that you are not eligible for targeted trastuzumab therapy, which is good!

18.01.2018

QUESTION: Vitaly Alexandrovich, hello! According to the results of the trephine biopsy, the conclusion was obtained: Invasive cancer of a nonspecific type (ductal) G3, luminal type B, negative HER2. Immunohistochemistry: ER=PS5+IS2=7 PR=PS1+IS1=2 by Allred. Ki67 6%, HER2 neo 0. 68 years old. Stage t2n1m0. Only hormone therapy and surgery? What can be the forecast?

ANSWER: Hello! You don't have luminal type B, you have type A, which is usually treated with surgery and tamoxifen, but you have G3 and lymph node metastases, so you need surgery, chemo, and tamoxifen.

18.01.2018

QUESTION: Vitaly Aleksandrovich, why does a tumor respond better to chemotherapy treatment at higher ki 67 values?

ANSWER: Hello! Yes, there is such a statement, but it is not always correct and the tumor does not always respond to treatment!

20.01.2018

QUESTION: Vitaly Alexandrovich, good evening! IHC result: PR 0 points, ER 0 points, her2neu +, ki67=50%. Is it triple negative cancer?

ANSWER: Hello! Yes, it is, chemotherapy with taxanes is indicated!

22.01.2018

QUESTION: Vitaly Aleksandrovich, what are Allred points?

ANSWER: Hello! For you, in simple terms, this is a scale of scores for the expression of estrogen and progesterone receptors, or rather, a gradation of low-expressing receptors, medium and high-expressing. It serves to determine the purpose of endocrine therapy for breast cancer.

22.01.2018

QUESTION: Vitaly Aleksandrovich, what studies determine the presence of ER/PR receptors in breast cancer?

ANSWER: Hello! In our arsenal there is a standard study - immunohistochemistry, it is with the help of it that we can determine the expression of estrogen and progesterone, as well as other indicators.

24.01.2018

QUESTION: Vitaly Alexandrovich, what are the chances for a long remission with a cell proliferation index ki 67=90%? Thank you.

ANSWER: Hello! What are the chances? Why think about it, I will tell you that not only Ki 67 determines remission here, but also the subsequent treatment! The chances of remission are good, you just need to heal well after the operation!

27.01.2018

QUESTION: Hello, Vitaly Aleksandrovich! I have a question: is a tumor considered hormone-positive if IHC values ​​are: ER 3 b, PR 0, HER2 0 ki 67 = 12%. Can this be treated with aromatase inhibitors? Or just chemistry? T2N0M0 G2

ANSWER: Hello! Yes, it is considered a hormone-dependent tumor and it is luminal type A. Aromatase inhibitors are prescribed in this case, but other factors must be taken into account, for example, menopause or not!

01.02.2018

QUESTION: Good afternoon! Mom has breast cancer, T2N1M0. Help decipher morphology - PR: 5 (PS) + 2 (IS) = 7 points, (TS) ER: 5 (PS) + 3 (IS) = 8 points, Ki-67 = 45%.
HER/2-neu=1+. What type of cancer is it, what does the Ki indicator mean, what does its value indicate? And what are the predictions, if it is possible to say. Thank you very much in advance!

ANSWER: Hello! This type of cancer is luminal B, it is necessary to carry out chemotherapy and then drink tamoxifen! The prognosis for this molecular type of cancer can be different and depend on many factors. The most important thing is a positive attitude, live and enjoy life!
Here you can read about ki 67 which is a proliferative index:

11.02.2018

QUESTION: Good afternoon! Vitaly Alexandrovich, I handed over my glasses and blocks after the operation for breast cancer for re-checking at the urgent request of my girlfriend. And I don't know what to do now. Should I do another check? Because according to one immunohistochemistry, I have high hormone scores, and according to the other, they are completely absent. I don't understand how this is possible?

ANSWER: Hello! It makes sense to review it in the third place and ask your oncologist which analysis to believe, although it happens that the third analysis may be different, because the tumor itself is heterogeneous and the antibodies for determining IHC are different in different clinics, so the results are different!

13.02.2018

QUESTION: Hello Vitaly Aleksandrovich. I have breast cancer T2N1M0 undifferentiated. from 01/31/17-6 red chemistries, mastectomy, histology and IHC according to the material of the operation, 15 radiation therapy for non-removed lymph nodes. IHC was not performed before chemo. I'm interested in how inaccurate the IHC result is after chemo. I had a metastatic lymph node done. The swelling in my chest had completely dissipated. Her2/neu-(-); ER-(+++); PR-(-); Ki67<3%. Возможно что если бы ИГХ был до химии то Her2/ neu мог ли быть положительным??? Дело в том, что хирург к которому я обратилась на счёт операции мне отказал из-за того, что результаты ИГХ будут искажены, и он не сможет мне назначить правильно дальнейшее лечение.

ANSWER: Hello! In worldwide practice, Her 2neu does not change before and after chemotherapy, so this result is considered correct for you and you can rely on it! You should be glad you don't have her positive cancer!

14.02.2018

QUESTION: Vitaly Alexandrovich, how right am I in my statement that the result ki 67=0 happens only at the zero stage of cancer? Thank you.

ANSWER: Hello! At the zero stage, you can not watch it at all! This happens (ki 67-0) very rarely, in any case it is very good for the patient!

17.02.2018

QUESTION: Good evening! Please help me decipher IGH research - er o,
pr o, her2+++ ki 67 50%. What does this mean and what will be the treatment. Thank you.

ANSWER: Hello! This tumor subtype says that it is aggressive and requires chemotherapy and targeted therapy: doxorubicin and tascans are most often prescribed, followed by trastuzumab!!!

05.03.2018

QUESTION: Vitaly Alexandrovich, what does her 2 negative status mean? Thank you.

ANSWER: This means that the tumor does not require targeted treatment and the tumor is less aggressive, unless, of course, it is triple-negative breast cancer.

05.03.2018

QUESTION: Vitaly Alexandrovich, hello! What does it mean when her 2 neu is not amplified? Thank you.

ANSWER: Hello! This means that this gene is not detected in you, and the tumor does not require targeted therapy!

05.03.2018

QUESTION: Vitaly Alexandrovich, what is the forecast for ki 67=90%? Have there been long-term remissions in your practice with such a high ki 67? Thank you!

ANSWER: Hello! This is a poor result in terms of prognosis, this Ki 67 definitely requires chemotherapy! Of course, there were long-term remissions with such ki 67 in my practice.

05.03.2018

QUESTION: Vitaly Alexandrovich, according to the results of immunohistochemistry, my mother has triple-negative breast cancer. Does it make sense to remake IGH in another laboratory? Do you often encounter mistakes in your practice? Thank you.

ANSWER: Hello, sometimes it makes sense, but in this case I think not, since all three receptors are negative!