Dear Grace Faculty,
It's been awhile since my last post, but I have been following this site religiously. My mother has tested positive for the HER 2 gene amplication and our oncologist is suggesting that she enrolls int he Phase III blind efficacy and safety study of Dacomitinib vs erlotinib. Her chances of receiving the study drug is 50/50. Have you heard about this study? I was wondering what the difference was between the HER 2 gene amplication and the HER 2 overexpression? Is having one type better than the other in terms of survival and treatment? I have read on the internet that a study found that platinum based chemo is ineffective on the HER 2 gene amplicaton. My mother was previously given two cycles of cisplatin and etoposide last year and it did not work. Just wondering which treatment has been found beneficial for those with HER 2 gene amplication in NSCLC. THANK YOU so much.
Reply # - July 25, 2012, 01:58 PM
Reply To: HER 2 positive (gene amplication)
Hi Meanie, I hope the links I've posted below help.
You've likely seen this blog but in case you've not, http://cancergrace.org/lung/2011/03/19/her2-by-m/
This is an extensive conversation that I think deals with what you're looking for. http://cancergrace.org/lung/topic/clinical-trial-nct01259089/page/5/
And next is the continuation of that topic.
http://cancergrace.org/topic/clinical-trial
many apologies if I have this wrong. Let me know and we'll start again.
Reply # - July 25, 2012, 02:20 PM
Reply To: HER 2 positive (gene amplication)
Thank you so much for your response and links to the blog, but I have already read Dr. Pinder's blog about HER2, dated in March 2011. I also have been following up on Gail's updates on her clinical trial. I may be wrong, but I recall seeing anything in Gail's update stating that she is HER2 +. I just wanted to get some recent updates and studies about HER 2 gene amplification since Dr. Pinder's blog was posted over one year ago. I also want to know if any Gracers are HER 2+ and if so, what treatment they are currently on. THANK YOU.
Reply # - July 25, 2012, 04:43 PM
Reply To: HER 2 positive (gene amplication)
Sure thing meanie. I'll have a doctor respond soon. I figured you'd read all that. I did some reading on Gail's thread and realized that too. I was going on the drug used, Dacomitinib. Again I'm pretty much in the dark about this and am trying to catch up.
Janine
In the meantime, would you copy your bio and paste it into the forum profile signature? Access the signature edit by clicking on your username, meanie11 on the left of any of your posts.
Reply # - July 25, 2012, 05:40 PM
Reply To: HER 2 positive (gene amplication)
Dear Meanie,
There are 3 ways of looking at HER2 in cancer and they mean very different things:
HER2 overexpression: this is a way of staining a cell to see how much of a protein it is expressing, meaning that there is a lot of that protein around in the cell.
HER2 amplication: This refers to the HER2 gene rather than the protein. In some cancer cells, there are an excess number of copies (normally there should only be 2) of a particular gene.
HER2 mutation: This means that the HER2 gene is mutated, resulting in a gene that provides instructions for a protein that is different than the normal HER2 protein. Mutation may result in a protein that helps the cancer cell to survive. This is the case for EGFR mutations.
The evidence to date does not support the idea that HER2 overexpression and/or amplification can be used to predict the outcome for a patient or whether or not she will respond to a particular therapy. I personally would not test my patients for HER2 overexpression or amplification.
HER2 mutation in lung cancer, on the other hand, may predict a group of patients who respond well to HER2-directed therapies (such as Herceptin or Dacomitinib). Currently, studies in lung cancer of HER2-directed therapy are focusing on patients with HER2 mutations rather than overexpression or amplification.
I am familiar with the study you are referring to. A similar phase 2 study showed an improvement in PFS for patients who received dacomitinib compared to those who received erlotinib. Of course, a phase 3 study is needed to confirm these results. I would consider this a very reasonable study for one of my patients, regardless of mutation status.
I hope this helps.
-Dr. Pinder
Reply # - July 25, 2012, 09:41 PM
Reply To: HER 2 positive (gene amplication)
Thank you so much Dr. Pinder and Janine. Janine, I tried to edit my profile,but I can't seem to access it. Thank you.
Reply # - July 26, 2012, 12:59 AM
Reply To: HER 2 positive (gene amplication)
You can get it by clicking on your avatar. Then you want to edit "Forum Profile" and hit Submit or Save. Here is a thread explaining how to do it:
http://cancergrace.org/topic/grace-site-tips-profile-bio-forum-signature
And here's your existing profile:
4/2010:Mom 65y/o never smoker dx with NSCLC adeno stage 1A; 6/2010:VAT seg of the inferior lingular subseg of the left upper lobe (25mm X 20mm); 7/2011:biop (lymph node R2 0.8mm intranodal met) stage 3b; 8/2011:no EGFR/Kras mutation; 8/2011to 10/2011:concurrent chemo (cis/etop) and radiation; 8/2011:per card eff (atyp. cells); 12/2011: CT/Pet shows mets to (lytic) L2 vertebrae, 2nd left rib, 12mm liver lesion, and 5mm brain. 1/12: Stereotactic radiation to L2 and brain; 2/2/12: clinical trial (docetaxol/ramucirumab/placebo every 3 weeks). 3//12/12: hematoma and taken off of study drug and only on docetaxol, 7/28/12: progression and taken off of docetaxol (two lesions in liver, many nodules on lung, growth in multiple lymph nodes, and brain met (5mm). HER2 genetic amplication and considering Phase III tarceva vs docomitinib).
Best of luck to your mother.