Better diagnosis, treatment for HER2 breast cancer

MANILA, Philippines - At a recent medical symposium, pharmaceutical company Roche invited Dr. Anthony Michael Bilous from Australia who talked on “Managing the Patient with Cancer — The Surgeon and Pathologist Working Together.”

Bilous, a clinical associate professor at the University of Sydney, NSW, Australia and a member of the International HER2 Testing Advisory Board, shared his insights on how pathologists can work hand in hand with surgeons to better manage their cancer patients efficiently through more accurate HER2 test results.

He focused on making HER2-testing more efficient and accurate, citing how proper diagnosis and treatment are highly dependent on correct pathological diagnosis/report, which can be done by following certain guidelines for sample collection and operating room procedures.

Bilous said pathologists are an important part of the multi-disciplinary team responsible for the care of a patient with cancer. Pathologists are responsible for providing information about the cancer, thus guiding the patient’s personalized health care and therapy.

Through the prognostic and predictive information that pathologists provide, oncologists can better assess and diagnose cancer patients and more accurately plot out their treatment protocol.

However, the information pathologists provide depends on receiving optimal, oriented tissue samples.

“Pathologists can provide important and accurate information with prognostic and predictive factors such as local control and extent of spread of the cancer,” Bilous said.

“However, in order to be able to precisely ascertain this information from the tissue samples, these need to be taken properly and given immediately to the pathologist,” he added.

Pathological diagnoses are important in every cancer. However, in some cancers such as breast cancer, additional information is required to help select the most appropriate therapy.

Human epidermal growth factor receptor-2 (HER2), in particular, has critical implications for patients with breast and gastric cancer. HER2-positivity portends a poor prognosis: HER2-positive cancer is likely to spread faster and is associated with shorter survival. Thus, treatment that specifically targets HER2 protein is invaluable.

Pathologists, technicians, surgeons and oncologists all play a pivotal role in ensuring that HER2 status is accurately determined and that patients receive appropriate treatment without delay.

According to Bilous, the SPHERE (Scientific Partnership for HER2 testing Excellence) program is an Asia-Pacific educational and training initiative that aims to promote and facilitate excellence in HER2 testing in breast and/or gastric cancer across the region. This is led by international experts and supported by Roche. 

“SPHERE began in 2011 with the pathologists and medical technologists in several development meetings and the culmination is the 18-month SPHERE Regional HER2 Testing Audit which has already started to enroll laboratories all over the APAC region,” Bilous said.

The program involves countries like Korea, Taiwan, Hong Kong, Malaysia, Indonesia, the Philippines, Thailand, and Vietnam. Feedback and insights will be collected and collated as SPHERE progresses,” Bilous said.

SPHERE in 2012 expanded to include collaboration with surgeons so that standardization of tissue handling for HER2 testing will be enhanced. This includes factors such as method of tissue processing, time of fixation, type of fixative, and laboratory procedures.

Through SPHERE initiatives, more comprehensive details will be taken into consideration to ensure a high-quality HER2 testing that would greatly increase accuracy of diagnosis and treatment.

These include transporting tissue samples to the lab promptly, preferably enabling slicing and fixing within 20-30 minutes, providing specimens to the laboratory fresh and oriented using sutures or clips, and providing documentation for the time and date of specimen acquisition in surgery.

“Steps such as these will ensure the HER2-testing is accurate and complete. This, in turn, will give oncologists the proper information to guide them on appropriate treatment and medication for the cancer patients,” Bilous said.

To learn more on HER2 testing, visit www.her2testing.org.