HR+ breast cancer flipping biomarkers

I have reason to suspect HR+ breast cancer (even stage IVers) is going to get a cure (90+% 5 year survivability) pretty soon, within a few years.    But cancer is an evolutionary disease.   So I'm interested in understanding the phenomenon of HR+ BC flipping into triple negative type BC.

http://breast-cancer-research.com/content/14/3/r71



http://www.medscape.com/viewarticle/805441_4

Total of 11 triple negative patients.  5 of whom were stage III at start of study.   6 of whom were either NED stage IV or maybe stage II.    Total of 2 relapsed.   Very small study.

Quote from this article:  To gain a better understanding of the targets of TM, we measured circulating markers of angiogenesis. SDF1 and its receptor CXCR4, involved in angiogenesis and metastatic progression, may have a role in EPC recruitment.^[36,37] In breast cancer patients, expression of SDF1 has been inversely correlated with survival.^[38] In our study, SDF1 decreased with copper depletion but increased before relapse. Likewise, MMPs increased in patients before relapse. MMPs regulate tumor growth and invasion^[36] and provide a permissive bone marrow niche to facilitate mobilization of progenitor cells.^[39] Our observations suggest that SDF1 and MMPs may have important roles in metastatic progression.

Though a randomized clinical trial is necessary to assess survival, efficacy measures were promising. Of 11 triple-negative patients on study, only 2 relapsed. One patient did not adequately copper-deplete despite incremental dose increases. The other patient progressed within 2 months of TM therapy, suggesting that active neoangiogenesis was occurring at the time of enrollment, which could not be halted due to delayed effects of copper depletion. We are cautiously optimistic about the low incidence of relapse and have extended the study to 6 years in selected patients. Two stage-4 NED triple-negative patients remain disease-free at 65 and 49 months on TM therapy, which is encouraging given the dismal median survival of 9 months in metastatic triple-negative patients

http://www.ncbi.nlm.nih.gov/pubmed/23686707

http://www.ncbi.nlm.nih.gov/pubmed/22825030

http://www.ncbi.nlm.nih.gov/pubmed/22510516



I'm reading this with interest because ovarian cancer is linked and related to some type of TN breast cancer
http://www.cancernetwork.com/ovarian-cancer/content/article/10165/2148722