Lungs Mets - Decision Time

[Mike]

Hi everyone,

My wife's condition is:

7/12-1.6*1.2 CM local reoccurence (ER+, PR-, HER2+++) with Lung
Mets, 2 spots in both lungs, size from 2-4 MM.
Completed Gemzar/Armidex 3 Cycles (3-on, 1-off)

9/28 - cat scan shows 4 tumors in lungs - ranging in size from 2-6 MM - local
reoccurence is the same size

Started new treament - Gemzar/Herceptin and Fasoldex(monthly), Herceptin weekly, High Dose
Gemzar 1200 Ml every 2 weeks, 1 week off. Had 3 cycles

11/30 - can scan shows 6 tumors in lungs - ranging in size from 2-8 MM - local
reoccurence is the same size

we are waiting to meet with onc later this week to discuss treatment plans

Here are my questions:

-Anybody else with similar experience? Gemzar is not working and not sure about Herceptin
-I think the onc will keep herceptin but switch chemo to navelbine - Comments?
-What about going straight to a taxotere/carboplatin/herceptin combination?
-Is it strange the the local reoccurence has stayed the same size while the nodules
in the lungs keep growing?
-Should we push for biopsy on the lung nodules?

Just some things I am thinking about - thanks very much,

-mike

[CathyB]

Mike - hope you get this but I am not exactly sure how to respond on the new site. At any rate, just wanted to pass along that I have several lung nodules along with skin mets. I was on Gemzar/Herceptin for approx 5 1/2 months and that combo did nothing for me. Recently started Avastin with the Herception and have had three cycles. My skin mets for the first time have been significantly reduced and it is my hope that the same thing is happening internally. I won't be having a scan for another 6-8 weeks but thought you might want to mention Avastin to your onc as one of the possibilities to be considered. All the best, CathyB

[judiek]

Mike,

I replied to you on another board regarding avastin...please read that post.

Warmly,

judiek

History

Discovered lump Sept. 2002 (mammo didn’t pick it up)
Dx Oct 2002-just turned 41
IDC and pagets disease, stage 2B, grade 3/3, nottingham scale 9/9
3cm, lumpectomy,clean margins
er/pr-pos, her2 neg, 2/25 nodes w/cancer
Nov 2002-March 2003-FEC (5fu, epirubicin, cytoxen)
March 2003- started tamoxifen
May 2003- finished rads (33tx)
June 2003-CT/PET Scan- clear
Started 3 month check ups w/lab
Dec 2003-complete hysterectomy
Jan 2004-extensive mets, both lungs & liver(labs normal)
Jan 2004-stopped tamoxifen
Feb 2004 CEA-23 (0-3 normal) CA27.29-66.1 (0-38 normal)
Feb 23to current-clinical trial, taxol & avastin
April 15th, 2004-CT-significant shrinkage on all tumors/plueral effusion gone
June 8th 2004-CT-all liver lesions decreased in size/lung mets gone
Aug 9th, 2004-CA27.29 is 22.3, CEA is .8)
Aug 9th, 2004-Brain-CT neg, lung mets/pleural effusion still gone, liver mets had slight shrinkage. Largest hypodesne lesion is 2.1cm, 6 others 1cm or less.
Sept-Tumor markers on the rise
Sept 13th-bone scan negative, mri revealed herniated disc.
Sept 27- Ct of brain, negative/lung mets still gone/ 2 liver lesions gone, 4 under 1cm, 1 @1.7cm.
Oct 5-CA27.29 down 9 points (29.9)
Nov 1-CA27.29 up 33.3, CEA 1.8
Nov 29-CA27.29 is 24, CEA is 2.4
Nov 29-CT shows stable, lungs still clear, liver tumors stable

[Lolly]

Mike,
I haven't had lung mets, but have had local and regional recurrence(skin mets in mast. scar and over collarbone, and tumors in lymph nodes over collarbone and in neck and axilla). The first recurrence was treated successfully with Navelbine/Herceptin, as was the second recurrence which didn't include skin mets. Both regimens were weekly tx, for 6 months. I just finished up the second regimen. Navelbine is fairly tolerable for most, although blood counts will drop and she'll probably need injections to keep counts up. It's got a good track record for breast cancer mets, and was initially developed as a treatment for lung cancer. The difference in response between the local recurrence and the lung lesions is strange. It's good the local recurrence has remained stable, but obviously something has to be done about the lungs...If it were me, I would push for the most aggressive treatment for the lungs now, follow-up scans in a month to determine if there's any change; if not at least stable then biopsy. From what I know from other's experience here, the most aggressive tx would include one of the platin's...they can be very effective in combination with Herceptin. Please keep us posted, and take care.
Lolly

[StephN]

Hi Mike -
I think you have been posting as treatment evolved with your wife. The lung spots are worrisome and I would definitely want to know more about them. I would want to find a way to determine that they are REALLY breast cancer mets and not something else happening concurrently. I would push for a PET scan if not a PET/CT new type of scan. Lungs are often quite difficult to biopsy, but check this idea out.
Navelbine was a good drug for me, as I have visceral dominant mets in my liver. Now they are gone due to a tough weekly regimen of navelbine, taxol and herceptin. I know many other mets patients who have had good response to Navelbine.
Let is know what you all decide. All the best for some positive results.

[Patty H]

I have lung mets and we just keep switching chemos. The first time navelb ine didn't work for me so we went to carbo-taxotere and herceptin. It worked the first time around but then stopped, so we went to xeloda. I then took a break and went back to navelbine and this time it is working. I just finished my third cycle of navelbine so one more and it will be time for a scan. We treat this like a chronic illness and just keep trying different things. Best of luck Patty H

[Peggy in Orlando]

I was diagnosed with lung mets about 18 months ago. In my case they were able to surgically remove the one nodule they found.

The chemo I had after that for the next 6 months was Herceptin and Navalbine. I found that combo pretty easy to tolerate. Sometimes my counts got low - mostly a result from the Navalbine. Some slight hair thinning but not what I would call hair loss.