Can Herceptin help to control brain mets?

[Ally]

I wonder if anybody here knows if Herceptin crosses the blood/brain barrier? Has anybody found that when used it helps to control brain mets.

I am asking on behalf of a friend.

Thank you

Ally x

[Kristen]

Ally,

From what I have read on this board. No, I am sorry it cannot. The molecules are to big to cross over and that seems to be the problem with a lot of the drugs out there that help us else where but not the brain.

I wish your friend the best and if you would like to give more info to us about her that might be useful to help guide you to a place that can help her. take care k

[imported_Joe]

[3053] Incidence of brain metastasis (BM) in HER-2 overexpressing metastatic breast cancer (MBC) responsive to trastuzumab.

Stemmler J, Kahlert S, Siekiera W, Heinrich B, Untch M, Heinemann V.. Munich, Germany; University of Munich, Munich, Germany; Oncology Practice, Augsburg, Germany

Objective: The aim of this analysis was to determine the incidence of brain metastasis (BM) in HER-2/neu overexpressing MBC patients. A specific focus was the rate of BM occurrence in relation to response of other metastasis to trastuzumab treatment.
Patients: Among 136 HER-2/neu overexpressing patients, 42 (31%) were identified who developed BM. Her-2/neu overexpression was determined by immunohistochemistry and reached a score value of 3+ in the Hercep assay (Dako). Trastuzumab was generally applied at the standard loading dose of 4mg/kg and a weekly maintenance dose of 2 mg/kg.
Results: In one patient BM was the only manifestation, two further patients showed synchronous brain- and visceral metastasis, and a third patient developed bone metastasis after diagnosis of BM. All other patients (n=38) had received trastuzumab either as a single agent or in combination with chemotherapy prior to diagnosis of BM. In these patients,
Here is a summation of a study presented in San Antonio, just two weeks ago.

Ally, How is the radiation going?

Regards
Joe


the median interval between visceral and brain metastasis was 18 months (range, 7-69 months). At the time BM was diagnosed, 22 of 38 patients showed a response of visceral metastasis during systemic treatment (OR: 58%, 95%CI: 41-74%; liver: 5 CR, 9 PR, lung: 1 CR, 6 PR, pleura: 3 PR). Among the 42 patients with brain metastasis, the median survival from diagnosis of BM was 7 months.
Conclusion: It is concluded that trastuzumab is highly effective for treatment of liver- and lung metastasis in HER-2/neu overexpressing patients, while it appears to be ineffective to prevent or treat brain metastasis. Since nearly one third of HER-2/neu overexpressing patients developed brain-metastasis, close surveillance for BM (clinical and/or imaging) is necessary even during effective systemic treatment.


Date: Thursday, December 09, 2004 04:30 PM
Session Info: Poster Session: Treatment: Antibody-based Regimens (4:30 PM-6:30 PM)
Presentation Time: 04:30 PM

[Ally]

Thanks for your reply Kristen

She has not been dx'd HER2+ but it was suggested by her doctor that she had the test and although she has now had WBR the HER2 test has not been carried out yet and I was wondering how important it was to get it done asap, but if Herceptin wouldn't help then I don't suppose it matters too much.

Ally xx

[Ally]

Thank you Joe

The WBR is finished and another scan has just been carried out. It showed shrinkage of the 3 original tumours but there are further 'twinklings' showing up on the new scan.

Do you know, can WBR be carried out again?

Ally x

[imported_Joe]

Ally,

I am happy to hear of your progress. It depends on how much radiation that you were given. Here in the US, they mostly administer the maximum lifetime amount of radiation when they give WBR.

If mets reappear they are generally treated with Gamma Knife.

Regards
Joe

[Kristen]

Ally,

I am no Dr. but I have read so many posts here about brain mets, I would have the test done ASAP.

A lot of women here who have BM stay on herceptin, they feel that it works to slow or hault the progression that may or have become met in other areas.

For example, Velva just had WBR and now has skin mets. I don't know if she is still on herceptin or not. I don't think anyone here feels that herceptin alone will ward off all the bad bugs but it can in some instances and we all know it works great in conjunction with other chemo agents.

I would go with the Dr. suggestion and it can't hurt to have it added to her regimine. The side effects are minimal as long as her heart is good. She will have to endure a muga test or ekg every so often to make sure it is still functioning at a certain level..If she falls below that level going off herceptin for a couple of months has shown the heart ample time to heal it's self and then most women will go back on it.

Ally you are such a good friend. We all have our support systems, but I don't know many who actually go on line and ask q's for there friends. You are very special and I hope to hear updates on your friend. Take Care K

[Lolly]

Ally, so nice to hear from you again and know you're making progress against the mets. In my mind is still a picture of you after your big swim, standing there with such a big grin. Keep fighting those mets, and you will win again!

Love, Lolly

[Celina]

Ally,

It would appear that the standard WBR given is 20 days. We live in Canada and my sister, who has numerous brain mets was given only 5 treatments. Her rad. cited some studies (which I never read) stating that there wasn't a significant difference if a patient did lessn WBR. He did said that because she had a small dosage, she could repeat WBR in the future if necessary. I'm not sure what to think about this, especially because there are still 20 small leisons...I keep wondering if they would have been gone if she would have had more treatments. He also said that even an MRI can't distringuish healing tissue with small mets...so of course we are hoping that the spots will remain just that..spots!

Happy Holidays,
Celina

[Velva]

Ally,
I haven't posted the last few days because I've been feeling so miserable w/skin mets.
Clarification: I elected not to have WBR at this time. I had 1 BT that grew for known 10 months, probably a year w/ no other mets. So, I'll have an MRI at 3 mos. & we'll see.
My onc was going to put me on Taxotere/Carboplatin/Herceptin, but put me on Taxotere only for first tx, will see her this Thurs.. I don't think it's working by itself. The skin mets showed up (3rd X) 1 wk before starting Taxotere. I don't know if Herceptin slows it down, but it is supposed to work better in combination. My onc is concerned about my heart, but I can always stop Herceptin if my EF drops.
Hope this helps your friend, I agree with Kristen, she should be tested for HER2. Positive thoughts, V