Herceptin

[Joannie]

Hello:
I just returned from my 3 month check-up with my onc. I finished 4 founds of A/C and 4 rounds of Taxol in August of 2003. We discussed the option of Herceptin this a.m. She said NCI is only recommending Herceptin for those currently being diagnosed with HER2 and beginning treatment now and for those who are 6 months or less out from their last chemo. There is no evidence to show that it will help someone like me who is almost two years out from my last chemo. My dilema ~ how do I know it will help now, is it worth the risk. I was 1 node positive and Her2 3++. I had both breasts removed, including 7 nodes from the cancer side.
The onc. acted like I could get it, but she wasn't recommending it. It would possibly be my out of pocket expense.
I am not pretending to be a Dr. but everything I have read on this drug seems so promising. Where do I go from here? It seems that there is a subset of women, finsihed with chemo, no recurrance that the Docs don't know what to do with us regarding this drug.
I would appreciate any input!
Thanks a bunch!

[Bev]

Our situations are similar. I finished treatment in April of 2003 and I also had one node positive. My onc actually called me and suggested I go on Herceptin. He believes my risk of recurrance will be cut in half if I take it. My insurance has agreed to pay for it, so I will be getting my first infusion in the near future.


Bev

[Joannie]

Bev:
So you will be taking Herceptin by itself? Did you insurance have any issues with paying? Is the Herceptin supposed to be as effective when not given with traditional chemo drugs? So many questions......
Thanks!

[PatS]

My situation is similar to yours. I was diag. Stage III in July 2002 and finished chemo in Jan. 2003. I discussed this with my onc. a couple of weeks ago and she also said there's no way of telling whether it would help us as there's been no studies done of people in our situation. But, there's also nothing saying it wouldn't help us.There's a big ASCO conference later this and she said she's sure there there'll be a lot of discussion about herceptin and others in our situation.
She did say she thought she'd probably give it to me if I wanted but wanted to see what was said at the conference first. So I'm going to call her after the conference to discuss but right now am leaning towards taking it if she'll give it to me. I never thought I'd be volunteering for chemo again, but being at high risk for recurrence, I feel like I need any edge I can get. I didn't think to ask about insurance though, so I'll also need to see if that will be an issue.

[Question for Bev]

Good to hear your story, Bev. Did your onc. say how long you'll be on Herceptin? Weeks? 6 mo. or 1 yr.? Will you also be taking other agents? I think halving a recurrence is good medicine and it sounds like you've got good insurance, too. Good luck to you.

[madubois63]

" never thought I'd be volunteering for chemo again, but being at high risk for recurrence, I feel like I need any edge I can get.

Pat S: Herceptin is NOT chemo. It is considered Adjunct therapy You will not have the nausea or hair loss. I get it weekly (for now - as I am stage IV). I also get chemo 3 weeks out of the month. The herceptin only week is my easy week!!!!

--------------------------------------------------------------------------------------------How Herceptin® Works

What is a monoclonal antibody?
An antibody is a protein made by the body's own natural immune system. They are directed against foreign and infectious agents, called antigens. Monoclonal antibodies engineered through biotechnology are produced to provide specific anti-tumor action within the human body.

Monoclonal antibody therapy works in a different way than standard cancer therapy, such as chemotherapy or hormone therapies. HERCEPTIN® (Trastuzumab) is believed to function in three different ways:

1) Blocking tumor cell growth:
HERCEPTIN binds to the HER-2 proteins (receptors) on the tumor cell surface. The HER-2 proteins, with HERCEPTIN® attached, are pulled back into the cell. When the HER-2 proteins are no longer on the cell surface, they can no longer tell the cell to grow and divide.

2) Signaling of the immune system:
HERCEPTIN attaches to the HER-2 proteins (receptors) on a tumor cell. Then certain immune system cells, called natural killer (NK) cells, are attracted to HERCEPTIN®. The NK cells detect that the cell is abnormal, and attach to HERCEPTIN®. Finally, the NK cells kill the tumor cell.

3) Working with chemotherapy:
HERCEPTIN and chemotherapy work in different ways, but when given together, the two drugs can form a partnership. For example, when Herceptin® is used with chemotherapy that attacks and damages the DNA in the cell nucleus of tumors, Herceptin® stops the cells from repairing themselves. Because these damaged cells cannot heal, they die. This slows the growth of tumors.

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Herceptin Side Effects
Words on this page

• Herceptin
• Adriamycin
• side effects
• Taxol

Herceptin has some side effects, but the good news is that it doesn't cause the hair loss and nausea associated with most chemotherapy drugs.

Mild side effects
Herceptin causes flu-like symptoms in about 40% of the women who take it. These symptoms may include fever, chills, muscle aches, or nausea. These side effects generally become less severe after the first treatment. Other side effects, including low white or red blood cell counts, diarrhea, and infections, are seen in some women receiving Herceptin in combination with chemotherapy, but are rarely seen in women taking Herceptin alone.

Serious heart side effects


Less commonly, Herceptin can damage the heart's ability to pump blood effectively. Rarely (about 5% of the time), the heart damage is bad enough that women experience stroke or life-threatening congestive heart failure—a condition in which the heart can't pump effectively. Slightly more often (about 7% of the time), Herceptin causes mild heart failure.

Women who experience mild or more serious heart damage can stop taking Herceptin and start taking heart-strengthening medications. This often brings heart function back to normal.

While heart damage can be more severe when Herceptin is given along with other chemotherapy drugs known to cause heart damage, including Adriamycin (chemical name: doxorubicin) and possibly other drugs like it.

Taking Herceptin with the chemotherapy drug Taxol (chemical name: paclitaxel) does not increase your risk of severe heart damage. Studies have shown that this combination causes only slightly more mild heart damage than Herceptin alone. Women in clinical trials who are receiving Herceptin plus Taxol are being watched very closely for this effect.

Testing your heart before and during Herceptin treatment
Before starting Herceptin therapy, you should have an echocardiogram or a MUGA scan to check how well your heart is functioning.

An echocardiogram uses sound waves to take detailed pictures of the heart as it pumps blood. For this quick test, you lie still for a few minutes while a device that gives off sound waves is briefly placed on your ribs, over your heart. There is no radiation exposure with this test.


A MUGA (multigated blood-pool imaging) scan takes about an hour. In this test, a tiny amount of radioactive material is injected into a vein in your arm. This material temporarily hooks onto your red blood cells. You lie still while a special camera that can detect the radioactive material takes pictures of the blood flow through your heart as it beats.
When you first start taking Herceptin, your doctor might want you to have MUGA scans or echocardiograms every few months to detect any sign of heart failure. But after you've been on Herceptin for a while, you may need a heart-monitoring test only every 6 months or so. This is because heart failure is less likely to occur the longer you take Herceptin.

If you're taking Herceptin, be sure to notify your doctor immediately, or go to the nearest emergency room, if you develop any symptoms of heart failure. These symptoms include shortness of breath, difficulty breathing, a fast or irregular heartbeat, increased cough, and swelling of the feet or lower legs.

Serious lung side effects
According to Genentech, the company that makes Herceptin, 62 of the approximately 25,000 women who had taken Herceptin as of 2001 had a serious reaction to the medication. There were two types of serious reactions: allergic–like reactions and lung reactions. Symptoms of the allergic–like reactions included hives, wheezing, and trouble breathing because of swelling and muscle spasms of the airwas. Lung reactions included swelling of the lung, low blood pressure, or fluid buildup around the lungs (called pleural effusions).

Fifteen of the 62 women with serious reactions ultimately died of complications from these reactions. Since approximately 25,000 women have taken Herceptin, the chance of these life–threatening reactions is quite rare, much less than 1% (15 out of 25,000). In most cases (about 75%) this reaction happened within the first 24 hours of the first dose of Herceptin. The rest of the time, it usually happened within the first week of the first dose. Only occasionally did reactions occur with the second or later doses.

The reactions are more severe if you've already had lung disease, such as asthma or emphysema, or if the breast cancer has spread significantly into your lungs.

If you are currently undergoing treatment with Herceptin and have been tolerating it well, you're very unlikely to develop these serious reactions.

Even though the severe side effects are relatively rare, your doctor should check you carefully for any heart or lung problems before starting to treat you with Herceptin. You should also be monitored closely for these serious side effects during treatment.

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DG DISPATCH - BREAST CANCER: Herceptin, In Adjunct Therapy, Reduces Tumor Size

By Robert Carlson
Special to DG News

SAN ANTONIO, TX -- December 13, 1999 -- Herceptin, the drug made from an antibody which works against the most aggressive types of breast cancer, is being teamed up with several different standard chemotherapy drugs in a search for synergistic activity.



A trial based at the M.D. Anderson Cancer Center in Houston is testing Herceptin and paclitaxel, while researchers at the Dana-Farber Cancer Institute in Boston are combining Herceptin with vinorelbine.


Herceptin is a monoclonal antibody which treats breast cancer by blocking the HER2/Neu protein from attaching to breast cells. HER2/Neu, a growth-factor gene found in normal as well as in cancerous cells, produces the protein.


In normal cells, the gene and its protein are thought to promote cell growth by signaling the cell to divide and multiply. Breast-cancer cells which produce an excess the HER2/Neu protein have an excess of receptors on their surface, which transmit the signal for the cancer cells to multiply at an accelerated rate.


Between 25- and 30 percent of women with breast cancer have tumor cells which overproduce HER2/Neu. Treating these women with Herceptin can interfere with the biological process of those tumor cells and cause the tumor cells' death.


Francisco J. Esteva, MD, M.D. Anderson Cancer Center, Houston, gave an update on the condition of 62 women being treated with a combination of paclitaxel and Herceptin for advanced breast cancer.


Both drugs are being given once per week. This was of considerable interest to the researchers here because paclitaxel is more commonly administered once every 21 days.


Dr. Esteva reported that 64 percent of the women had responded to the two-drug combination, meaning that their tumors had shrunk in size by 50 percent or more. In three women, the tumors had shrunk completely.


Interestingly, the combination also reduced tumor size by 50 percent or more in 37 percent of those women found to have tumors that did not produce an excess of HER2/Neu. This was unexpected because, theoretically, the Herceptin should have no effect on HER2/Neu-negative tumors.


In a separate presentation, Eric Winer, MD, Dana-Farber Cancer Institute, Boston, described preliminary results of a treatment that combines Herceptin with the standard anticancer drug vinorelbine. Both drugs are being given once weekly.


Among the 34 patients who have been treated long enough to be evaluated, 71 percent have had their tumors shrink by at least 50 percent.

[Bev]

My insurance pre-approved the herceptin, and I will be getting it alone. My onc feels that there are benefits for me in just getting the herceptin, and he's up on all the latest information, so I trust him. His thinking was that if herceptin helps those with mets when it's given alone, it should also be able to get rid of anything I might have lurking around.

Bev

[Bev]

I'll be getting an infusion every 3 weeks for one year. I'm not getting any other chemo drugs, but I do take arimidex which I will continue with. My insurance is Blue Cross. I have to say that I'm surprised they approved this treatment, but I'm thankful they did.

[Barbara2]

My situation is similar to Bev's. I am Her2+ and had one positive node in Oct 02. I finished chemo in March 03. Did not receive herceptin.

Last week I saw my onc and he agreed to give me herceptin now. He said we would proceed as was done in the trail with 52 treatments.

I am currently waiting to see if the insurance will pay, and I am hopeful that it will. As soon as we get the word, which should be today or tomorrow, I will get the port put in, wait a week or so, and start treatments. I, too, will continue taking Arimidex.

Barb