Effect Of Herceptin On Primary Tumour

[heblaj01]

From many posts on this forum it appears that Hercetin alone (or in combination with Navelbine) has dramatic beneficial effects on metastases.
But what about the primary tumour if it has not been surgically removed?
How soon does it start to shrink?
Can it be eradicated & if not can its size be sufficiently reduced (say 1cm or less) to allow surgical excision under local anesthesia (as opposed to general anesthesia which is risky in the case of elderly patients with cardiovascular problems)?
Has anyone experienced treatment along these lines?

[al from Canada]

What you are talking about is neo-adjuvant tx. What you say makes sense however, it is an extremely small percentage of women who experience benefit from herceptin alone, with herceptin being the entire tx plan. Herceptin is most effective as an maintenance drug, ie after surgery.

Al

[tousled1]

I had a very large primary tumor with axillary lymph node invovement. I agree with Al that it's the neoadjunct chemotherapy that helps shrink primary tumors.

I went through neoadjunct chemo. Had 4 rounds A/C and 4 rounds Taxatore. The Taxatore was what really helped the primary tumor -- it did not actually shirnk it but did manage to kill the active cancer as shown by a PET scan. With some women the neoadjunct chemo actually does shrink the tumor -- sometimes completely. Even then it is recommended that you have surgery.

[callen03]

Herceptin keeps the cancer from spreading. It is the chemo that actually shrinks the tumor.

[heblaj01]

Thanks to all for replying to my initial post.
Since Herceptin is not shrinking primary tumours & for those who are unable or unwilling to tolerate chemo for that purpose, I am inclined to consider radiotherapy (especially if it can be combined with local hyperthermia as described in abstract below) as a way to downstage the primary tumour prior to surgical excision.

Has anyone undergone radiotherapy of primary tumours at the same time as getting Herceptin? or after?



17TH INTERNATIONAL CONGRESS ON ANTI-CANCER TREATMENT (jan-feb06)

http://www.icact.com/Abstract_Book_ICACT_2006.pdf (p.181)

■ POSTER SESSION

Effect of Local Hyperthermia combinedwith External Radiation Therapy as AntiCancer-treatment in Recurrent Breast Cancer
Rigler Marcus Yves, Spenger M, Lenhart U.med-uni-graz - Graz - Austria

Hyperthermia combined with radiation therapy has been confirmed in several randomised studies to be more effective than radiation therapy alone in various cancers. We evaluated the potential synergistic effect of local hyperthermia and conventional external beam radiation.

We used a wave-guide applicator with a typical emitting diameter of 15 cm and a frequency of 150-430 MHz with a therapeutic depth of 3 cm. Hyperthermia was performed for 60 minutes for at total of six sessions, twice weekly, the temperature was exactly calibrated between 40and 43 degrees C. Immediately after hyperthermia external radiation with 60 Gy was applied in a daily fraction of 1.5 Gy. No major side effects were observed during hyperthermia.

Twelve patients were treated and followed for during 2-12months. Ten of the tumours responded to the treatment (3 CR, 7PR), two patients died of distant metastases within one year.Local hyperthermia combined with conventional radiation therapy may be useful tool to promote tumor regression and the local recurrence-free survival in cases of recurrance breast cancer.We conclude that hyperthermia and radiation therapy is effective in treatment breast cancer treatment and should be used in selected cancer patients

[Taffy]

Yours was an interesting post Hebladj. I am on Herceptin after chemo failed to shrink my tumour. After my first dose of Herceptin I noticed shrinkage after four days. This has continued and I just had my second dose yesterday. My breast tumour went from the size of an orange to the size of a golf ball in just three weeks and is continuing to shrink.

My breast was very hard and red prior to Herceptin but is now soft and smaller and I can actually feel the breast tissue rather than the huge mass that it was before. I am eternally grateful to have been given the chance to try this drug. I do realise that my experience is slightly unusual and other people may not have such dramatic results as myself.

love
taffy

[heblaj01]

Hi Taffy,
After reading the preeceeding posts by Al, tousled1 & callen03 it appears I concluded too quickly that Herceptin is never able to shrink primary tumours.
So your post was a big but pleasant surprise to read.
Was it also a big surprise to your onc?
Did he express any speculation as to what may have made you respond so well to Herceptin?
His opinion,if he has one, may be interesting.
Was there anything special in your previous treatments, markers, or in your diet or supplements?
The only thing I can come up with (& it seems quite outlandish) is that the breast tumour is not the primary cancer but a met. I can't believe myself.

[R.B.]

Question.

What is it about chemo that is claimed to activate tumours to herceptin?

How long does the effect of chemo continue after completion of administration (washout)?

If herceptin is reliant on chemo and chemo washes out what is the logic of long term herceptin if it will not work without chemo?

Why should chemo impact on the reported ability of Herceptin to block FAS pathways which is recognised as a having significant in vivo anti tumour effect ( and herceptin may also work at other levels)?

So many questions.

RB

[Taffy]

Hi Heblaj!

My tumour is a new primary/recurrance. I had better start from the beginning!

I live in the UK, by the way, so you might not be familiar with some of the chemo mentioned here. Anyway, here goes!

I was diagnosed in 2003 with a large tumour in my right breast. I had a mastectomy, FEC chemo and rads. I was then put on Tamoxifen for five years. All was well until last year when I developed a tumour in my left breast. This was dismissed as 'hormonal' and a few months passed before I could convince them to take me seriously. By the time they did, I had skin involvement. I was put straight on Taxotere in order to shrink the tumour prior to surgery. This didn't work and after five doses I was transferred to EC.

The EC did shrink the tumour but not enough for surgery. My onc put me on Herceptin and was going to try another chemo along with it after the first dose. However, when I saw him last week just prior to having my second dose of Herceptin, he was amazed at how much my tumour had shrunk with the Herceptin alone and told the nurse to 'Scrub the chemo, lets continue with Herceptin alone'!

The Herceptin has worked far, far better than the EC. It took four ECs to shrink my tumour a little, but with only one Herceptin it went from the size of an orange to a golf ball. Before starting Herceptin, I could not press my breast in ....... it was like pushing against a rock. Within a week of my first dose I could press my breast and feel it go in. I can even feel my ribs under the breast tissue now! There is still some tumour there, high up in the outer quadrant of the breast but the rest of my breast is now soft. The skin nodules are also healing rapidly. My onc called it amazing!

I don't take any supplements only Omega 3 oils from Wilkinson's (a store) and occasionally iron tablets. My diet is normal, no special foods or supplements there either.

I am on Arimidex one per day as well as the three weekly Herceptin.

Hope this helps you Heblaj.

love
taff

[heblaj01]

Taffy,thanks for the reply.

This raises even more questions & speculation related to the three items you take in addition to Herceptin (Omega3 oil, iron, Arimidex).
There is a lot of animal testing showing the anticancer properties of Omega 3 fish oil (as well as GLA in primrose oil) for breast tumours. And there is one or two animal studies showing that adding iron to fish oil is even more effective in particular for radiotherapy.
However none of this has been tried on women & I would be very carefull with iron since on its own it tends to promote cancer growth. (Fish oil is OK).

I assume that Arimidex was prescribed because your onc knows or suspects you still are ER+ as well as HER+. Or is it possible that Arimidex shifts your cancer cells to be mostly in the HER+ camp making Herceptin a more adapted treatment?
If there was a plausible answer to these questions (or others) it might enhance the chances of more patients in hastening the healing process & in avoiding resistance to Herceptin. So next time you see your onc please try to find his thinking on this: he may have an opinion which may be usefull to others on this forum (Don't tell him an audience is waiting for his comment: he may then shy away from talking candidly!)