Herceptin Plus a Taxane:To SusanV, Bev, and Karenann

[AlaskaAngel]

SusanV, Karenann, and Bev,

I realized when reading your posts that we all tend to think primarily in terms of our own situation, not realizing that when we give short answers they are easily confusing, and I'm probably guilty here of that.

In my situation, what my onc was specifically referring to I think was to my question as someone who already finished original chemotherapy that didn't include a taxane, and was asking if I could now have both a taxane and Herceptin (for treatment more than 2 years out from original treatment). He said off the cuff that the taxane mostly really only helped those who were HR-. I had asked him about it because on the whole there was much greater success for those who got both a taxane and Herceptin.

Bev and Karenann, I think you were assuming from SusanV's post that she was saying Herceptin wouldn't be helpful to her--but I think she (like me in my earlier post) was not talking about not having Herceptin, but rather talking about whether adding Taxol was helpful, and her onc then told her the same thing mine told me--that adding a taxane works best for those who are HR-. Am I right, SusanV?

I am getting more puzzled by both our oncs' answers to SusanV and I.

I hope no one minds if I start a new thread for this. It is getting hard to follow this one because it is so long.

AlaskaAngel

[tousled1]

Alaska Angel,

When I had my chemo (neoadjunct) my oncologist gave me Taxatore after my A/C and the Taxatore was what shrunk my tumor. Now granted I had mine before surgery and without any Herceptin but if it worked then why wouldn't it work later -- for you. I do know that once you have Adryiamicin (spelling??) you can not have that again.

[PatS]

I have also read that the taxanes work best for those who are HER2-. However, I had neoadjuvant chemo to shrink my tumor and had A/C followed by Taxotere. For me taxotere seemed to shrink the tumor more than the A/C did.

Pat

[Becky]

At ASCO 2006 I personally went to the presentation on the benefit of adding a taxane after 4 dense dose AC treatments.


A taxane is most beneficial to those who are Her2 positive (regardless of hormone status - and this part was stressed over and over again because....) a taxane was shown to be of NO benefit to those who were only hormone positive (and Her2 negative). Adding a taxane was also of great benefit to triple negatives.

If I had a tumor that was Her2+ and over 1cm - even with negative nodes, I would insist on 4 taxol treatments after the AC adding in the Herceptin with the taxol treatments and then Herceptin out to a year. It is that much more beneficial. Check it out under the ASCO 2006 site (when I get home late tonight, I will look it up and let you know the abstract number).

Kindest regards

Becky

[SusanV]

Yes Alaska Angel, you hit the nail on the head....


I was asking my onc to add Taxol with my herceptin, instead of just herceptin only. His response was that it provided minimal benefit in my case as I am Her 2+++ ,Srongly ER + 80% and Strongly PR + 90 % (I just inquired about my % yesterday too) For me the jury is still out on my oncoligist. I am just two treatments in, and he & I haven't spent a whole lot of time together. I explained to one of his associates that I want everything available including taxol with my herception. We will see what happens..I still have 2 A/C treatment to do, which will take me to Nov 6th to plea my case. I like all of you ,want to look back later and know that I did all that I could.

I won't give up too easy with my onc, and Becky I will really being looking forward to your next post to do some more reading on the subject.

A million thanks to all of You, and then a million more !

P.S. Sorry if my other post confused anyone

[Becky]

Abstract No:

510

Citation:

Journal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings Part I. Vol 24, No. 18S (June 20 Supplement), 2006: 510

Author(s):

D. F. Hayes, A. Thor, L. Dressler, D. Weaver, G. Broadwater, L. Goldstein, S. Martino, J. Ingle, I. C. Henderson, D. Berry

Abstract:



Background: CALGB 9344 showed 4 cycles of paclitaxel (T) after 4 cycles of doxorubicin/cyclophosphamide (AC) improved disease-free (DFS) and overall survival (OS) compared to 4 cycles of AC. Higher dose of A had no benefit (Henderson JCO '03). Prior studies suggest HER2 is associated with benefit from standard vs low dose of C&A (Dressler JCO '05). We hypothesized that HER2 might predict benefit from higher dose of A or from T, and that HER2 might refine the observed negative interaction of T with estrogen receptor (ER). Methods: 3121 node + women in CALGB 9344 received 4 q3wk cycles of AC (A: 60, 75, or 90 mg/m2) and then 4 cycles of T (175 mg/m2 q3wk) or no T. Blocks were collected from ~2800 subjects. 2 sets of 750 patients each were randomly selected from these cases: Set 1 to develop hypotheses; Set 2 for validation. Tissue specimens were available from 643 (set1) and 679 (set2) cases (20% & 22% total enrolled in 9344 respectively). HER2 was evaluated by FISH and by IHC (by antibody cb11 and by Herceptest). Statistical analyses used Cox proportional hazards models, including interaction terms, and Kaplan-Meier estimates for comparing 5-yr DFS by treatment group. Results: In Set 1, all 3 assays suggested that T improved DFS for HER2+ but not for HER2-. For this single set the interaction was not statistically significant. There appeared to be an interaction of HER2, T and ER. IHC using cb11 was applied to Set 2, revealing nearly identical results. In the two sets combined (n=1322), the interaction between HER2 and T was statistically significant (p=0.013). The 3-way interaction of HER2, ER and T was hypothesis-generating and not tested statistically. Differences in 5-yr DFS rates (95% CI) for T vs. no T by HER2 and ER (both sets combined) There was no interaction between HER2 and dose of A. Conclusions: These results suggest that the benefit of adding T to AC is greater for HER2+ tumors, even if ER+, while T was of no apparent benefit in the ER+, HER2- group. Further validation is needed from remaining cases in 9344 and from other trials involving T. ALLER-ER+HER2-2%
(-3,8)8%
(-2,18)-1%
(-8,5)HER2+22%
(12,32)31%
(17,44)9%
(-6,24)ALL7%
(2,12)16%
(8,24)0%
(-6,7)



http://www.asco.org/portal/beans/virtualmeeting/images/clear.gif

[Becky]

Abstract No:

582

Citation:

Journal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings Part I. Vol 24, No. 18S (June 20 Supplement), 2006: 582

Author(s):

C. Dang, K. Smith, M. Fornier, S. Sugarman, T. Troso-Sandoval, D. Lake, G. D'Andrea, A. Seidman, N. Sklarin, L. Norton, C. Hudis

Abstract:

Background: DD q 2 weekly (w) AC → T is superior to conventionally scheduled (cs) AC → T and safe w/long follow-up (Hudis et al, SABCS 2005). With q 3 wk AC, adjuvant (adj) H is safe and effective (Romond et al and Perez et al, NEJM 2005). We therefore tested DD q 2 w AC → T + H × 1 year (y) as adj treatment (Rx) of patients (pts) with HER2/neu (+) BCA to determine cardiac safety. Based on the reported cardiac event (CE) rate of < 4% in the randomized trials using cs chemotherapy (CRx) + H, we evaluated DD q 2 w AC → T + H with a 1° endpoint of cardiac safety defined as discontinuation (DC) of H due to 1) cardiac death or 2) congestive heart failure (CHF). The 2° endpoint is time to recurrence and overall survival. Methods: Pts with HER2/Neu IHC 3+ or FISH-amplified BCA were enrolled, regardless of tumor size or nodal status. Rx consisted of AC at 60/600 mg/m2 × 4 → T at 175 mg/m2 × 4 q 2 w w/pegfilgrastim 6 mg on d 2 + H × 1 y. Multi-gated radionuclide angiography scan (MUGA) is obtained at baseline and at months (mo) 2 (after AC × 4), 6 (after T × 4), 9, and 18. Pts w/baseline LVEF of > 55% and w/o cardiac illnesses are eligible. Pts w/significant (sig) asymptomatic (asx) LVEF ↓ after DD AC based on mo 2 MUGA did not receive H, and pts w/sig asx LVEF ↓ during H had it DC'd. If the CE rate is > 4%, Rx is deemed not feasible. Results: From January 4, 2005 to November 1, 2005, 70 pts were enrolled. Median (med) age is 49 years (range, 27-72). Forty one of 70 pts (60%) had node (+) BC and 27/70 pts (40%) had (-) nodes. Med baseline LVEF is 68% (range, 55%-81%). As of January 9, 2005, all pts had mo 2 MUGA after DD AC and there is no sig LVEF ↓ and the med LVEF is 67% (range, 58%-79%). To date 39 pts had mo 6 MUGA w/med LVEF of 66% (range, 56%-75%) and one pt had a sig asx LVEF ↓ from baseline of 74% to 56%; H was DC'd. Twenty-three pts had mo 9 MUGA w/a med LVEF of 64% (range, 57%-69%). One patient had clinical CHF at mo 4 w/EF of 45% and improved sig w/cardiac medications. One had pneumonitis during radiation (RT). One had atrial fibrillation w/pericarditis after completion of RT. Discussion: DD AC → T + H appears to have an acceptable cardiac toxicity profile w/1/70 pts having a CE. Updated cardiac safety data will be presented.


The only reason I included this study is to show that Sloan Kettering does AC followed by TH for node negative women.

Kind regards

Becky
http://www.asco.org/portal/beans/virtualmeeting/images/clear.gifhttp://www.asco.org/portal/beans/virtualmeeting/images/clear.gifhttp://www.asco.org/portal/beans/virtualmeeting/images/clear.gif

[SusanV]

Thank you very much Becky for the info...I will print for my next visit with the onc on Monday, October 16th. I really appreciate it !

Many thanks & Love too

[karenann]

Thanks everyone for the information. I didn't realize that Taxol was the drug being talked about. After reading Becky's post, I am glad Taxol was part of my treatment

Karen

[Hopeful]

Doing a little research on taxanes, I found this article from 2 years ago: http://researchnews.osu.edu/archive/taxanes.htm. Picking up Lani's comments about Herceptin enhancing the body's own immune system from the "propellerhead" thread, maybe this is why the combination is so powerful? Food for thought.

Hopeful

[saleboat]

Hi Susan,

I bet if you go to a major cancer center and get an opinion on your treatment plan, your Onc would be much more likely to see the point of adding Taxol-- at Sloan, I'm 90% certain that you'd get Taxol with your treatment given your stage and node status. Seems like it is much easier to change an Onc's mind when another Onc gets involved.

Good luck,
Jen

[Mary Jo]

Hello,


I also received 4 dose dense A/C and 4 dose dense taxol along with herceptin. My oncologist also said that in my situation the taxol along with herceptin was proven to be beneficial. I'm coming up on my LAST herceptin treatment (Oct. 11) and am finding that I am becoming a bit scared of recurrence.

God Bless all -

Mary Jo

[AlaskaAngel]

My onc is a general medical onc and doesn't specialize in breast cancer, so maybe it is harder for him to keep up with it all. But also, I got that opinion from him about 9 months ago at my most recent visit with him, prior to the date on those studies.

That said... it still appears that he consistently doesn't seem to see very far ahead...

Thanks again, Becky, for catching this thread and clearing up the confusion.

AlaskaAngel

[Bev]

I was confused, I thought Herceptin denied. I have read H & T synergistic. I have also read taxol makes cells more sensitive to be destroyed by rads. For triple positives, I think AC may be eventually abandoned. Except for eyelashes, brows and the top of your head and pain in extremeties, Taxanes are easier than AC. I'm a layman, I just know my feeling was to be as aggressive as posiible because I don't want to be in this place again, ever. BB

[Becky]

Adriamycin will never be abandoned for about half of Her2+ women (regardless of hormone status) because about half of Her2+ women are also TopIIA positive (although it is not routinely tested right now, it will be) and adriamycin really knocks down and kills TopIIA positive bc. Therefore, about half the women who are Her2+ will get AC followed by TH and the others will get TCH (Taxol or taxotere with carboplatin and herceptin).


This is the wave of the future - better tumor marker testing so you only get the drugs that will work the best on your tumor and avoid others that don't do anything to the cancer.

Kind regards

Becky

[rinaina]

Becky, you mentioned that for all her2+ breast cancers, even those who are stage I and node negative, you would recommend taxol. I am stage I and node negative, er/pr negative, my tumor was 1.4 cm and I received two opinions from two highly regarded oncs in Chicago and both said no to taxol. I pressed this issue heavily with both of the oncs and they stood their ground on not to do taxol along with the herceptin. I completed 4 rounds of AC and started herceptin 6 weeks ago..once every 3 weeks. Do you think I should press the taxol issue further and if so why?

[penelope]

me too Rinaina....same opinions....can't help but feel I may have missed the boat. I only have 5 herceptins left. Getting down to the wire and with it a raising anxiety.

[atdec05]

I also was told that Taxol would not lower my recurrence rate enough to justify it. I'm 2/3 of the way through Herceptin. Has anyone heard of Taxol being added later to treatment?

- Anna

er/pr-, her2+
Stage 1 (2 tumors=1.05cm, extensive DCIS) grade 3
node neg
49 & premenopausal at diagnosis
4 x AC (DD)
34 treatments weekly Herceptin (18 more to go)

[Bev]

Thanks for clarifying Becky. This is so complicated. BB