Well Poop - Liver Met Back
 

Hi gang,
I received the results of my 6 month PET/CT a week ago and the liver met identified in 11/07 is back.

I believe it was Chrisy who said that when her liver met came back that the sad part about the recurrance is that she was holding on to a sliver of hope that she would somehow beat the odds. I know I certainly was.

I had a liver biopsy yesterday to confirm the original characteristics of the tumor (originally er-/pr- and her2+) We'll see if it's stayed the same. Glad to have the confirmation for appropriate next steps.

The current thinking is that since the taxotere was tolerable and did a pretty good job the first time around that I would go back on another round. (potentially 10 cycles ---YIKES---I was ready to be done at 6 but I am sure I can manage)

I am also checking into Radio Frequency Ablation to quickly blast the tumour.

Does anyone remember the sister on the site that had used Cyberknife. I believe the procedure was performed in California.

Rich...I have a call into the University of Michigan vaccine trial but I think that I am not a candidate as I have not had an anthracycline.

T-DM1 sisters - I looked into available trials here and there is one but I would have to travel and the randomized second arm was not taxotere. I am afraid of changing horses.

My daughter is 16 and a sophmore in highschool. A consideration (hopefully not short sighted so challenge me on this one...I appreciate all of your honesty) is trying to not disrupt these precious years for her by being gone too much for treatment.

SOOOO sad right now, a little scared...but certainly not willing to give up the fight.

Any words of encouragement, advice etc. appreciated.

So glad I could come here for support....love Lori

Lori, we are in the same boat. I too have a 16 year old at home, so I know how you feel. I just started on navelbine. If you had luck with the taxotere,I would stick with that. There are lots of different drugs out there and we will be fine. Hang in there girl! Let's make those cancer cells beg for MERCY!

Cyberknife for liver mets
 

Hi Lori,
I think it is Esther (from California) who had cyberknife for liver mets. She also posts on BCmets.org under luv2ski. She's been away for a few weeks - vacation?

Good luck in your treatments - I know how you feel about being close to home during your daughter's last few years in high school. My daughter is a senior and now that she is going away to college this fall she has become quite the home-body and wants to hang out with me a lot.

Marianne

Sending you comfort
 

Oh Lori-

I am sure you are sad and scared.......but you also sound so strong. Amazing! You are an inspiration and I bet your daughter is so very proud of you. I am sending you warm thoughts and lifting you up prayer today.

I wish I had the words to really express my heart to you. Please stay stong. I love what Woman of Steel wrote......bring those bad cells to their knees!

Maureen

In addition to cyberkife, you could look into liver directed therapies at Swedish hospital there in CO:
http://www.swedishhospital.com/Custo...0-7D345CD59DC5}

I don't think you have to be Swedish but I would learn a little just in case it opens some doors.

This was an interesting article, similar to others I have seen, which might be applicable to your case:

1: J Vasc Interv Radiol. 2009 Mar 26. [Epub ahead of print]http://www.ncbi.nlm.nih.gov/corehtml...PubMedLink.gif Links
Radiation Lobectomy-A Minimally Invasive Treatment Model for Liver Cancer: Case Report.

Siddiqi NH, Devlin PM.
Division of Vascular and Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO 63110.
Chemotherapy-resistant colon carcinoma metastases to a patient's right hepatic lobe progressed after right lobar radioembolization with yttrium-90. The metastasis-free left lobe had adequate volume as a future liver remnant. Repeat right lobar radioembolization with supratherapeutic activity of (90)Y caused shrinking of the tumors and the right lobe with no adverse outcome. With an adequate tumor-free future liver remnant, one hepatic lobe bearing a large tumor burden may be administered supratherapeutic activity of (90)Y, risking lobar ablation for greater probability of tumor eradication. This is analogous to hepatic lobectomy. This case is presented as a proof of principle.
PMID: 19328722 [PubMed - as supplied by publisher
I seem to remember an MD Anderson raticle discussing how getting rid of the offending lobe was giving great results.I think they were using Trans arterial Chemo.

There is a forum of patients dedicated to Yttrium 90 issues:
send an e-mail to yes@discussthis.com to join.

Isolated hepatic perfusion is starting to make a comeback. Dr. Alexander seems to be the US guru. I think it's totally off-label for BC liver mets:

1: Front Biosci. 2009 Jan 1;14:1771-84.http://www.ncbi.nlm.nih.gov/corehtml...es-medlink.jpg Links

TNF-based isolated hepatic perfusion.

Bellavance EC, Alexander HR Jr.
Department of Surgery, University of Maryland Medical Center, Baltimore, MD 21201, USA.
Unresectable primary and metastatic cancers confined to the liver often determine the prognosis for patients with primary hepatic cancers, colorectal cancer, ocular melanoma, and neuroendocrine tumors. Although many locoregional therapies have emerged as options for patients with unresectable liver malignancies, these treatments frequently have limited clinical benefit. Isolated hepatic perfusion (IHP) has emerged as a regional therapy effective in inducing tumor regression in isolated liver metastases from multiple histologies. Tumor necrosis factor alpha (TNF) is a biologic agent well suited to isolated therapy because of its single-dose efficacy, synergistic effect with hyperthermia, and effects on tumor neovasculature. When combined with chemotherapeutic agents in IHP, TNF may improve response rates in patients with hepatic metastases of some histologies. However, there are additional toxicities associated with the administration of TNF and further studies are needed to determine whether TNF confers a clinical advantage in IHP.
PMID: 19273161 [PubMed - indexed for MEDLINE]


With all that said, perusal of liver metster profiles in this forum seems to support what worked for you in the past. Taxotere/Herceptin with or without Navelbine seems to be a powerful combination. It's not like it stopped working. So..you might be in a good position to use local therapies along with chemo that's benefitted you before.

Lori,

I am sorry to hear your news but I have a strong feeling that you will beat this very quickly. From what I have reading on this forum, many of our brave sisters have beaten it and I pray that God will guide you to the right drugs too.

Lots of prayers and hugs,
shobha

Lori! You'll pick just right on what to do.
Just remember that the kids today are part of the technology generation.....they can talk, twitter, text, sky dive....oops anything anywhere. I'm just betting that your 16 year old, while she needs you day to day, most of all needs you to fight to be there for a very long time! I'm betting she will be supportive of you whichever you choose to do! Remember, she's your daughter!!!
Wishing you many hours of peace over the next few days!
With love, ma

Hi Lori;

Sorry to hear your news, I've traveled that same road a few times now, and also have a 16 year old daughter. I always find the following site very useful when I am trying to figure out which bat to take out for my pesky hide and seek liver met.

http://breastcancer.evidencewatch.com/ search for liver met and you will find many articles on the latest options.

Tomorrow will mark 5 years since DX with liver mets so hang in there you can beat this back.

Lori,

Well POOP
I guess you've correctly described MY feelings on this as well!

Sounds like you are getting lots of good advice and options. If it were me and I was dealing with a single met, I'd look at the local options - yes, it is Esther/luv2ski who had the cyberknife done on her liver met, it's not commonly done but she did it at Stanford.

I'm not familiar with the option Rich has posted, but it sounds close to you and worth looking into, especially if you know swedish. Or maybe you just need to like big fluffy pancakes...

Finally, I'd like to offer this thought on the chemo options. I agree with what you say about not changing chemos - going back to the "winning horse". On the other hand, you've had such a good response to Herceptin you would be a great candidate for a DM1 trial. I wouldn't rule that out.

My doctor at UCSF who is one of the cutting edge researchers in BC is a very big advocate of using targeted therapies and avoiding chemo as much as possible. Keeping your body and immune resources strong is so important.

Lori, I'm bummed that you are having to deal with this, but it is what it is,so now your goal is to MANAGE it...as I know you will.

Hang in there, keep us posted!

Lori,

I'm sorry to hear about the return of your liver met. Perhaps you should think about RFA since you have no other mets.

The treatment has been used a lot in the liver to good result. Also, it may give you some time to be off from chemo, as you would be NED after the procedure.

I had RFA in the lung. In my case I developed complications related to coughing up blood from a fungus/mold infection that took hold a few months later. However, I also had brain surgery two months after the RFA and was on steriods which can promote an infection.

But that is no reflection on liver RFA. Also, despite the lung complication, the cancer has not returned in the lung. (I had a lung wedge resection two years ago and a year later there was a recurrence, which is why I had the RFA.) And I have no other spots on PET/CT.

Joan

Thank you all soooo sooo much for the words of encouragement and advice. I am sure each of you knows the lonely feeling of fighting this disease while trying to keep a positive face for family and friends.

It is such a relief to have a place to come and "let it all hang out".

I am excited by all of the advice and I will spend the next few hours following up to continue to challenge (er....drive my onc crazy) my Dr. in her thinking and game plan.

Rich...I used to be blonde so maybe I can act like I am Swedish. I'll have to try to develop a Swedish accent for when I contact them!!!

Chrisy....We are absolutely on the same page in regards to going back on Chemo that would destroy my immune system. The first round of Taxotere really did a number and I had to take the neulasta shots to keep afloat. Maybe my body is sensing that something is in the works as after being incredibly healthy, I just came down with a whopper head cold. Hmmmmm.

I don't know what I would do without this site...WOS and KK1, thank you for letting me know that I am not alone in trying to support a teenage daughter. It sounds as if your daughters are as generous and loving as mine. Aren't we lucky.

I love you all and feel much more at peace knowing that I have such a fantastic support team. HUGS!!!! Lori

You could rent the muppet show series and study the Swedish Chef. He managed to communicate with a 3 or 4 word vocabulary.

I was sorry to hear your bad news but very glad to see all the help and info you are receiving here. I hope your successful treatment occurs real soon and that you get the treatment that is just what you need!

Dear Lori,
I certainly understand the need to remain close to home and not disrupt your daughter's high school years. I have a 16 year old daughter too. More than anything I didn't want my family and daughters to worry about me. I tried very hard to be as normal as I could be~ which isn't very normal.

Lori, Sounds like your lining up the best treatment and you will win this combat once again. Praying for strength and wishing you good health.

Love,
Dana

Lori
It seems to be the time of year for mets for many of us...you have gotten so much good advice...Chrisy is a veteran at liver mets...the go to girl.....it sound like your onc, has a plan...that is the beginning....prayers that it will rid you of that met quickly and thoroughly!

Studies to watch:


http://clinicaltrials.gov/ct2/html/i...e/triangle.gif Purpose RATIONALE: Biological therapy using a gene-modified virus that can make interleukin-12 may help the body build an effective immune response to kill tumor cells.
PURPOSE: This phase I trial is studying the side effects and best dose of a gene-modified virus that can make interleukin-12 in treating women with breast cancer that has spread to the liver.


Condition Intervention Phase Breast Cancer
Metastatic Cancer
Biological: adenovirus-mediated human interleukin-12
Phase I






Purpose
RATIONALE: Interleukin-12 may kill tumor cells by stopping blood flow to the tumor and by stimulating a person's white blood cells to kill breast cancer cells.
PURPOSE: Randomized phase II trial to study the effectiveness of interleukin-12 in treating patients who have metastatic or recurrent breast cancer.

Similar Dx...did RFA, did Liver Resect - liver NED since 12/05
 

Hi Lori~
First & foremost, I'm sorry you're wrestling with a stubborn liver met. I know how disheartening it is to deal with the recurrence.
I have a similar story to yours & I hope my experience & my journey is helpful to you.
I was dx'd Stage IV @primary dx too (5/02). I had single liver met, but after failing navelbine+herceptin, the disease progressed to "innumerable, immeasurable" lesions. Fortunately, Taxol+Herceptin cleaned up my liver & I was NED for a year!
In 9/04, a single lesion recurred. We did short cycles of TH & the lesion would resolve, I'd go off chemo, but then it would pop back up.
I researched RFA & consulted with an Interventional Rad.When the lesion recurred in 1/05, I had RFA. But it was only partially successful because the lesion was located adjacent & very close to the main portal vein. The proximity to the vein creates a "heat sink" effect - carrying the heat from the RFA away from the lesion during the procedure & preventing the lesion from heating up sufficiently to kill off all the cells. So, while some of the tumor was blasted away, it did leave a crescent shape of viable cells that eventually just grew back.

So back on chemo - Abraxane
+ Herceptin, but no response.Then TCH & complete response again.
In the meantime, I started consulting with a liver surgeon.He followed me through the year, then in 11/05 when the lesion recurred again, he said he felt confident a liver resection would be curative, unlike the RFA. (Incidentally, he said that he would have never expected the RFA to be completely successful/curative because of the location & heat sink effect. He suggested the IR should have known this & should have been completely honest with me about the best potential outcome. He's right, the IR never stressed the importance of the heatsink...)
In 12/05, I had a right partial hepatectomy - they removed the R lobe of my liver, which is 55% of the organ. My surgeon did a full exploratory internal sonogram of the liver while I was in surgery to make sure there was in fact only a single lesion. He said if he found small lesions he could RFA them internally, but if there were too many, he would have had to abandon the procedure.
By the grace of God, there was in fact, only 1 lesion. They removed the R lobe. I was in ICU overnight, then on the regular floor the next day. Believe it or not, I was up & walking (thanks to the epidural) & dc'd from the hospital after only 4 days.
I don't mean to imply that the surgery was easy -b/c it wasn't. I have a big incision that runs 1" below my sternum to 1" above my bellybutton. And the 1st few weeks post-op were tough - incision pain, really weak. Taking a shower was exhausting.
BUT with each passing week, I could feel myself getting stronger.By week 3, I was able to travel to LA to be with my family.
The good news is, the liver resection was curative and my liver has been NED ever since.

Unfortunately, I have wrestled with recurrences in the supraclav nodes (2x) & mediastinal nodes(1x) since, but that's the unfortunate cirucmstance of a Stage IV'er. As far as I'm concerned, a recurrence in a lymph node is less threatening compared to a vital organ.

I'll mark 7years as a Stage IV'er in a couple of weeks. Surviving this disease, through all the surgeries, radiation & 105 chemos-to-date is definitely worth celebrating.
Now I have the "7 Year Itch" & I wish, hope & pray to move past this disease. But ultimately, if I have to live with this disease, I will do so vigilantly, but peacefully.

Sorry this is soo long, but, I do hope the info is helpful to you. Most of all, I urge you to get as much info as you can about RFA, you candidacy for a Liver Resect, and consult w/an IR and a Surg Onc & always get 2nd opinions!

Please feel free to send me a note via pm & if I can be additional help.
Successful treatment for any one of us is a victory for all of us. We will help you find yours too!

Keep the Faith, Lori~
Jessica

I had Cyberknife to liver in Nov. 08. The actual procedure is painless, there was some pain with the fiducials you have placed around the tumor, but that was it. lots of scans before for placement, etc. I had mine done in Wisconsin, but I know they do it in CA.
As far as I know (have PET on Fri) the CK got over 95% of tumor.

Web site is cyberknife.com and you can ask questions and find facilities.

Good luck to all,
Di