Tykerb-Only Treatment
 

MJ is now on a Tykerb-only treatment. She finished her 4th cycle of Xeloda a couple of weeks ago(she refused to do the 6 cycles that were suggested due to the harshness). Is anyone else taking just Tykerb? Our oncologist said he will add Herceptin again at some point if necessary(even though it stopped working by itself). I understand the synergy discussion I've read on here so I'm good with trying again, if necessary. I would appreciate any thoughts on whether Tykerb-only is a good plan or if we should start up Herceptin again just in case?

Thanks,
Greg

Re: Tykerb-Only Treatment
 

Tykerb as a single agent has not Had a blockbuster track record, although I saw a presentation at San Antonio BC symposium a couple of years back which was teasing out which patients it DID work for. Recently a study was published showing synergy with herceptin, so I think that's a good option (maybe someone can find the link here on this site) especially since tykerb may be more protective for the brain.

Another option might be to add back xeloda, at a lower dose. I can hardly believe I'm saying that as I had a horrible time with xeloda - and then it didn't work very well anyway. Might be because I couldn't keep it in my system. But lower doses can be effective and it's not unusual to get a reduced dose.

Just my 2 cents...

Re: Tykerb-Only Treatment
 

As far as we know, MJ is NED right now. We are waiting on biopsy results from a cyst but aren't expecting it to be cancer. Are chemos like Xeloda necessary if you are not currently trying to target any mets? I guess I understand targeting specific mets with chemo but don't understand the whole preventative treatment process. Are most patients taking Tykerb and Xeloda until they stop working? Thanks.

Re: Tykerb-Only Treatment
 

I think that Herceptin should never be discontinued but that things need to get added to it.

Re: Tykerb-Only Treatment
 

If you look again at my MUST READ thread, it and scores and scores of other studies show the value of the continuation of herceptin beyond progression ie, it is not that herceptin is not effective, but that another pathway needs to be blocked in addition. Most experts in the field concur that few cancers will be cured with single agent orchestrated lethality, but rather with the combination of a few targeted therapies ie, let's imagine a combination like herceptin+pertumab+ tykerb + anti Estrogen agent if necessary. or herceptin+mTor inhibitor+HSP inhibitor etc.

In those cases where a particularly overwhelming driving mutation or fusion protein is found, monotherapy may be appropriate, but those will probably be the vast minority of cases.

I will post an article/link from today's NYT to illustrate that concept(has to do with leukemia, but principle is the same)

Re: Tykerb-Only Treatment
 

What hoops are people having to jump through to get Tykerb with Herceptin instead of Xeloda?

Re: Tykerb-Only Treatment
 

As always, Lani has great points. There are some women that can have a single med recovery, but the majority will need additional medications to attack resistant cells. TDM-1 has a dual action mode and may show additional single med effectiveness, but it is likely that a secondary medicine (Tykerb as an example) may be necessary for most women. The drug attached to Herceptin that makes up TDM-1 is significantly enough different that I have high hopes for it, but realistically there will need to be additional drugs in all likelihood. Even Pertuzumab with TDM-1 or Herceptin will be beneficial in many cases as they are two attachment points on the Her+ protein. This is a rapidly developing area of medicine that will be clarified for our daughters and grand-daughters. Even treatment in the brain/spine is undergoing significant change with drastic improvements in lifespan and removal of disease. I hope Herceptin in the near future becomes the "Polio" of today, with a vaccine to prevent occurence. My hopes are with my co-horts in getting this disease to only being seen in textbooks.

Re: Tykerb-Only Treatment
 

I remember reading someone's post on this forum that the tykerb and herceptin combo is being reviewed by FDA. Sorry i can't find the link. But it seems many stage V Her2+ people are on this.

Re: Tykerb-Only Treatment
 

I'm doing just Tykerb and Herceptin (no Xeloda) as part of a study, but my doctor told me she could simply prescribe it. I live in Boston. I agreed to do the study because I want to help others, and the requirements aren't too onerous. A friend of mine has been stable of Tykerb and Herceptin for 8 months. She's not in a study and also lives in Boston.

Re: Tykerb-Only Treatment
 

I am Ned and am on herceptin and tykerb. My ins first denied it and I appealed and they decided to cover it.

I am actually taking a break this summer from both, as I am having a lot of side effects, but this combo has kept me Ned for 17 months.


Laurie

Re: Tykerb-Only Treatment
 

I have been on Tykerb/Herceptin since Nov. 2009 and remain NED. My insurance denied it, but later approved it with a letter from my oncologist. I did not want to take Xeloda.
Best,
Barbara H.

Re: Tykerb-Only Treatment
 

Thanks everyone for your input. We are heading on a much-needed vacation next week and then will meet with the oncologist when we get back. ~Greg

Combination, Synergy and Maintenance Therapy
 

Greg

Combination chemotherapy frequently, but not always, has produced greater degrees of clinical benefit than single agent therapy. There are two potential explanations for this. First, when two or more drugs are given, there is a greater probability that at least one of the drugs will be active. Second, there is the potential for true synergy, where the whole is greater than the sum of the parts.

Among the most sought after attributes of chemotherapy drug combinations is drug synergy. Synergy, defined as supra-additivity wherein the whole is greater than the sum of the parts, reflects an elegant interaction between drugs predicated on their modes of action. While some synergistic interactions can be predicted based upon the pharmacology of the agents, others are more obscure.

The application of synergy analyses may represent one of the most important applications of the functional cytometric profiling platform; enabling clinicians to explore both anticipated and unanticipated favorable interactions. Equally important may be the platform's capacity to study drug antagonism wherein two effective drugs counteract each others’ benefits. This phenomenon, characterized by the whole being less than the sum of the parts, represents a major pitfall for clinical trialists who simply combine drugs because they can.

Laboratory oncologists feel that conceptually, maintenance allows for a cytotoxic exposure when the cell enters a “chemosensitive” period in its life cycle. Cancer cells that are “out surviving” their normal counterparts often do so in a quiescent stage (G0 Gx). The GO phase is a period in the cell cycle in which cells exist in a quiescent state, where the cell is neither dividing nor preparing to divide.

In order to capture these cells, drugs must be present in the body when these cells awaken from their dormancy. As we have now achieved increasingly durable remissions in diseases like breast cancer, small cell lung and ovarian, we are confronting patients in long-term complete remission.

Regardless of all of this, most of the cells that leave home don't survive the journey in the blood or lymph systems and many cancerous cells that eventually do lodge in a distant organ simply remain dormant, leaving it up to the immune system to take care of them. Researchers have learned that full-blown metastasis is an extremely challenging trade and the great majority of cancer cells are not up to the task.

Even those malignant characters that manage to slither their way into the blood or lymph system usually fail to do anything further. Most tumor cells lack the streamlined form of the blood and immune cells that are designed for cross-body trafficking, shear forces in the smaller vessels may rip the intruders apart.

Hope you enjoyed your much needed vacation!

Greg

Re: Tykerb-Only Treatment
 

Greg I really need a guy like you at my appointments. You are priceless!

Re: Tykerb-Only Treatment
 

You might think about monitoring serum HER2. It often falls when the targeted drug is work, or conversely rises when things aren't going so well. To learn more see www.labtestsonline.org and www.hertestonline.com.

Re: Tykerb-Only Treatment
 

My mother was diagnosed with Pulmonary toxicity (interstitial pneumonitis) with additional infections (K. Pneumonae), towards the end of her 12 week Herceptin+Taxol cyle. After spending a considerable time in the hospital (4liter oxygen, Saturation at 90, fever) she's now recovering, but our oncos are uncertain whether this is a case of pulmonary toxicity caused by Herceptin or by Taxol!!! She was due for a year long treatment on Herceptin, but her oncos have suggested moving to Trykerb at this point, given that there is no way of knowing and they do not want to risk another episode of pulmonary toxicity.

Also, post her 4th taxol+herceptin cycle, she started developing unexplained tachychardia, which till date hasnt been explained. The oncos once again think it could be herceptin, but state that there is no way of knowing!!

Any inputs on the above situation would be great!

Questions in our mind right now - Is Tykerb as good as Herceptin? Was the episode really caused by Herceptin?? Is it a risk to move from Herceptin to a Tykerb only treatment given that she is node+ve.



Summary:
Dx: Stage 2b, 2 lymph nodes, Her2+ve, ER-ve, PR-ve, no mets
MRM: Sept 21st 2012, 4 AC cycles started on Oct 10th after which 12 Taxol+Herceptin weekly cycles were started in Jan.

Study suggests Tykerb (lapatinib) may protect heart

http://cancerfocus.org/forum/showthread.php?t=3891

Herceptin (Trastuzumab) for Breast Cancer Linked to CNS Metastases

http://cancerfocus.org/forum/showthread.php?t=3907

Re: Tykerb-Only Treatment
 

I'd suggest monitoring serum HER2 (www.oncogene.com and www.hertestonline.com) during a course of Tykerb treatment. If the serum value is rising or level, in all likelihood the Tykerb isn't working.

Re: Tykerb-Only Treatment
 

Thanks everyone!

I'm also hoping to connect with someone at Roche/Genentech to register this as an adverse event or side effect and request them to connect me with someone who might be able to throw some light on this situation.

Any tips on how I can do that? Any email ids/helpline numbers?? My mother has been receiving her treatment in India, so Roche markets Herceptin here, but I'm assuming the two organizations must have a single clinical research team.

Thanks!

Re: Tykerb-Only Treatment
 

Hi Daughter 1,
I was diagnosed in August 2009, stage 2B her2+, ER/PR - at age of 35. After my 3rd TCH, I had pulmonary toxicity and was admitted for a month and was on oxygen therapy. My oncologist also could not say whether the toxicity was caused by herceptin or taxotere, but we would not dare to continue with the same regime. Therefore I was given tykerb/ xeloda for 4 cycle and later the tykerb alone. I now have pulmonary fibrosis half of my lungs and causing me breathlessness on exertion but I'm doing fine. I don't dare to stop the tykerb as my PET scan shows 'possible treated metastatic lesion on pelvic bones'( I was not officially diagnosed with stage4)... I'm still on tykerb and have minimal side effects and at the moment NED,