HER2 Support Group Forums - View Single Post - To treat or not to treat VERY early stage HER2 IDC

Joan M · 02-22-2011, 04:14 PM

Just want to give a clarification or update. It seems that herceptin and tykerb (trastuzumab and lapatinib) given together without chemotherapy are listed as a treatment for metastatic breast cancer. It's on page 56 of the guidelines (capecitabine is Xeloda):

NCCN Guidelines for PatientsTM: Breast Cancer

Discussion Version 2010

Preferred Chemotherapy Regimens in Combination with Trastuzumab
(HER2-Positive Metastatic Disease)

• Paclitaxel with or without carboplatin
• Docetaxel
• Vinorelbine
• Capecitabine

Preferred Regimens for HER2-Positive Tumors Already Treated with Trastuzumab (HER2-Positive Metastatic Disease)

Lapatinib and capecitabine
Trastuzumab with different chemotherapy drug than was used before
Trastuzumab and capecitabine
Trastuzumab and lapatinib (with no other chemotherapy)

This is a relief to know, as several women had complained about not being able to get both together. I believe it was Sheila whose insurance company initially would not pay for Herceptin and Tykerb in combination, but only for Tykerb and Xeloda (capecitabine). After much pavement pounding with the insurance company, doctors, and the drug companies, I believe the insurance company finally agreed. Another woman mentioned more recently that her oncologist did not want to prescribe the two drugs together and was being cautious.

Joan

02-22-2011, 04:14 PM	#26
Joan M Senior Member Join Date: Oct 2007 Posts: 1,851	Re: To treat or not to treat VERY early stage HER2 IDC Just want to give a clarification or update. It seems that herceptin and tykerb (trastuzumab and lapatinib) given together without chemotherapy are listed as a treatment for metastatic breast cancer. It's on page 56 of the guidelines (capecitabine is Xeloda): NCCN Guidelines for PatientsTM: Breast Cancer Discussion Version 2010 Preferred Chemotherapy Regimens in Combination with Trastuzumab (HER2-Positive Metastatic Disease) • Paclitaxel with or without carboplatin • Docetaxel • Vinorelbine • Capecitabine Preferred Regimens for HER2-Positive Tumors Already Treated with Trastuzumab (HER2-Positive Metastatic Disease) Lapatinib and capecitabine Trastuzumab with different chemotherapy drug than was used before Trastuzumab and capecitabine Trastuzumab and lapatinib (with no other chemotherapy) This is a relief to know, as several women had complained about not being able to get both together. I believe it was Sheila whose insurance company initially would not pay for Herceptin and Tykerb in combination, but only for Tykerb and Xeloda (capecitabine). After much pavement pounding with the insurance company, doctors, and the drug companies, I believe the insurance company finally agreed. Another woman mentioned more recently that her oncologist did not want to prescribe the two drugs together and was being cautious. Joan __________________ Diagnosed stage 2b in July 2003 (2.3 cm, HER2+, ER-/PR-, 7+ nodes). Treated with mastectomy (with immediate DIEP flap reconstruction), AC + T/Herceptin (off label). Cancer advanced to lung in Jan. 2007 (1 cm nodule). Started Herceptin every 3 weeks. Lung wedge resection April 2007. Cancer recurred in lung April 2008. RFA of lung in August 2008. 2nd annual brain MRI in Oct. 2008 discovered 2.6 cm cystic tumor in left frontal lobe. Craniotomy Oct. 2008 (ER-/PR-/HER2-) followed by targeted radiation (IMRT). Coughing up blood Feb. 2009. Thoractomy July 2009 to cut out fungal ball of common soil fungus (aspergillus) that grew in the RFA cavity (most likely inhaled while gardening). No cancer, only fungus. Removal of tiny melanoma from upper left arm, plus sentinel lymph node biopsy in Feb. 2016. Guardant Health liquid biopsy in Feb. 2016 showed mutations in 4 subtypes of TP53. Repeat of Guardant Health biopsy in Jana. 2021 showed 3 TP53 mutations, BRCA1 mutation and CHEK2 mutation. Invitae genetic testing showed negative for all of these. Living with MBC since 2007. Stopped Herceptin Hylecta (injection) treatment in March 2020. Recent 2021 annual CT of chest, abdomen and pelvis and annual brain MRI showed NED. Praying for NED forever!! Last edited by Joan M; 02-22-2011 at 04:20 PM..