HER2 Support Group Forums - View Single Post

Christine MH-UK · 06-09-2006, 03:00 AM

Your first oncologist was basing your treatment on a trial whose results were announced in December. This trial indicated that herceptin + carboplatin + taxotere->year of taxotere produces significantly fewer heart problems that AC->(taxotere+herceptin)->year of taxotere without being significantly less effective. Herceptin's inventor was very involved in the trial and indicated that it raised questions about whether the risks of anthracyclines were worth it for her2 positive patients, given that the AC->taxotere+herceptin->rest of year of herceptin combination seems to cause long-term heart damage. The study also showed that the patients with topoIIa benefitted from the addition of anthracyclines, such as AC chemo. Other oncologists, however, question the advisability of dropping AC chemo or anthracyclines.

It may not be that you shouldn't have AC after herceptin. It may be more likely that herceptin after AC is the problem, since herceptin seems to aggravate heart problems started by AC. Unfortunately, there have only been two rather small trials using anthracyclines after herceptin-based chemo, although the results have been favourable, including a trial of herceptin, cisplatin, taxotere followed by AC in stage III women that had an 83% three-year disease free survival rate.

My concern with the HCT->AC->year of herceptin combo was that it might be really hard on the heart, since the HCT trial did have some added cardiotoxicity even without AC and this mix has never been studied in any trial I have ever heard of. So, here are some thoughts:
1) Get tested for topoIIa before making a decision. You may be negative.
2) I believe there was a study of HCT->AC without the herceptin tail announced at San Antonio in 2004. It was a phase one trial, but the result was 7/8 complete response in 8 patients, 7 with stage III and 1 with stage IV breast cancer. You might see if there was any followup to that at ASCO, since this is a small number.
3) Some oncologists have replaced AC with EC (epirubicin) chemo, which is easier on the heart. However, even with this combo, there have been heart risks.

06-09-2006, 03:00 AM	#2
Christine MH-UK Senior Member Join Date: Sep 2005 Posts: 414	Mixing the trials? Your first oncologist was basing your treatment on a trial whose results were announced in December. This trial indicated that herceptin + carboplatin + taxotere->year of taxotere produces significantly fewer heart problems that AC->(taxotere+herceptin)->year of taxotere without being significantly less effective. Herceptin's inventor was very involved in the trial and indicated that it raised questions about whether the risks of anthracyclines were worth it for her2 positive patients, given that the AC->taxotere+herceptin->rest of year of herceptin combination seems to cause long-term heart damage. The study also showed that the patients with topoIIa benefitted from the addition of anthracyclines, such as AC chemo. Other oncologists, however, question the advisability of dropping AC chemo or anthracyclines. It may not be that you shouldn't have AC after herceptin. It may be more likely that herceptin after AC is the problem, since herceptin seems to aggravate heart problems started by AC. Unfortunately, there have only been two rather small trials using anthracyclines after herceptin-based chemo, although the results have been favourable, including a trial of herceptin, cisplatin, taxotere followed by AC in stage III women that had an 83% three-year disease free survival rate. My concern with the HCT->AC->year of herceptin combo was that it might be really hard on the heart, since the HCT trial did have some added cardiotoxicity even without AC and this mix has never been studied in any trial I have ever heard of. So, here are some thoughts: 1) Get tested for topoIIa before making a decision. You may be negative. 2) I believe there was a study of HCT->AC without the herceptin tail announced at San Antonio in 2004. It was a phase one trial, but the result was 7/8 complete response in 8 patients, 7 with stage III and 1 with stage IV breast cancer. You might see if there was any followup to that at ASCO, since this is a small number. 3) Some oncologists have replaced AC with EC (epirubicin) chemo, which is easier on the heart. However, even with this combo, there have been heart risks.