[chrisy]

HI Rick,

Well, that was not news you were expecting or wanting to hear. But the story is not necessarily as grim as has been painted for you so far.

There are many on this site who have been dealing well with brain mets, some for many years. There are options and you do need to get some input from top docs in that area of expertise.

All of the places you mention would be good choices for 2nd opinions. Several people have been treated at UCSF which is closest for you and is a major cancer center. If you are seeking MORE options, Dr. Keith Black at (I think at Cedars in LA area) is a top doc in this field.

You indicated that your wife has just completed 15 days of WBRT. Maybe I misread. But if I read that right, you would consider her "treated", and be watchful for recurrence but not do any additional "zapping" unless/until that happens. If I misread and she has NOT been treated, that's a lot of mets for targeted radiation but not necessarily out of the question - it's been done.

Having WBRT would likely preclude getting that (WBRT) again, if there is a recurrence. However, cyberknife or gamma knife or IMRT to target specific mets could still be an option. It's not necessarily a "this was the only chance" situation.

As far as systemic therapy, the issue is that herceptin and other large-molecule drugs do not pass the blood-brain barrier so are not so effective against brain mets. However Tykerb (another Her2 targeted therapy) does cross the BBB and can be very effective. It is usually given in combination with Xeloda. Brenda (posts her as hutchibk) has had good success with Tykerb/Xeloda and then also Herceptin in conjunction with IMRT targeted radiation to control brain mets for several years. There are also other chemos that can be effective.

I'm not one of the "experts" on board here, but as an interested observer I know that there are options.

Keep the faith