[Rolepaul]

Denise and I tried to get her in to see people for the past four months. That is why it is so frustrating to hear about her death.
Intrathecal Herceptin is the use of an Ommaya reservoir or spinal tap to introduce drugs into the central nervous system (CNS). Spinal fluid is the solution that is used to move food and remove waste in the spine and brain. The solution can have cancer cells in it and these then deposit throughout the brain and spine once they penetrate the blood brain barrier. This is a part of the body where no blood cells can go, only spinal fluid. Unfortunately, cancer cells can somehow make it through the barrier in some HER+ patients. Since Herceptin, Pertuzumab, and TDM-1 cannot make it through the barrier, they now are able to grow without worry. Putting these drugs on the other side of the barrier does the same thing as IV treatment does in the rest of the body! The problem is that the dose needed to be therapeutic was not well understood. The new knowledge is that doses five to ten times higher in spinal fluid concentration than blood are needed because the spinal fluid clears these drugs so much faster than the blood system does. Clinical trials at the higher dosage are being developed, but right now treatment at the higher dose is only available through compassionate use (or compassionate care) on an individual basis with the treating physician. I am trying to have all individuals contact MD Anderson as they have acted to assist doctors and patients at this point in time.