[Jackie07]

Glad your daughter's tumor marker has become almost normal. Below is the abstract of an article published almost a year ago when "The combination of lapatinib [Tykerb]plus topotecan was not active and was associated with excess toxicity."

Since then the researchers must have figured out something as it seems to be effective in treating your daughter's Her2 breast cancer. A few of our members have also used Perjeta. You can use the 'Search' button on top to look up previous discussions.

Since it's a fairly new protocol, there might not be much discussion on the nutrition part. My own experience is that rice soup (plain 1/2 cup of rice cooked in 4 cups of water) can help maintain weight as rice = starch and can be dissolved by the enzymes in our mouth water. As her appetite increases, other finely chopped vegies/ground meat can be gradually added to the soup. I've also seen staff in the nursing home putting whole plate of lunch meal into the blender for those who have trouble chewing. You might want to give it a try.

J Neurooncol. 2011 Dec;105(3):613-20. doi: 10.1007/s11060-011-0629-y. Epub 2011 Jun 26.
Randomized phase II study of lapatinib plus capecitabine or lapatinib plus topotecan for patients with HER2-positive breast cancer brain metastases.

Lin NU, Eierman W, Greil R, Campone M, Kaufman B, Steplewski K, Lane SR, Zembryki D, Rubin SD, Winer EP.
Source

Division of Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA. nlin@partners.org

Abstract

Approximately one-third of patients with advanced, HER2-positive breast cancer develop brain metastases. A significant proportion of women experience central nervous system (CNS) progression after standard radiation therapy. The optimal treatment in the refractory setting is undefined. This study evaluated the toxicity and efficacy of lapatinib in combination with chemotherapy among patients with HER2-positive, progressive brain metastases. Patients with HER2-positive breast cancer with progressive brain metastases after trastuzumab and cranial radiotherapy were included. The primary endpoint was CNS objective response, defined as a ≥ 50% volumetric reduction of CNS lesion(s) in the absence of new or progressive CNS or non-CNS lesions, or increasing steroid requirements. The study was closed early after 22 of a planned 110 patients were enrolled due to excess toxicity and lack of efficacy in the lapatinib plus topotecan arm. The objective response rate (ORR) in the lapatinib plus capecitabine arm was 38% (exact 95% confidence interval [CI] 13.9-68.4). No responses were observed in the lapatinib plus topotecan arm. Although the study was stopped prior to full enrollment, some promising indications of CNS activity were noted for lapatinib plus capecitabine. The combination of lapatinib plus topotecan was not active and was associated with excess toxicity.