[kk1]

Hi;

I had good success with Tykerb, xeloda, and Herceptin as a triplette together. But at that time TDM1 and Perjeta were not around.

In theory Tykerb can cross the blood brain barrier. Note there have bee several studies in the metastatic setting which it was shown that laplatinib + chemo + herceptin works better than Laplatinib and chemo alone, particularly in Her2+ and ER+ patients.

From last Feb ASCO meeting by Dr. Rugo
http://www.ascopost.com/issues/febru...e-in-2013.aspx

"We have learned that we can improve outcomes by overcoming resistance through combined signal blockade targeting different parts of the HER pathway. We are already doing so by adding lapatinib (Tykerb) to trastuzumab, and have seen that pathologic complete response rates are high—47% to 60%—though lapatanib does add toxicity. As a single agent (combined with chemotherapy) lapatanib is inferior to trastuzumab, probably because it is difficult to administer easily (due to unpredictable toxicity, especially diarrhea). In addition to the data seen in the neoadjuvant setting, the single-agent lapatinib arm in the eagerly awaited adjuvant ALTTO study was closed due to futility, meaning that lapatinib with chemotherapy in the adjuvant setting was inferior to trastuzumab or the combination of trastuzumab and lapatinib. This is in keeping with other studies showing that lapatinib by itself is inferior, though it can be an important partner to trastuzumab. Other means of combined HER family blockade are needed."


I think most of us with mets would say to never drop the herceptin from the plan. Even if you have progressed, add to it and block it has many ways as you can.

all the best