HER2 Support Group Forums - View Single Post - Intrathecal (IT) Herceptin (Trastuzumab) for brain mets (Leptomeningeal Metastases)

YoungMD · 05-21-2016, 10:23 PM

In the NYC Metro area, I know for a fact that Dr. Joachim Baehring at the Yale Smilow Cancer Hospital in New Haven, CT treats leptomeningeal disease with an IT Herceptin regimen. 50 mg or 100 mg IT Herceptin is administered with 50 mg theradopa (cytotoxic agent) on a weekly basis through an Ommaya or lumbar resorvoir. There are minimal side effects at the 100 mg dosage, as in lethargy the day after administration, that's it. I've seen it have brilliant effects.

That being said, I still think radiotherapy is necessary in known areas of disease in the brain and spine. If it was not done already, though, you may want to discuss doing the IT Herceptin first if the tumors are not compromising critical brain stem areas (e.g. controlling breathing) or are causing paralysis.

IT Herceptin has proven to be excellent in prolonging the life of LM patients. I've read case reports of patients pulling 2-4 years until the disease stopped responding. That is the greatest danger with IT Herceptin. Once the tumor mutates to lose the HER2 ligand, the options are limited just to cytotoxic therapies and radiotherapy. IT Methothrexate is allegedly well tolerated (I have no personal experience to attest to that) but controls disease progression for maybe 4-6 months.

So, combination therapies could be a good option. I am personally in favor of IT Herceptin 100 mg every week as a base therapy coupled with the pulsile Tykerb treatment which was made reference to on this forum (protocol of biweekly lapatinib administered orally with a loading dose of 5000 mg /20 pills/ on Day 1, 6250 mg on Day 4 /25 pills/ and 7500 mg on Day 8 /30 pills/ administered every four days therafter). That way, you have two HER2 immunotherapies attacking the tumor.

For those willing to also integrate some additional therapies, CBD oil 2 ml twice a day should be given, Curcumin extract, Rei-Shi mushroom extract, and essential element supplementation as necessary based on bloodwork (especially K, Mg, and Ca if you are using Tykerb in combination with IT Herceptin). Care should also be taken to enrich your diet with tumeric, ginger, garlic, sweet potatoes, habaniero peppers, and eliminate any and all dairy products and oils, plant or animal based.

05-21-2016, 10:23 PM	#209
YoungMD Member Join Date: Apr 2016 Posts: 5	Re: Intrathecal (IT) Herceptin (Trastuzumab) for brain mets (Leptomeningeal Metastase In the NYC Metro area, I know for a fact that Dr. Joachim Baehring at the Yale Smilow Cancer Hospital in New Haven, CT treats leptomeningeal disease with an IT Herceptin regimen. 50 mg or 100 mg IT Herceptin is administered with 50 mg theradopa (cytotoxic agent) on a weekly basis through an Ommaya or lumbar resorvoir. There are minimal side effects at the 100 mg dosage, as in lethargy the day after administration, that's it. I've seen it have brilliant effects. That being said, I still think radiotherapy is necessary in known areas of disease in the brain and spine. If it was not done already, though, you may want to discuss doing the IT Herceptin first if the tumors are not compromising critical brain stem areas (e.g. controlling breathing) or are causing paralysis. IT Herceptin has proven to be excellent in prolonging the life of LM patients. I've read case reports of patients pulling 2-4 years until the disease stopped responding. That is the greatest danger with IT Herceptin. Once the tumor mutates to lose the HER2 ligand, the options are limited just to cytotoxic therapies and radiotherapy. IT Methothrexate is allegedly well tolerated (I have no personal experience to attest to that) but controls disease progression for maybe 4-6 months. So, combination therapies could be a good option. I am personally in favor of IT Herceptin 100 mg every week as a base therapy coupled with the pulsile Tykerb treatment which was made reference to on this forum (protocol of biweekly lapatinib administered orally with a loading dose of 5000 mg /20 pills/ on Day 1, 6250 mg on Day 4 /25 pills/ and 7500 mg on Day 8 /30 pills/ administered every four days therafter). That way, you have two HER2 immunotherapies attacking the tumor. For those willing to also integrate some additional therapies, CBD oil 2 ml twice a day should be given, Curcumin extract, Rei-Shi mushroom extract, and essential element supplementation as necessary based on bloodwork (especially K, Mg, and Ca if you are using Tykerb in combination with IT Herceptin). Care should also be taken to enrich your diet with tumeric, ginger, garlic, sweet potatoes, habaniero peppers, and eliminate any and all dairy products and oils, plant or animal based.