[chrisy]

Hi Amy

I have input to your questions, but first let me say do not lose heart. Many women on this forum are doing well years after liver mets diagnosis. I don't know if this is your mom's first recurrence, it would help if you can provide more info.

The FDA approved indication for Tykerb is metastatic disease that is not responding to Herceptin. I can't tell from your post, but if this is your mom's first time on herceptin, that may be the basis for the denial - that it hasn't "failed". So the standard would be to try Herceptin first, then if it doesn't work, move on to Tykerb. Herceptin is a wonderful drug and could slap down those liver mets very effectively.

There's not much data re Tykerb+ Herceptin used together, so that is an unproven combination and I'm curious as to why that is being recommended. Or his he recommending Tykerb instead of Herceptin? If there's a reason, the insurance co's decision could be challenged.

That said, Herceptin and Carbo is a good combination (although usually I see it with a taxane either Taxol or Taxotere), and with Tamoxifen she's hitting lots of targets - that's good. You want to strike a balance between hitting the cancer hard and minimizing toxicity to your mom.

There is no generic version of Tykerb, but the scientific name is lapatanib.

Good luck, keep us posted.