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Rich66 · 04-17-2009, 10:45 AM

In addition to cyberkife, you could look into liver directed therapies at Swedish hospital there in CO:
http://www.swedishhospital.com/Custo...0-7D345CD59DC5}

I don't think you have to be Swedish but I would learn a little just in case it opens some doors.

This was an interesting article, similar to others I have seen, which might be applicable to your case:

1: J Vasc Interv Radiol. 2009 Mar 26. [Epub ahead of print]

Links
Radiation Lobectomy-A Minimally Invasive Treatment Model for Liver Cancer: Case Report.

Siddiqi NH, Devlin PM.
Division of Vascular and Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO 63110.
Chemotherapy-resistant colon carcinoma metastases to a patient's right hepatic lobe progressed after right lobar radioembolization with yttrium-90. The metastasis-free left lobe had adequate volume as a future liver remnant. Repeat right lobar radioembolization with supratherapeutic activity of (90)Y caused shrinking of the tumors and the right lobe with no adverse outcome. With an adequate tumor-free future liver remnant, one hepatic lobe bearing a large tumor burden may be administered supratherapeutic activity of (90)Y, risking lobar ablation for greater probability of tumor eradication. This is analogous to hepatic lobectomy. This case is presented as a proof of principle.
PMID: 19328722 [PubMed - as supplied by publisher
I seem to remember an MD Anderson raticle discussing how getting rid of the offending lobe was giving great results.I think they were using Trans arterial Chemo.

There is a forum of patients dedicated to Yttrium 90 issues:
send an e-mail to yes@discussthis.com to join.

Isolated hepatic perfusion is starting to make a comeback. Dr. Alexander seems to be the US guru. I think it's totally off-label for BC liver mets:

1: Front Biosci. 2009 Jan 1;14:1771-84.

Links

TNF-based isolated hepatic perfusion.

Bellavance EC, Alexander HR Jr.
Department of Surgery, University of Maryland Medical Center, Baltimore, MD 21201, USA.
Unresectable primary and metastatic cancers confined to the liver often determine the prognosis for patients with primary hepatic cancers, colorectal cancer, ocular melanoma, and neuroendocrine tumors. Although many locoregional therapies have emerged as options for patients with unresectable liver malignancies, these treatments frequently have limited clinical benefit. Isolated hepatic perfusion (IHP) has emerged as a regional therapy effective in inducing tumor regression in isolated liver metastases from multiple histologies. Tumor necrosis factor alpha (TNF) is a biologic agent well suited to isolated therapy because of its single-dose efficacy, synergistic effect with hyperthermia, and effects on tumor neovasculature. When combined with chemotherapeutic agents in IHP, TNF may improve response rates in patients with hepatic metastases of some histologies. However, there are additional toxicities associated with the administration of TNF and further studies are needed to determine whether TNF confers a clinical advantage in IHP.
PMID: 19273161 [PubMed - indexed for MEDLINE]

With all that said, perusal of liver metster profiles in this forum seems to support what worked for you in the past. Taxotere/Herceptin with or without Navelbine seems to be a powerful combination. It's not like it stopped working. So..you might be in a good position to use local therapies along with chemo that's benefitted you before.

04-17-2009, 10:45 AM	#5
Rich66 Senior Member Join Date: Feb 2008 Location: South East Wisconsin Posts: 3,431	In addition to cyberkife, you could look into liver directed therapies at Swedish hospital there in CO: http://www.swedishhospital.com/Custo...0-7D345CD59DC5} I don't think you have to be Swedish but I would learn a little just in case it opens some doors. This was an interesting article, similar to others I have seen, which might be applicable to your case: 1: J Vasc Interv Radiol. 2009 Mar 26. [Epub ahead of print] Links Radiation Lobectomy-A Minimally Invasive Treatment Model for Liver Cancer: Case Report. Siddiqi NH, Devlin PM. Division of Vascular and Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO 63110. Chemotherapy-resistant colon carcinoma metastases to a patient's right hepatic lobe progressed after right lobar radioembolization with yttrium-90. The metastasis-free left lobe had adequate volume as a future liver remnant. Repeat right lobar radioembolization with supratherapeutic activity of (90)Y caused shrinking of the tumors and the right lobe with no adverse outcome. With an adequate tumor-free future liver remnant, one hepatic lobe bearing a large tumor burden may be administered supratherapeutic activity of (90)Y, risking lobar ablation for greater probability of tumor eradication. This is analogous to hepatic lobectomy. This case is presented as a proof of principle. PMID: 19328722 [PubMed - as supplied by publisher I seem to remember an MD Anderson raticle discussing how getting rid of the offending lobe was giving great results.I think they were using Trans arterial Chemo. There is a forum of patients dedicated to Yttrium 90 issues: send an e-mail to yes@discussthis.com to join. Isolated hepatic perfusion is starting to make a comeback. Dr. Alexander seems to be the US guru. I think it's totally off-label for BC liver mets: 1: Front Biosci. 2009 Jan 1;14:1771-84. Links TNF-based isolated hepatic perfusion. Bellavance EC, Alexander HR Jr. Department of Surgery, University of Maryland Medical Center, Baltimore, MD 21201, USA. Unresectable primary and metastatic cancers confined to the liver often determine the prognosis for patients with primary hepatic cancers, colorectal cancer, ocular melanoma, and neuroendocrine tumors. Although many locoregional therapies have emerged as options for patients with unresectable liver malignancies, these treatments frequently have limited clinical benefit. Isolated hepatic perfusion (IHP) has emerged as a regional therapy effective in inducing tumor regression in isolated liver metastases from multiple histologies. Tumor necrosis factor alpha (TNF) is a biologic agent well suited to isolated therapy because of its single-dose efficacy, synergistic effect with hyperthermia, and effects on tumor neovasculature. When combined with chemotherapeutic agents in IHP, TNF may improve response rates in patients with hepatic metastases of some histologies. However, there are additional toxicities associated with the administration of TNF and further studies are needed to determine whether TNF confers a clinical advantage in IHP. PMID: 19273161 [PubMed - indexed for MEDLINE] With all that said, perusal of liver metster profiles in this forum seems to support what worked for you in the past. Taxotere/Herceptin with or without Navelbine seems to be a powerful combination. It's not like it stopped working. So..you might be in a good position to use local therapies along with chemo that's benefitted you before.