for those whose doctors, insurance cos. or govt.heath services want to stop herceptin

[Lani]

this is merely a case report (report of a single patient) but as the international gold standard as I understand it has been to continue herceptin as long as NED, this might be pause for thoughtL

Tumori. 2007 Sep-Oct;93(5):491-2.
When should trastuzumab be stopped after achieving complete response in HER2-positive metastatic breast cancer patients?

Beda M, Basso U, Ghiotto C, Monfardini S.
Department of Medical Oncology, Istituto Oncologico Veneto-IOV, Padua, Italy. m.beda@libero.it
We report the case of a woman with HER2-positive metastatic breast cancer who achieved prolonged complete remission of multiple liver metastases after treatment with weekly trastuzumab plus paclitaxel but relapsed in the brain soon after stopping trastuzumab maintenance therapy which had been prosecuted for almost three years. In the absence of randomized trials, the optimal duration of trastuzumab administration after achieving complete remission of metastatic breast cancer remains questionable.
PMID: 18038883 [PubMed - in process]


Since her recurrence occurred in her brain, it might have occurred anyway, but the timing of this was uncanny...

[Lani]

http://www.tumorionline.it/allegati/...0(491-492).pdf

[StephN]

Interesting post, Lani.

In my case it took about 2.5 years after I achieved complete remission from my extensive liver mets for the tumors to show up in my head. My med onc told me he thought they had been "seeded" when my cancer was very active with those liver mets. Just took longer to show themselves, as I had NO symptoms from them when I had my annual brain MRI.

No way would he have recommended I stop Herceptin, even though it does not normally pass through the blood/brain barrier. By keeping the mets in body/organs at bay, we are protecting our brains just the same. (He did feel that with as much Taxol I took, my BBB could have become "leaky" and let some of the Herceptin through thereby killing off any more little seedlings.)

I certainly hope with the more recent information on the spread of mets to the brain, the docs would not be so cavalier about stopping a drug like Herceptin for NED patients, even though it is expensive.

[Mary Anne in TX]

It seems to me that if they would project how expensive it would be if we recur, the cost to keep us on H would be nominal! Staying on H is one fight that I would be willing to take on! They'll have to make me stop!

[fullofbeans]

Very interesting post indeed.

In the UK they often stop Herceptin for stage 4 after a year like for other stages. I know someone that was stage 4 NED and recurred 4 months after they had stopped her. They are even not offering her herceptin anylonger now.. She was part of a small support group here and I have not seen her since I have heard of her recurrence. I will attend the meeting next week just so I can tell her to ask to go back on it.. incredible how clueless people here get such a raw deal.

[Lani]

they try that in Denmark as well

I just posted the following which does portend well for breast cancer patients requiring herceptin in the UK:

http://news.bbc.co.uk/2/hi/health/7115540.stm