a Question on herceptin...

Jean · 02-23-2009, 03:57 PM

Does anyone know or heard from their onc. or has anyone read written material on the viability of herceptin afer a patient completes the year of herceptin treatment?

Thank you,
Jean

hutchibk · 02-23-2009, 04:24 PM

You know, I hope Maryanne in TX sees this and answers. I think her doc is a real forward thinker who might have given her a clue about this...

Laurel · 02-23-2009, 04:49 PM

Jean,

Are you asking whether there may be an option for us adjuvant patients to continue Herceptin for another year or more?

My onc. had said that she is expecting trials to begin where patients like us can continue Herceptin for 2 years. I will ask her about this when I see her in mid-March.

SoCalGal · 02-23-2009, 04:49 PM

had to log in just to comment on the avatar Hutch...who is that?

Mary Anne in TX · 02-23-2009, 05:52 PM

Hi! I did take close to 2 years of Herceptin alone. My onc and I both thought that I needed it. He had to fight for me over and over with my insurance co. they finally told me no more. I did have to pay a part of it, but I still believe that I needed every single bit I got! I'd still be on it, if I could. The battles were worth it! ma

karen z · 02-23-2009, 06:48 PM

Good question- I haven't come across anything and my doc has never brought up.
karen

Jean · 02-23-2009, 08:54 PM

Hi Laurel,
My question is after our treatment of one year (which is what is now protocol) for most stage 1 Her2 patients, how long does the therapeutic value of herceptin last? How long is it expected to last?
Does anyone have written assesments on this?

I was interested in length of time that the herceptin has in our systems. Is it months? a year? two years?
Or even if the dr. have any information on this.
Or any studies?

Thanks all,
Jean

Laurel · 02-24-2009, 05:00 PM

Jean,

I think I read somewhere that Herceptin has a half-life of approx. 28 days. Perhaps its work has been accomplished in binding the majority (hopefully) of circulating Her2 + ca. cells over the year it is administered? This is an interesting post. I'll have to try poking around to see if I can find anything. Lani?

StephN · 02-24-2009, 07:50 PM

Hi Jean -
Before taking my two Herceptin Holidays, I have had this discussion with my med onc. The answer is that this drug has a long serum half life and takes an average of 18 - 20 weeks to clear your system.

I also recall in the early days of using Herceptin it was thought to have a much shorter half life and thus the three-week protocol was not ready for prime time until more studies came in to show that this was viable for patients.

Cut to the chase - I can feel comfortable taking a 12 week break and know that the drug is still working in my body - in both the intracellular and extracellular domains.

Hope this helps.

P.S. Laurel - I love your quizzical kitty. Is it a Burmese?

Paris · 02-25-2009, 07:56 AM

Hi Jean, Do you mean how long herceptin suppresses the Her2 oncogene? I'd be very interested to know that. The most I've found in that regard is that the more aggressive subtypes Her2 bc and triple negative bc tend to recur earlier and then drop off as opposed to er breast cancer which maintains a steadier rate of recurrence.

Hopeful · 02-25-2009, 07:57 AM

Jean,

My recollection is that it takes about 18 weeks to fully "clear" the body of Herceptin after treatment ends. (My onc said to me, "Don't tell me I never gave you anything!")

Insofar as the lasting effects of the drug, no one really knows. I recall two papers that came out in 2007 that did a cost/benefit analysis of Herceptin from an insurance perspective (one was a Medscape article). I have them somewhere, but not ready to hand. In that paper, they used an assumption that Herceptin would provide 3 years of protection, and did comment that they thought it was an "outside" estimate. Of course, these folks are bean-counters and not scientists, but that is what I can recall seeing.

Hopeful

Jean · 02-25-2009, 08:46 AM

Paris,
Yes, you are correct...how long to fully clear the body.

Hopeful, interesting that we cannot find any aritcles on this?

Steph, thank you for confirming the length of time, yes that helps.

Here is a thought ladies: Paris writes,
"more aggressive subtypes Her2 bc and triple negative bc tend to recur earlier and then drop off as opposed to er breast cancer which maintains a steadier rate of recurrence. "

What are your thoughts for a triple neg...(sorry I mean triple positive)...who is er positive, that combo subtype. I am wondering if certain subtypes are being followed to examine the benefit of herceptin on a maintenance program?

Does this sound strange?
Has anyone discussed this topic or seen any articles, trials, etc. for those types?

Just thinking out loud...Thank you all for your replies.

jean

Debbie L. · 02-25-2009, 09:13 AM

Jean, I didn't understand what you were asking at first (and I'm still not entirely sure that I understand).

I'm hearing two questions here. If Herceptin is being given to control mets, then half-life has relevance. But I don't think that's what you're asking.

If Herceptin is given adjuvantly, it is my understanding that it's like chemo - the goal is to eradicate completely any stray cancer cells and "cure" the person of the cancer, during that time of administration. Of course the rub is that there's no way to know who those cured people are. But the theory as I understand it is that those who are not cured will recur at some point and then the game shifts to control rather than total eradication which may be possible with adjuvant treatment (which is not to say that there won't appear to be total eradication for long periods of time).

So half-life of Herceptin for adjuvant treatment isn't relevant. What IS relevant, and we do not know the answer yet, is how long to give Herceptin for best results. A small trial with a very short duration (six weeks?) appeared to do as well as the more-studied one-year duration (but it was not a head-to-head as far as chemo regimen, etc, and it was a small trial). But still, the results were as impressive as the one-year results were. Now there's at least one active trial looking at duration - one year vs. two years. I don't think we have any results yet, though.

Can you say more about your question? I'm still not clear. (And triple negative can't BE positive for ER and would not get Herceptin because HER2 is one of the negatives also.)

Again, being somewhat unsure what you're asking, I'm not sure if what I'm saying is even on-topic. I think that there is increasing interest (research) about triple positives (ERPR+ and HER2+) because there appear to be a subset (probably the highly ERPR+'s) in there who do very well and do not seem to have the typical HER2+ worse-prognosis. In addition, they need to figure out the best way to combine Herceptin (or other anti-HER2 treatment) with hormonal treatment for those who are less ERPR+ and/or are in the worse-prognosis group. But it seems like we're just beginning to hear these questions. I hope that all the adjuvant Herceptin trials that have already reported will begin sorting thru such details and at least clarifying what questions we should be asking.

Phew. Sorry - once I get started asking questions it's hard to reign the thoughts back in.

Debbie Laxague

Jean · 02-25-2009, 10:10 AM

Hi Debbie,
You are on topic...
I aplogize I made a typo error and meant to type positive, (type way too fast)...haste does make waste.

Anyways, getting back to topic.
My thoughts of late have been on duration of herceptin and subtypes. What trials or studies are being done for the subtypes in regards to length of treatment, do we have any results thus far?

I was hoping that some information or data had been released and one of us had viewed it or had some knowledge in regards to adjuvent herceptin trials and offering details.

Just seems there is nothing reported on trials that would place the data in sub groups...as to length of time,
seems one lump sum of duration is what we now have,
I just thought at this point in time we may be hearing more data about subtypes.

I was also curious to the viabilty (length of time) do you think that the herceptin range would change due to subtypes, ( I know this may seem like a strange question Debbie) but it is something my thoughts had hit on.
As we know herceptin works for some not all, what if anything does subtypes play into that? Or does it equate at all?

Last but not least yes, I did not know what length of duration herceptin remained in our systems for
both the adjuvent setting and those patients who have spread of diesease, only knew that for some continued treatment of herceptin will work to remain NED.

Once again thanks,
Jean

Debbie L. · 02-25-2009, 10:36 AM

Interesting discussion! And even when we're not sure we're talking about the same thing, it turns out that we are.

I agree with you, Jean. It seemed like a big deal to figure out HER2 but now we see that might be just the tip of the iceberg.

And now I understand, and agree with, your question about duration related to subtypes. The biggest part of that question to me is to ask whether it might it be important that hormonal treatment for triple positives be accompanied by some sort of Herceptin (or other anti-HER2) for the duration of the hormone treatment? There have been suggestions that treating HER2 might reverse or control resistance to hormonal treatment. Perhaps it would turn out to be not even the same Herceptin dose/interval as is used for adjuvant treatment. Or maybe one of the other, newer, targeted treatments would be a better match. I know there are studies looking at hormonals+targeted agents of various kinds, in metastatic disease (and not just HER2+ disease).

Again, the adjuvant Herceptin trials were not designed to look at all these nuances (at least I don't think that they were). But they did track these things (ERPR positivity, etc) so even a retrospective look back at these subtypes will be of some use. It could at least clarify what the questions ARE that need to be asked. I hope that we start hearing these results soon.

Debbie Laxague

Jean · 02-25-2009, 11:20 PM

Debbie had to chuckle....when I read...

"And even when we're not sure we're talking about the same thing, it turns out that we are. "

There is so much to be uncovered and discovered!
I appreciate your reply.

Best Wishes,
Jean

Savta · 02-26-2009, 12:41 PM

Just a thought on the Herceptin one year vs. two years....My oncologist also told me she would have no problem giving me an additional six months of Herceptin, after the initial year, but that I would have to finance it since the insurance would not cover it. But she also said she wouldn't recommend it, as studies done with Herceptin for nine weeks (I think in Finland?) showed results just as good as the one year plan, but that the accepted protocol is one year. Furthermore, there are studies going on giving Herceptin for two years, and the biggest proof that there don't seem to be any adavantage, is that the pharmecutical companies are not yelling from the rooftops how much better it is. They are interested in selling as much as they can, therefore, if there was any hint of an advantage, they'd be the first to announce it.
Seeing as Herceptin is a fairly new drug, we're all hoping we're on the right track.
Best of health to us all.