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Old 08-17-2011, 08:42 AM   #1
alex1
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Herceptin or Tykerb ?

Diagnosed in 03/2010 with carcinoma breast (tumor 3 x 3 x 2) post right MRM , with infiltrating duct carcinoma , LN 1/19 + ve , ER & PR – ve and HER – 2 + ve (FISH test) . Received CEF x 3 and Docetexal x 4 and Herceptin . Taken inj Herceptin 360 mg IV 3 weekly for a duration of 1 year , final dose completed on 30/05/2011.

PET scan on 10/08/2011 suggestive of liver metastates and pre caval lymphatic metastates after completing above treatment schedule.

Medical oncologist has prescribed Tykerb 250 mg x 5 times daily for 21 days and Xeloda 500 mg x 4 times daily for 14 days. Not prescribed liver biopsy as it will be risky and would be of no use in his opinion .

Quiries

01) Should liver biopsy be done ? Can HER – 2 + ve turn HER – 2 – ve ?
02) There will be delay in starting chemo till biopsy wound is healed . Will it be harmful?

03) What are other targeted chemotherapy options available for liver metastates?
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Old 08-18-2011, 02:06 AM   #2
pibikay
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Re: Herceptin or Tykerb ?

Hema had liver mets which got reduced/disappered in the latest PET scan.She is on Tykerb/Xeloda combination after 9 infusions of Herceptin.For her bone mets she is continuing Zoletrust infusion once in 3 montths.Hope for the best from the Tykerb Xeloda combination
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huband of Hema
Metstatic Breast Cancer Stage 4
Left breast cauliflower 25x20cm
ossousmetstatis in vertbrae secondaries L4=L5secondary
nodules in both liver lobes secondary
Diagnosed 10th March 2010
ER/PR-ve
Her 2 neu +++
Taxotrne Zylotec started 16th March
Herceptin added 5th April.9th Herceptin over on 20th Sep '10.Started on Tykerb and Xeloda on 22nd Oct2010TYKERB 4 TAB A DAY XELODA 4 TAB A DAY ONE WEEK ON ONE WEEK OFFZoletrust infusion every 4 months.Lesion in Brain 3D CRT Radiation started on 1st Feb'12 for 20 days ,5 days a week for 4 weeks.Devloped a small lump in breast.Xeloda stopped from 11th April '12.On Taxol.After 3 cycles of Taxol Taxol stopped.Back to Xeloda regime from 3rd July
Herceptin started again on 27th Dec 2012.Xeloda stopped Navelbin added on 7th February 2013.Now on Tykerb Herceptin and Navelbin
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Old 08-18-2011, 08:44 AM   #3
chrisy
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Re: Herceptin or Tykerb ?

Hi Alex
Here's my thoughts, remember I am not a doctor just a patient
1. Biopsy or not? This would not be a standard recommendation I think. Yes tumor biology CAN change but it is not all that common and the procedure is not without cost or risk. Your onc may be taking the "proof is in the pudding" approach which is what mine did. Assume the her2 status is unchanged and monitor effect of the treatment.
2. That said, the procedure has a quick recovery time so won't delay treatment. I started xeloda the next day and could have had the biopsy while on treatment.
3. Tykerb and herceptin are the only targeted therapies currently approved in the US. Others are in the pipeline but would only be available on a clinical trial. Nothing wrong with using the tried and true first.
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Chris in Scotts Valley
June 2002 extensive hi grade DCIS (pre-cancer-stage 0, clean sentinal node) Mastectomy/implant - no chemo, rads. "cured?"
9/2004 Diag: Stage IV extensive liver mets (!) ER/PR- Her2+++
10/04-3/05 Weekly Taxol/Carboplatin/Herceptin , complete response!
04/05 - 4/07 Herception every 3 wks, Continue NED
04/07 - recurrence to liver - 2 spots, starting tykerb/avastin trial
06/07 8/07 10/07 Scans show stable, continue on Tykerb/Avastin
01/08 Progression in liver
02/08 Begin (TDM1) trial
08/08 NED! It's Working! Continue on TDM1
02/09 Continue NED
02/10 Continue NED. 5/10 9/10 Scans NED 10/10 Scans NED
12/10 Scans not clear....4/11 Scans suggest progression 6/11 progression confirmed in liver
07/11 - 11/11 Herceptin/Xeloda -not working:(
12/11 Begin MM302 Phase I trial - bust:(
03/12 3rd times the charm? AKT trial

5/12 Scan shows reduction! 7/12 More reduction!!!!
8/12 Whoops...progression...trying for Perjeta/Herceptin (plus some more nasty chemo!)
9/12 Start Perjeta/Herceptin, chemo on hold due to infection/wound in leg, added on cycle 2 &3
11/12 Poops! progression in liver, Stop Perjeta/Taxo/Herc
11/12 Navelbine/Herce[ptin - try for a 3 cycles, no go.
2/13 Gemzar/Carbo/Herceptin - no go.
3/13 TACE procedure
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Old 08-18-2011, 08:49 AM   #4
chrisy
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Re: Herceptin or Tykerb ?

You didn't ask this specifically but tykerb vs. Herceptin? Current thinking is to switch them up to confuse the cancer. This may be what your onc is thinking. Also, tykerb is a smaller molecule so crosses the blood brain barrier thus may be mire protective of the brain than herceptin which is good
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Chris in Scotts Valley
June 2002 extensive hi grade DCIS (pre-cancer-stage 0, clean sentinal node) Mastectomy/implant - no chemo, rads. "cured?"
9/2004 Diag: Stage IV extensive liver mets (!) ER/PR- Her2+++
10/04-3/05 Weekly Taxol/Carboplatin/Herceptin , complete response!
04/05 - 4/07 Herception every 3 wks, Continue NED
04/07 - recurrence to liver - 2 spots, starting tykerb/avastin trial
06/07 8/07 10/07 Scans show stable, continue on Tykerb/Avastin
01/08 Progression in liver
02/08 Begin (TDM1) trial
08/08 NED! It's Working! Continue on TDM1
02/09 Continue NED
02/10 Continue NED. 5/10 9/10 Scans NED 10/10 Scans NED
12/10 Scans not clear....4/11 Scans suggest progression 6/11 progression confirmed in liver
07/11 - 11/11 Herceptin/Xeloda -not working:(
12/11 Begin MM302 Phase I trial - bust:(
03/12 3rd times the charm? AKT trial

5/12 Scan shows reduction! 7/12 More reduction!!!!
8/12 Whoops...progression...trying for Perjeta/Herceptin (plus some more nasty chemo!)
9/12 Start Perjeta/Herceptin, chemo on hold due to infection/wound in leg, added on cycle 2 &3
11/12 Poops! progression in liver, Stop Perjeta/Taxo/Herc
11/12 Navelbine/Herce[ptin - try for a 3 cycles, no go.
2/13 Gemzar/Carbo/Herceptin - no go.
3/13 TACE procedure
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Old 08-19-2011, 06:48 AM   #5
alex1
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Re: Herceptin or Tykerb ?

@ pibikay@chrisy thanks a ton for your replies.
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Old 08-22-2011, 09:33 AM   #6
alex1
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Re: Herceptin or Tykerb ?

herceptin already taken for 1 year 12 infusions. Not going for liver biopsy . Started tykerb+xeloda . Review after 2 months.
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Old 03-05-2012, 09:12 PM   #7
alex1
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Re: Herceptin or Tykerb ?

Tykerb / Xeloda not working
15 Aug 2011 – Oral chemotherapy started – Tykerb 250, Xeloda 500
28 Feb 2012 – PET-CT Scan –hepatic metastasis,lymphatic
metastasis,skeletal metastasis

I.V. 3 weekly chemo started PacliALL given as suggested by Onco . What are other options ?


_________________________________________________
Age 38 years
17 Feb 2010 – Mammography – Mass in right breast suspicious of malignancy
19 Feb 2010 – FNA from right breast – Duct carcinoma cells seen
04 Mar 2010 – Right radical modified mastectomy – tumor 3X3X2, LN1/19 +ve
15 Mar 2010 – Hormone receptor – ER negative, PR negative, c erb B2 –
positive score3
25 Mar 2010 – Detection of HER-2/neu by FISH - positive
1 Apr 2010 – Chemotherapy Started – 3 CEF + 4 Docetaxel + Herceptin (3wkly X 17)
30 May 2011 – Course of Herceptin completed
9 Aug 2011 – CT Scan – focal lesion 3.2X2.9cm in segment IV of liver
10 Aug 2011 – PET-CT Scan – solitary hepatic metastasis, precaval LN
suspicious mets
15 Aug 2011 – Oral chemotherapy started – Tykerb 250, Xeloda 500
28 Feb 2012 – PET-CT Scan –hepatic metastasis,lymphatic
metastasis,skeletal metastasis
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Old 03-06-2012, 05:03 AM   #8
Becky
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Re: Herceptin or Tykerb ?

See if your doctor will keep you on the Tykerb but add in Herceptin with a chemo. I think you need to reconsider Herceptin.
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Kind regards

Becky

Found lump via BSE
Diagnosed 8/04 at age 45
1.9cm tumor, ER+PR-, Her2 3+(rt side)
2 micromets to sentinel node
Stage 2A
left 3mm DCIS - low grade ER+PR+Her2 neg
lumpectomies 9/7/04
4DD AC followed by 4 DD taxol
Used Leukine instead of Neulasta
35 rads on right side only
4/05 started Tamoxifen
Started Herceptin 4 months after last Taxol due to
trial results and 2005 ASCO meeting & recommendations
Oophorectomy 8/05
Started Arimidex 9/05
Finished Herceptin (16 months) 9/06
Arimidex Only
Zometa every 6 months for osteopenia

NED 9 years!

Said Christopher Robin to Pooh: "You must remember this: You're braver than you believe and stronger than you seem and smarter than you think"
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Old 03-06-2012, 05:25 AM   #9
Jackie07
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Re: Herceptin or Tykerb ?

The article below gives an overview of different treatment options:

"Beyond trastuzumab: novel therapeutic strategies in HER2-positive metastatic breast cancer."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3251862/?tool=pubmed
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Old 05-04-2012, 10:28 AM   #10
potra
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Re: Herceptin or Tykerb ?

Herceptin and Tykerb attack the Her2 receptor at different levels, thus they have a potentiated effect. As far as I know there is still no way to determine at which level it will work for you except after seeing the effects. It's not unusual to prescribe both with or without Xeloda.
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Old 05-11-2012, 03:25 AM   #11
alex1
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Posts: 8
Re: Herceptin or Tykerb ?

Onco suggested Navelbine + Gemcitabine . As per onco disease not responding to aggressive traetment being given .What are other options at this stage ?


_________________________________________________
Age 38 years
17 Feb 2010 – Mammography – Mass in right breast suspicious of malignancy
19 Feb 2010 – FNA from right breast – Duct carcinoma cells seen
04 Mar 2010 – Right radical modified mastectomy – tumor 3X3X2, LN1/19 +ve
15 Mar 2010 – Hormone receptor – ER negative, PR negative, c erb B2 –
positive score3
25 Mar 2010 – Detection of HER-2/neu by FISH - positive
1 Apr 2010 – Chemotherapy Started – 3 CEF + 4 Docetaxel + Herceptin (3wkly X 17)
30 May 2011 – Course of Herceptin completed
9 Aug 2011 – CT Scan – focal lesion 3.2X2.9cm in segment IV of liver
10 Aug 2011 – PET-CT Scan – solitary hepatic metastasis, precaval LN
suspicious mets
15 Aug 2011 – Oral chemotherapy started – Tykerb 250, Xeloda 500
28 Feb 2012 – PET-CT Scan –hepatic metastasis,lymphatic
metastasis,skeletal metastasis
03 Mar 2012 - I.V. 3 weekly chemo started PacliALL (Paclitaxel ) given
05 May 2012 - PET CT Scan " Hypermetabolic hepatic , lymphatic and osseous metastates . Paclitaxel ineffective.
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