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Re: Brain mets, WBRT, SRS, TDM1 and a VP shunt
TDM-1 has Herceptin and emanstine bound together. If they get to the brain, it might be too aggressive inside of the fixed confines of an encapsulated lesion. It was important to start Intrathecal Herceptin at 40 mg per patient before going to the higher dose to prevent this same issue! Nina had no issues with Intrathecal Herceptin after SRS (twice) and another round of band radiation. She had radiation to the lower spine due to mets there. Nina has been on IT Herceptin at for 27 months with the disease kept at bay. I think TDM-1 is not a good idea for brain mets, but I am not 100% sure. I am sure for IT treatment. Please be aware that Emanstine was not allowed in the past because it was so toxic in the general body usage. If the cells are compromised in any way, and there are residual tumor cells present, the reaction may be too strong. That does not appear to be the case with Herceptin. We are looking at Perjeta the same way, but there is a reluctance by those in Clinical Affairs to use Perjeta because the Phase I trial at Northwestern for Herceptin through Intrathecal introduction is not yet complete.
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