Can someone explain?

[Mary Jo]

Hello,

Can someone explain to me what happens when herceptin is completed? What I need explained is what exactly did the herceptin do or should I say, what was it suppose to do? I do understand that being her2 positive means that we over express the her2 neu gene that allows our cancer to grow. What I wonder about being on herceptin is this................................does being on the herceptin change the over expression for good or only while on the herceptin? Will our body go back to the way this gene was over expressed when treatment is finished?

I'm hoping that you will understand what I mean? I meet with my oncologist on Oct. 11 when I will receive my LAST herceptin treatment (after being on it 1 year at that point) and plan on discussing this with her at that appointment.

I just wondered who knew about this question on this forum.

Thank you.
marejo

[mts]

The Herceptin will not change the over-expression capabilities of the cancer. It will however prevent cells from multiplying. If you have a tumor and take Herceptin, you will likely have tumor shrinkage. If you however stopped taking the Herceptin then that tumor will begin to grow again. Remeber that Herceptin was primarily created for the metastatic HER2+ bc patient.
Navigate through the below website- it will tell you how herceptin works- for the metastatic patient. Not enough data has been collected to gauge how beneficial it has been for the Stage I, and II bc women. Evident from the posts on this board, it is clear that Herceptin shrinks tumors and helps the immune system fight-off cancer. And it absolutely helps when used with taxol. It also prolonged the life of many Stage IV patients too. Some women still progress (very few) with it and others (mostly) are NED or stable. Some women on this board have been taking Herceptin for 6+ years! I think that once the Stage I, II and some III's are off the Herceptin, only time will tell exactly what it did for them. We can only hope that the success brought forth by those women with more advanced disease that are taking Herceptin will be the promise that it will work for those of us with earlier stage. I mean, if it shrinks mets, and Stage I's supposedly do not have mets, then our immune system fortified by the herceptin should kill off any errant cancer cells. Because it is relatively safe to take, I suppose we are lucky it will be there if the earlier stages reccur...

Maria (MTS)

http://www.herceptin.com/herceptin/p...about/work.jsp

[tricia keegan]

Maria thank you for explaining that so well as I also was a little confused about it and am due to finish my year in November.
Tricia

[rinaina]

I am one of the early stagers...stage one, node negative, her2+, er/pr-, clean margins and I was wondereing the same thing so thank you marejo for asking that great question and thank you mts for answering it so well. I just received my first herceptin treatment yesterday and while it is uncertain what it will do for us early stagers, I am still happy to be receiving it at this point because at least I feel like I am attempting to do something to prevent this disease from metastisizing or reoccuring. I have one more question mts...So based on your answer to marejo's question, am I too believe that once you complete herceptin treatments, you are no longer protected from a metastisis occuring or a reoccurence? If this is the case, then why not be on herceptin longer? I know my onc said I will only be on it for a year. Then what? I worry so about longevity and then once I am off herceptin, (assuming it does anything for us early stagers), I will be even more worried about longevity. I know we just have to take things a day at a time and most of the time I do not dwell on it but you can't help but think sometimes about the future.

[Mary Jo]

Thank you so much for the explanation. I still am a bit confused but get it better than I did. I was an early stage breast cancer 2A or B - mastectomy and pet/ct scan showed no mets anywhere - thank the Lord. I was er/pr neg. but her2 pos. grade 3 tumor. So.......................have been on herceptin and am due to finish up Oct. 11. That will be 1 year. I did the a/c and taxol also and started my herceptin along with the taxol. So...........God willing it helps me to not recur BUT if it does hopefully we get it early as well.

marejo

[mts]

Because of the overwhelming success of Herceptin keeping Stage IV bc at bay it is assumed that the longevity of Stage I,II, and III's taking herceptin can only improve also. I look at it like this: if you are metastatic, pretend your tumors are like hard candy. The herceptin will "eat away" at the outer layers of the tumor until it reaches the dead cancer cells, at which point the little mass just sits there until the body somehow resorbs it. IF the tumor still contains live cancer cells within its body and you get off the herceptin, then the likelihood of that tumor to re-grow is high. IF you are non-metastatic, then there are no layers to be eaten away, and any lurking cells will be eaten.

I suppose any of us can remain on Herceptin indefinitely in the non-met stage, but as long as there is no scientific data to back up that need for Herceptin for longer than a year, then it will be difficult (not impossible) to obtain or for onc's to validate. I too just finished a year of Herceptin. Despite the fact that I was treated VERY aggressively with chemo and rads...I can only hope that every bit of my cancer is gone...

For me, all I know is that I have done everything I needed to do to rid my body of cancer. And yes Marejo, hopefully it will not recur and if it does, it will be found early.

Warmly,
Maria

[astrid]

I have an article printed in the New England journal of medicine in October 2005 (Vol 353 No. 16). This discusses Herceptin after Adjuvant chem. In HER2 + breast cancer.



http://content.nejm.org/cgi/content/full/353/16/1659



The discussion of this article is:

This study shows that trastuzumab can benefit women with HER2-positive breast cancer when given after completion of adjuvant chemotherapy. As compared with observation after primary therapy (including surgery with or without radiotherapy and neoadjuvant or adjuvant chemotherapy), trastuzumab given after primary therapy reduced the rate of recurrence, particularly distant recurrence, by approximately 50 percent. This degree of benefit in early breast cancer is the largest to be reported since the introduction of tamoxifen in hormone-receptor–positive disease.

Another concern is that longer follow-up may show that trastuzumab is not effective in reducing the incidence of disease recurrence in the central nervous system. Brain metastases developed in approximately one third of the women receiving trastuzumab as treatment for advanced breast cancer, despite control of systemic disease.

At a median of one year of follow-up, trastuzumab improved the disease-free survival in all subgroups, further follow-up may show that the magnitudes of absolute benefit differ across subgroups. For example, almost 60 percent of the disease-free–survival events observed so far occurred in the hormone-receptor–negative cohort (48 percent of the patients), but we cannot rule out the possibility that in the future disease-free–survival events may occur disproportionately more often among patients in the subgroup with hormone-receptor–positive tumors. By design, women with cardiac risk factors and an LVEF of less than 55 percent after completion of chemotherapy with or without radiotherapy were excluded from the study, and our data are not applicable to the treatment of such women.

The results of this trial indicate that one year of adjuvant trastuzumab should be considered a standard option on completion of locoregional therapy and neoadjuvant or adjuvant chemotherapy for women who fulfill the study eligibility criteria used in the HERA trial.