Herceptin with or without a taxane?

[Brenda_D]

Why do you think that some Oncs give Herceptin with a taxane, and some give it alone, even if you've been through a prior chemo regimen, such as A/C?
What's the deciding factor?

[Becky]

Dear Brenda

I think it depends on if you are newly diagnosed or if you have recurred to Stage 4 disease

If newly diagnosed - older Standard of Care (since Herceptin has been okayed in early disease) was 4 AC followed by Herceptin for a year. This is what women were given since May 2005 that were Stage 1. Since 2006, it was shown that 6 TCH worked as well as 4 AC followed by taxol with Herceptin except that AC causes more cardiotoxicity and can cause leukemia more often in the future than TCH. Also, there have been studies that taxane + herceptin has synergistic effects so it works better (for some women) than herceptin alone. In early disease, chemo is used so the disease does not recur. That is the aim - to be cured. Now a days, since taxanes work so well with women who have Her2 disease (regardless of hormone status), oncs like to at least combine Herceptin with one.

In Stage 4 disease (those who have recurred and never had chemo to begin with), oncs like to try a taxane with Herceptin in hopes of a complete remission much like in early disease. However, for women who have recurred, sometimes less is more. Perhaps Herceptin alone (sometimes combined with an antihormonal if the women is hormone positive) can retard or delay disease progression and give a great quality of life for many, many years. Then, if progression does occur, differing chemo regimes can be done. However, I think if the recurrence is bad - raging liver mets let's say - there is no choice but to knock those mets back as fast as you can.

Lastly, its the onc (or cancer center's tumor board) who may just plain ole like certain chemos or combos. I like vanilla ice cream the best and you may like chocolate. So it can just be personal preference.

I think literature and studies say a taxane + Herceptin works best but I had them separately and next week, it will be 4 yrs for me so something worked so far.

Love to you

You know I often wonder this. I was part of the 2005 regimine and had 3 oncologist weigh in on my treatment. Given that I was node negative and had a tumor around 7mm, only one offered taxol. In the end I went with the majority opinion that said that AC followed by a year of herceptin was the best and missed the taxol train. I wonder if my teatment was as good.

[nancy dip]

I often worry about this. I was never offered a taxane as it was not standard of care in the uk in 2006. My alternative on the trial was cmf.
If I knew then what I know now , I would have tried to change this and have a taxane.
Should I worry about this? How many people do well with herceptin and non-taxane chemo?

Nancy

Sorry about bold type. I can't get rid of it!

[swimangel72]

My oncologist put me on Herceptin without any taxanes or A/C - his reasoning was based on a study that showed Herceptin works well with ANY chemo, so he put me on 4 months of Navelbine even though I don't have mets. I get my infusions every two weeks - I've finished the Navelbine and will continue with Herceptin until April '09. Tomorrow I start on Arimidex. I do worry that my treatment is very unorthodox - but 3 different oncologists have told me that this treatment plan would be OK for me since my tumor was small and node negative and since I had the mastectomy. I feel confident that all will be well, but only time will tell!

[caya]

I had 2 tumours, 1.7 cm. and 1.0 cm., node negative, had a MRM. My chemo regime was 3 x FEC, 3 X Taxotere, one month off, then Herceptin every 3 weeks for a year.
I was diagnosed in Oct. 2006, Herceptin was already approved in Canada for early stagers, so my onc. told me I would be getting it.
We discussed the Taxotere, and he said it was a strong and very effective chemo for Her2+, and he had been using it for a couple of years already with great success. At that point I was so shell shocked I just told him I wanted him to hit me with everything in the arsenal so the beast would never come back. I'm almost 2 years out, pretty confident I'm okay.
FEC is pretty standard here in Canada and other Commonwealth countries like Australia, New Zealand, England. I think what Becky says is true, each onc./oncolgy unit has their particular chemo regime they like, FEC, AC, and now the TCH.

all the best
caya

[atdec05]

I also had my first treatment in 2005: 4xAC and a year of weekly Herceptin. I was stage 1 and had a mastectomy. On my last month of Herceptin I found a local recurrence near my scar. My onc. thought it should be treated as a progression, and recommended Tykerb+Xeloda. My 2nd opinion thought it should be considered a failure of treatment and recommended 6 TCH, effectively starting over. My 3rd opinion thought I should be treated as an incomplete treatment, and recommended 12 TH, saying that Herceptin could work synergistically with Taxol.

All doctors recommended radiation, which I had not previously done because of my mastectomy, though in retrospect my margins were very close (2mm).

When looking into trials it seemed that one had to have had taxol previously to be eligible.

I'm almost one year out from treatment now.

take care,
Anna