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Old 01-09-2010, 06:05 PM   #1
adrien
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Question What worked for you?

Hi,
I have several liver mets, the largest over 4cm, and a scattering of lung mets. I'd like to know a cross section of treatments that worked for those of you with similar issues. It's the liver I'm most interested in.
__________________
1999 IVDC oe+ grade 3
epirubicen, cysplatin, 5FU;
lumpectomy L breast, radiotherapy 6 wks, tamoxifen 3 mths, Examestane 5 yrs

2005 mastectomy (Left ) 10cm IDC in lymphatic system and blood vessels oe- HER2 ++;Taxotere, Herceptin 18 mths
2006 skin tumours below scarline Add Femera, 3 weeks radiotherapy twice daily (unsuccessful)
excision of tumours.
2007 jan skin tumour on L chest wall; positive Right axilla
Temerifen.
September Ca markers rise. Start Tykerb 3 wks radiotherapy
2008 skin tumours regrow. latissimus dorsal flap for excision of skin tumours March 08. HER2++++
Faslodex injections
CEA and Ca15.3 rising
2009
CT scan shows multiple mets in liver, lungs and inguinal glands. Stop Tykerb. Start Xeloda
CEA and Ca15.3 dropping like a stone. Skin tumours disappear.
Return 6 months later.
CT shows increase in size and number liver and lung mets.
Oct: Cyclophosphamide
Markers continue to rise. Change to Caelyx
2010
CEA marker in the 2000s Back to Herceptin
New tunour R Breast
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Old 01-09-2010, 06:34 PM   #2
Jackie07
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Re: What worked for you?

Adrien,

I 'searched' past postings and found that Lori R and CourtneyL both are currently undergoing treatment for liver mets. I hope they will see your thread and reply soon.
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Old 01-09-2010, 07:59 PM   #3
adrien
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Wink Re: What worked for you?

Thanks Jackie,
It's nice to know people are looking out for others.
__________________
1999 IVDC oe+ grade 3
epirubicen, cysplatin, 5FU;
lumpectomy L breast, radiotherapy 6 wks, tamoxifen 3 mths, Examestane 5 yrs

2005 mastectomy (Left ) 10cm IDC in lymphatic system and blood vessels oe- HER2 ++;Taxotere, Herceptin 18 mths
2006 skin tumours below scarline Add Femera, 3 weeks radiotherapy twice daily (unsuccessful)
excision of tumours.
2007 jan skin tumour on L chest wall; positive Right axilla
Temerifen.
September Ca markers rise. Start Tykerb 3 wks radiotherapy
2008 skin tumours regrow. latissimus dorsal flap for excision of skin tumours March 08. HER2++++
Faslodex injections
CEA and Ca15.3 rising
2009
CT scan shows multiple mets in liver, lungs and inguinal glands. Stop Tykerb. Start Xeloda
CEA and Ca15.3 dropping like a stone. Skin tumours disappear.
Return 6 months later.
CT shows increase in size and number liver and lung mets.
Oct: Cyclophosphamide
Markers continue to rise. Change to Caelyx
2010
CEA marker in the 2000s Back to Herceptin
New tunour R Breast
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Old 01-09-2010, 08:55 PM   #4
Rich66
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Re: What worked for you?

Go to this page and you can see Andrea and Steph N's treatment profiles in their posts. MamaCZ had complete remission on Navelbine/Herceptin. All had liver mets. Note that they are ER/PR-. Some significant thought out there that Chemo is not as helpful to ER+. But..there is some info and case studies regarding combining chemo and endocrine, i.e. "chemoendocrine" therapy. Rapamycin may be helpful in reversing resistance to some chemos. And the delivery of what you have already had may be worth investigating. Did you have Decadron (glucocorticoid) with your Taxotere? May have interfered. Some have revisited "failed" chemos in a lower-dose/metronomic fashion without breaks and had benefit. Cyclophosphamide is a favorite tool of metronomic guru, Dr. Kerbel. Capecitabine and Cyclophosphamide have been combined. Faslodex has been shown to synergize with chemo. There is thought that her2 therapies push the cancer to rely more heavily on estrogen and vice versa, suggesting blocking both pathways as best. There are strategies to sensitize or reverse resistance to ER therapies. Since Her2+ is more often ER-, it can be hard to good examples here. There are numerous liver directed thrapies. RFA, SirSpheresMy mom is in the exact same boat, mets-wise (though her2 borderline) as you and Xeloda gave her the best run so far.
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Old 01-10-2010, 12:18 AM   #5
Chelee
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Re: What worked for you?

Rich, Very impressive! I was going to give her a few names and you beat me to it. You covered alot of ground & then some. I'm glad you stick around here...your posts are always so informative. Great job.

Chelee
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DX: 12-20-05 - Stage IIIA, Her2/Neu, 3+++,Er & Pr weakly positive, 5 of 16 pos nodes.
Rt. MRM on 1-3-06 -- No Rads due to compromised lungs.
Chemo started 2-7-06 -- TCH - - Finished 6-12-06
Finished yr of wkly herceptin 3-19-07
3-15-07 Lt side prophylactic simple mastectomy. -- Ooph 4-05-07
9-21-09 PET/CT "Recurrence" to Rt. axllia, Rt. femur, ilium. Possible Sacrum & liver? Now stage IV.
9-28-09 Loading dose of Herceptin & started Zometa
9-29-09 Power Port Placement
10-24-09 Mass 6.4 x 4.7 cm on Rt. femur head.
11-19-09 RT. Femur surgery - Rod placed
12-7-09 Navelbine added to Herceptin/Zometa.
3-23-10 Ten days of rads to RT femur. Completed.
4-05-10 Quit Navelbine--Herceptin/Zometa alone.
5-4-10 Appt. with Dr. Slamon to see what is next? Waiting on FISH results from femur biopsy.
Results to FISH was unsuccessful--this happens less then 2% of the time.
7-7-10 Recurrence to RT axilla again. Back to UCLA for options.
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Old 01-10-2010, 12:26 PM   #6
StephN
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Re: What worked for you?

Hello Adrien -
sorry your liver mets are on the march again. I hit my mets hard with a 3-pronged approach: Taxol, Navelbine and Herceptin all at the same time. They never came back, but I am the exception.

You need to fight mets in more than one area, so I do think you need a combo of drugs that will close pathways, as well as kill the cancer cells.

I learned at San Antonio about the difficulty with treating "hetergenous" BC, which uses more than one pathway or is able to switch them on and off. Makes it all more complicated. (Sort of made my head swim!)

I hope the Herceptin will help, but you need something else that is synergistic with H. You already had Tykerb, but with what?
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"When I hear music, I fear no danger. I am invulnerable. I see no foe. I am related to the earliest times, and to the latest." H.D. Thoreau
Live in the moment.

MY STORY SO FAR ~~~~
Found suspicious lump 9/2000
Lumpectomy, then node dissection and port placement
Stage IIB, 8 pos nodes of 18, Grade 3, ER & PR -
Adriamycin 12 weekly, taxotere 4 rounds
36 rads - very little burning
3 mos after rads liver full of tumors, Stage IV Jan 2002, one spot on sternum
Weekly Taxol, Navelbine, Herceptin for 27 rounds to NED!
2003 & 2004 no active disease - 3 weekly Herceptin + Zometa
Jan 2005 two mets to brain - Gamma Knife on Jan 18
All clear until treated cerebellum spot showing activity on Jan 2006 brain MRI & brain PET
Brain surgery on Feb 9, 2006 - no cancer, 100% radiation necrosis - tumor was still dying
Continue as NED while on Herceptin & quarterly Zometa
Fall-2006 - off Zometa - watching one small brain spot (scar?)
2007 - spot/scar in brain stable - finished anticoagulation therapy for clot along my port-a-catheter - 3 angioplasties to unblock vena cava
2008 - Brain and body still NED! Port removed and scans in Dec.
Dec 2008 - stop Herceptin - Vaccine Trial at U of W begun in Oct. of 2011
STILL NED everywhere in Feb 2014 - on wing & prayer
7/14 - Started twice yearly Zometa for my bones
Jan. 2015 checkup still shows NED
2015 Neuropathy in feet - otherwise all OK - still NED.
Same news for 2016 and all of 2017.
Nov of 2017 - had small skin cancer removed from my face. Will have Zometa end of Jan. 2018.
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Old 01-10-2010, 01:02 PM   #7
Carolyns
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Re: What worked for you?

Hi Adrien,

I have had liver mets for going on 4 years now. I am ER positive and Her2 positive. The liver mets have responded to (in this order) - Gemzar w/ Herceptin, Herceptin w/ Tykerb, Abraxane w/ Herceptin, Xeloda w/ Tykerb. I am presently on TDM1 with Pertuzumab since Sept. 2009 via a trial that is closed now).

I have mets in liver, skin and lymph nodes.

Best wishes to you.

Carolyn
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Old 01-10-2010, 02:19 PM   #8
Ellie F
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Re: What worked for you?

Carolyns- how are you on T-DM1? Do you also get pertuzumab as well?
Ellie
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Old 01-10-2010, 02:59 PM   #9
Carolyns
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Re: What worked for you?

Hi Adrien, I forgot to add that I was also on Navelbine.

Ellie F. - TDM1 has gotten much easier for me and we added Pertuzumab. Scans have been good and the liver has improved. I still work full time (home based) and take care of my 11 year old son as a single parent.
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Old 01-11-2010, 10:50 AM   #10
Lori R
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Re: What worked for you?

Hi Adrian,
Isn't this site amazing.....Jackie has a great memory to recall that Lori R was dealing with liver mets. Quite impressive the folks on this board.

I used cryosurgery to whack down a liver met in May of 2009. We decided on a one...two punch and followed the cryosurgery with Abraxane to knock down any remaining cells. I just finished the Abraxane treatment in early November. I passed a scan in August with flying colors and will have a follow up scan in a couple of weeks. (to say I am having scanxiety is an understatement)

I am soooo hoping that I'll be able to return with good news.

I wrote a lengthy overview of the cryosurgery procedure and how relatively simple the procedure and recovery was. (at least for me).

Please let me know if you have any questions. I work full time, so I can't spend too much time on the site at work. I'll try to log in tonight when I get home.

Lori
__________________
2007
Oct - Diagnosed - Stage IV
5 c.m. IDC - Left Side er/pr- Her2+++
Node + 2/14 - Single Liver Met
Double Mastectomy
Nov - Begin T+H
2008
Feb-Complete 6 cycles- T&H- NED
March - Continue - Herceptin Only
April - Rads for 6 weeks
2009
Continue Herceptin - Continue NED
April - Recurrance- 3 cm. Liver Met
May - Cryosurgery
June - November - Abraxane + Herceptin
Aug - PET/CT - CTC = 0 Back to NED
2010
January - Continue NED
July - Recurrance - 3 cm Liver Met CTC=1
August - Cryosurgery #2
August - November Navelbine
November - Back to NED - End Navelbine
2011
Feb - Recur - 4 cm Liver Met - Same Left Lobe
March Surgery it is -Couldn't get a clean margin
July - Confirmed continued liver involvement
August - Begin Herceptin + Tykerb
October - Mixed results from H+T
Add Abraxane + H + T - Nov - April
2012
January PET Scan - It's working!!
April - Back to NED
July - Recurrance
August - Begin TDM-1 Trial (Taxol + TDM-1)
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Old 01-11-2010, 01:56 PM   #11
DanaRT
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Re: What worked for you?

Rich, You are a wealth of information and very generous to share. This is the first I have read that Decadron may interfere with Taxotere...well, ...darn.

Adrien, I will be watching this thread to see how you're doing and read what you've discovered.

Love,
Dana
__________________
-Dana-

]
Diagnosed - Nov. 2, 2007 at 45
Lumpectomy - Nov. 13, 2007
Tumor 1.2 cm
Stage 1 Grade 3
ER/PR - Her2 +++ (3.8)
Taxotere/Carboplatin/Herceptin- 6 rounds
Neulasta
Radiation 33 treatments - will be done 6/6/08
Herceptin through 12/08
12/07 MUGA 61%, 4/08 MUGA 60%, 7/08 MUGA 64%
three wonderful daughters, a terrific husband,
Life is Good
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Old 01-11-2010, 03:07 PM   #12
Kathy T
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Re: What worked for you?

Carolyn
You and I are on the same trial--when did you add Pertuzamab--I have staging this week so may be adding next time. Has it been an easy drug so far?
Kathy T
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Old 01-11-2010, 04:48 PM   #13
CourtneyL
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Re: What worked for you?

Hi Adrien - I am sorry to hear that you are dealing with liver and lung mets. What a crappy way to start the new year. Jackie is right, I have successfully battled both. When I was first diagnosed in April 2008, I had too many liver mets for them to even count and a smattering of spots on my lungs. We did an aggressive treatment of Herceptin, Cytoxan and Taxotere - every two weeks for 7 rounds. Then we dropped the Cytoxan and did one more with Taxotere. This combo got me almost to NED when it spread to my brain. So then I added Tykerb and eventually Xeloda to the Herceptin. That kept things in check for a long time - until this past October when I had some slight progression in my lung nodules. Now I am on Herceptin and Gemzar and my markers are dropping. Haven't re-scanned yet so I don't know for sure that it is all gone but I feel great and am confident things are going well on the inside. Gemzar is the easiest chemo I've ever been on.

Praying you find your magic bullet! Let me know if there is anything I can do!
__________________
4/17/08: Dx Stage IV at age 30 - extensive mets to liver, lungs, and bones. Er/Pr-, Her2+++
April 08-Aug 08:Taxotere, Cytoxan, Herceptin, Zometa - complete response!
Sept 08-Dec 08: Herceptin +Zometa for maintenance.

Jan 09-April 09: Brain mets. Add Tykerb. Watch and wait.
April 09: Gamma Knife 10 brain mets, add Xeloda.
Sept 09: Gamma Knife to 1 brain met.
Nov 09- April 10: Lung progression, add Gemzar to Herceptin, Zometa.
May 10- Sept 10: HER2 Vaccine Trial

Sept 10: Add Tykerb for more brain mets.
Oct 10: Gamma Knife to 7 brain mets.
Dec 10: Switch from Zometa to Denosumab.
Jan 11: Gamma Knife to 3 brain mets.
March 11: Gemzar/Herceptin for lung/bone progression.
April 11: More brain mets - Intrathecal Herceptin
June 11: Ixempra/Herceptin for lung, soft tissue progression.
Aug 11: Gamma Knife
Sep 11: Abraxane/Herceptin
Future: NED

Send me a PM if you'd like to follow my journey on Caringbridge.
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Old 01-17-2010, 10:28 PM   #14
waterdreamer
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Re: What worked for you?

Rich, I am on Taxotere and Herceptin, and I am given Decadron prior to infusions. Where can I find information that indicates that Decadron may interfere with the effectiveness of Taxotere?
Thank you
Fern
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Old 01-17-2010, 10:37 PM   #15
Rich66
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Re: What worked for you?

Glucocorticoids
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Mom's treatment history (link)
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Old 01-28-2010, 11:33 PM   #16
adrien
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Wink Re: What worked for you?

Wow,
haven't logged on for a while. (Went a bit (lot) down). Will keep logged in more often now.
Will take this battery of suggestions to my 2nd and 3rd opinions coming up soon. Have now found tumour in right breast. Seems strange since I've had positive right lymph node for 3 years and not a sign in mammos or MRI until now.
Thank you everyone. Feel well supported.
__________________
1999 IVDC oe+ grade 3
epirubicen, cysplatin, 5FU;
lumpectomy L breast, radiotherapy 6 wks, tamoxifen 3 mths, Examestane 5 yrs

2005 mastectomy (Left ) 10cm IDC in lymphatic system and blood vessels oe- HER2 ++;Taxotere, Herceptin 18 mths
2006 skin tumours below scarline Add Femera, 3 weeks radiotherapy twice daily (unsuccessful)
excision of tumours.
2007 jan skin tumour on L chest wall; positive Right axilla
Temerifen.
September Ca markers rise. Start Tykerb 3 wks radiotherapy
2008 skin tumours regrow. latissimus dorsal flap for excision of skin tumours March 08. HER2++++
Faslodex injections
CEA and Ca15.3 rising
2009
CT scan shows multiple mets in liver, lungs and inguinal glands. Stop Tykerb. Start Xeloda
CEA and Ca15.3 dropping like a stone. Skin tumours disappear.
Return 6 months later.
CT shows increase in size and number liver and lung mets.
Oct: Cyclophosphamide
Markers continue to rise. Change to Caelyx
2010
CEA marker in the 2000s Back to Herceptin
New tunour R Breast
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