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Old 02-16-2012, 03:42 AM   #1
Mandamoo
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Off the Bolero Trial

Well - it looks like I got 7 months out of everolimus. My last scan showed progression in my lungs - new spots and growth of existing spots.

I am due to start Tykerb and Xeloda next week. Had a lung biopsy yesterday as we could finally reach one - they are still relatively small but numerous. My lymph node and skin met remain stable - just my lungs going crazy.

I am feeling pretty bummed. I have made major lifestyle changes, coped really well with treatments, still mothered my children, meditate and try to enjoy life but this cancer just keeps growing.

I saw my surgeon today - a wonderful man but brutally honest with me. He said the speed at which the cancer spread while on treatment was not a good sign and that the likely course is treatments becoming progressively less effective until there is nothing left.

I find this so difficult to comprehend. I am still asymptomatic. I have three young children 5, 7 and 10 who need their mother. I have been struggling to keep the tears at bay today.

No one seems particularly hopeful regarding Tykerb and Xeloda - just a time buyer - well I guess they all are. My oncologist seems to be ticking the box so that I might qualify for the Th3resa trial.

Probably just my headspace tonight - usually I am so inspired by everyone on here and the hope that abounds but I went searching for threads on Xeloda and Tykerb side effects and noticed that some of them were a few years old and many posts from members no longer with us and struggled with that.

I am looking for wise words from those of you with experience. Any tips on Tykerb and Xeloda also very much appreciated.
Amanda x
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Amanda xx
40 year old Mum to three gorgeous kids - son 5 and daughters 8 and 11
Wife to my wonderfully supportive husband of 17 years!
22 February 2011 - Diagnosed Early Breast Cancer IDBC Stage2b (ER/PR -ve, Her2+ve +++) - 38 years old
(L) skin sparing mastectomy with tissue expander, axilla clearance (2/14 affected) clear margins.
Fec*3, Taxotere and herceptin*2 - stopped due to secondary diagnosis

June 24 2011 Stage IV - Skin met, axilla node, multiple lung lesions

Bolero3 trial - Navelbine, Hereptin weekly, daily Everolimus/Placebo
February 2012 - July 2012 Tykerb and Xeloda - skin mets resolved, Lungs initially dramatically reduced but growing again
August 2012 (turn 40!) tykerb and herceptin (denied compassionate use of TDM1) while holidaying in Italy!
September 2012 - January 2013 TDM1 as part of the Th3resa trial - lymph nodes resolved, lungs slowly progressing.
January 2013 - herceptin, carboplatin and Perjeta (compassionate access)
April 2013 - Some progression in lungs and lymph nodes - Abraxane, Herceptin and Perjeta
July 2013 - mixed response - dramatic reduction of most lung disease, progression of smaller lung nodules and cervical and hilar nodes - ? Add avastin.
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Old 02-16-2012, 05:12 AM   #2
Redwolf8812
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Re: Off the Bolero Trial

Praying for you and your family. Did you by any chance ever get tested for a BRCA gene? If you're positive, you could try a Parp inhibitor. They sound promising.

Love,
Penny
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Penny

July 2010 IDC grade 3 stage 3 er-/pr-/her2+++, BRCA2
Skin mets 11/10
1/12/11 Surgery path - complete response
Rads 2/11-4/11
Liver mets 11/11 now stage IV
Xeloda & Tykerb 12/11
Allergic reaction to Tykerb 12/11
Xeloda only 12/11
Added herceptin January 2012
Progression February 2012.
Started Veliparib (parp inhibitor) trial 3/5/12.
4/30/12 Liver met shrunk in half! Praise Jesus!
6/18/12 another 25% shrinkage, down to @3x3. Thank you, God!
8/8/12 Brain MRI - clear! Praise to You, Lord Jesus Christ!
8/27/12 Thank You, God - another 20% decrease in liver met! Now @ 3.2x1.9.
10/5/12 stable-ish
11/21/12 allergic reaction to carboplatin
12/10/12 stable & progression
12/31/12 liver ablation
2/6/13 ablation successful but new tiny mets in liver. May or not be cancer.
Another ablation scheduled 2/28/13. Cancelled.
2/20/13 started taxotere & herceptin. Pretty toxic. Oncologist says start tdm1 4/3/13. From her lips to God's ears. Praying for no allergic reactions/adverse side effects.
3/28/13 increase in liver mets - number & size
4/3/13 started TDM1
6/25/13 Praise God! Scan shows only one viable lesion and it's smaller.
10/8/13 MRI shows 1 large and two small tumors.
10/11/13 Ablation of tumors. It's in God's Hands.
10/23/13 Jesus and TDM1
12/19/13 Started trial of palbociclib & herceptin after scan showed growth of liver tumor and a questionable spot on rib.
2/6/14 CT scan - previous suspicious spot on rib probably damage from radiation - Praise God! MRI - over 200% growth in cancer in liver.
2/19/14 started Navelbine, Perjeta, & Herceptin combo.
5/2-5/4/14 hospitalized with very high liver function numbers, plus skin and eyes are yellow, plus urine is orange. Feel ok, so doctor not sure if liver failing due to cancer, chemo, or infection. Hospital gets numbers to go down and sends me home. MRI done in hospital reveals cancer shrinking - praise God!
5/6/14 - 5/8/14 hospitalized with no white blood cell count. Released when they go back up, @ 6 days after doctor gave me a neulasta shot.
5/16/14 - informed blood cultures done in hospital are back and that I contracted hepatitis e. Have to take ribavirin (anti-hep med) until liver function numbers are back to "normal" before re-starting chemo. Will probably go on veliparib and temodar this time.
5/26/14 - my birthday - GI doctor informed me that the hepatitis e was completely gone - I didn't even need the anti-viral meds! This is a miracle from God!
5/28/14 - started veliparib and temodar (compassionate use)
8/18/14 MRI shows 90% growth in liver tumors
8/20/14 start Perjeta, Herceptin, & Navelbine. Thanking & giving Glory to God for each moment.
9/22/14 - 9/24/14 Hospitalized with 102.2 fever and neutropenia
11/13/14 ER for high fever and fast heart rate. Got both down with IV antibiotic and fluids. Sent home same night. Thank You, Lord!
12/2/14 MRI shows progression in liver. Grateful to God that I still feel good.
12/11/14 Simulated SIR-spheres. Successful. Real thing (1st lobe) scheduled for the 23rd. Also starting Xeloda on 22nd for 2 weeks because it's synergistic with the spheres.
12/23/14 SIR-spheres in left lobe of liver. On Xeloda 12/22/14 - 1/4/15.
1/7/15 Receiving Perjeta & Herceptin while awaiting next course of action.
2/9/15 SIR-spheres in right lobe of liver. On Xeloda for 2 weeks (started 2/8). Still on Perjeta & Herceptin. Don't know what's next for me. :-)
3/25/15 Final read on MRI report - there are new and multiple lesions in both lobes of liver. Sigh. Praise God I've made it this far!
4/1/15 Started Gemzar & Herceptin. 1st week G&H, 2nd week G only, 3rd week off. Thank You, Lord, for this option.
4/15/15 Labcorp - liver enzymes in 200's. Appointment 4/22 with oncologist to discuss. Also, "radiation recall" in previously treated area? Very itchy. Need to discuss.
4/22/15 Enzymes came down. Received reduced dose of Gemzar only. No herceptin. Will get labs at lapcorp next two weeks since taking break for vacation purposes. Treat radiation area.
5/9/15 ER for severe abdominal pain. Constipation. Sent home with meds and advice to follow up with oncologist regarding jaundice and bilirubin.
5/11/15 Hospitalized for rising bilirubin and jaundice. CT scan reveals larger and more constricting tumors in liver.
5/13/15 Met with my oncologist. Bilirubin came down. If still down by Monday, I'll get chemo. If not, than I guess I'll see you all in Heaven. Praise God. Please pray, pray, pray.
5/18/15 Bilirubin jumped up. Trying lowered dose of Ixempra, with Herceptin. Oncologist is surprised that I'm functioning so well, given the high bilirubin. I have anywhere from 2 weeks - 2 months to live.
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Old 02-16-2012, 06:40 AM   #3
Sheila
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Re: Off the Bolero Trial

Amanda
Many times the chemos have only been a "Patch" for me, to get me through until something that works better comes along...each one so far has given me time, and I am thankful for that....your list is still quite short, and I can think of several that might work well in your case...i found Eribulen (Halaven) worked well with Herceptin....I have always been on Herceptin with each chemo...even the metronomic chemo might be worth a try....look at some of the lists below our names, jot down the drugs and go see the oncologist and ASK what about this drug...etc.....they like a patient who is planning their future.....sometimes I think they are so busy they forget some of the possibilities or old standards....

Seems you have alot of drugs to try yet...one may be your miracle that gets you to NED.....ASK!!!!
Sending prayers and positive vibes to get you over this hurdle!
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is fighting some kind of battle."



Hugs & Blessings
Sheila
Diagnosed at age 49.99999 2/21/2002 via Mammography (Calcifications)
Core Biopsy 2/22/02
L. Mastectomy 2/25/2002
Stage 1, 0.7cm IDC, Node Neg from 19 nodes Her2+++ ER PR Neg
6/2003 Reconstruction W/ Tissue Expander, Silicone Implant
9/2003 Stage IV with Mets to Supraclavicular nodes
9/2003 Began Herceptin every 3 weeks
3/2006 Xeloda 2500mg/Herceptin for recurrence to neck nodes
3/2007 Added back the Xeloda with Herceptin for continued mets to nodes
5/2007 Taken Off Xeloda, no longer working
6/14/07 Taxol/Herceptin/Avastin
3/26 - 5/28/08 Taxol Holiday Whopeeeeeeeee
5/29 2008 Back on Taxol w Herceptin q 2 weeks
4/2009 Progression on Taxol & Paralyzed L Vocal Cord from Nodes Pressing on Nerve
5/2009 Begin Rx with Navelbine/Herceptin
11/09 Progression on Navelbine
Fought for and started Tykerb/Herceptin...nodes are melting!!!!!
2/2010 Back to Avastin/Herceptin
5/2010 Switched to Metronomic Chemo with Herceptin...Cytoxan and Methotrexate
Pericardial Window Surgery to Drain Pericardial Effusion
7/2010 Back to walking a mile a day...YEAH!!!!
9/2010 Nodes are back with a vengence in neck
Qualified for TDM-1 EAP
10/6/10 Begin my miracle drug, TDM-1
Mixed response, shrinking internal nodes, progression skin mets after 3 treatments
12/6/10 Started Halaven (Eribulen) /Herceptin excellent results in 2 treatments
2/2011 I CELEBRATE my 9 YEAR MARK!!!!!!!!!!!!!
7/5/11 begin Gemzar /Herceptin for node progression
2/8/2012 Gemzar stopped, Continue Herceptin
2/20/2012 Begin Tomo Radiation to Neck Nodes
2/21/2012 I CELEBRATE 10 YEARS
5/12/2012 BeganTaxotere/ Herceptin is my next miracle for new node progression
6/28/12 Stopped Taxotere due to pregression, Started Perjeta/Herceptin
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Old 02-16-2012, 07:22 AM   #4
sarah
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Re: Off the Bolero Trial

I'm far from knowledgeable but aren't you still on Herceptin? also what about TDM-1 which seems to be a great drug? also I read somewhere about radiation of metatastic sites, any discussion about this? maybe see some more doctors and see if you get some different answers. I agree with Sheila, you haven't done a lot of drugs yet.
big hugs and love
sarah
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Old 02-16-2012, 07:23 AM   #5
sarah
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Re: Off the Bolero Trial

also maybe change your post title to looking for answers when chemos aren't working or something like that then you'll get answers from the pros.
big hug
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Old 02-16-2012, 01:12 PM   #6
tricia keegan
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Re: Off the Bolero Trial

Amanda I'm sorry this med did'nt work for you and as Sheila says there's still many out there to try to stay positive one of them will work well for you.
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Dx July '05 IDC 1.9cm Triple positive 3/9 nodes positive
A/C X 4 ..Taxol/Herceptin x 12 wks then herceptin 1 yr
Rads x 36 ..oophorectomy August '06
Currently taking Arimidex..
June 2011 osteopenia/ zometa x1 yearly- stopped Zometa 2015 as Dexa show normal bone density.
Stopped Arimidex July 2014- Restarted Arimidex 2015 for a further two years on the advice of my Onc.
2014 Normal Dexa scan
2018 Mammo all clear, still NED!
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Old 02-16-2012, 05:06 PM   #7
7andcounting
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Re: Off the Bolero Trial

Hi,

Sorry you are off the Bolero trial. I guess I don't know much but I am surprised that your onc doesn't hold out much hope for Tykerb and Xeloda. I think that is a pretty hopeful combo.

There are hopeful, new drugs on the horizon....we just need them to get approved...but we know the names of them...TDM-1, Pertuzamab, Neratinib.......

Hang on. Saying a prayer for you for your encouragment.
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Old 02-16-2012, 05:45 PM   #8
chrisy
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Re: Off the Bolero Trial

Hi Amanda,
Of course it is disappointing (I know, I am the master of understatement) when a treatment stops working. And doubly discouraging when your doctor so starkly lays out the challenges before you.

However, don't lose sight of the fact that the list of options is quite extensive and even if some of them are only "buying time", it might be just the right amount of time for the right treatment for you to come along. The early Phase II trials of TDM1 showed spectacular results in a patient population that had a median of 7 prior therapies.

Also, remember that each cancer is unique - tykerb/xeloda may be a good one for you, don't give up on it before popping your first pill!

You just don't know what is around the corner. Keep the faith,
chris
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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 02-16-2012, 10:27 PM   #9
NEDenise
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Re: Off the Bolero Trial

Amanda,
You are in my prayers every single day! I'll add a bit about hoping Tykerb is your best treatment yet, tonight.

Remember...People don't cry because they're weak...they cry because they've been strong for too long...and need a little relief!

And, please listen to the wisdom of Chris and Sheila...you still have lots and lots of options waiting for you!

Denise
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1/11-needle biopsy
2/11-Lumpectomy/axillary node dissection - Stage 3c, ER/PR-14/17 nodes
3/11 - Post-op staph infection,cellulitis, lymphedema,seroma,ARRRGH!
4/12/11-A/C x 4, then T/H x 4, H only,Q3 weeks
8/26/11 finished Taxol!!!
10/7/11 mastectomy/DIEP recon
11/11 radiation x28
1/12/12 1st CANCER-VERSARY!
1/12 Low EF/Herceptin "Holiday" :(
2/12 EF up - Back on Herceptin, heart meds
4/2/1212 surgery to repair separated incision from DIEP recon
6/8/12 Return to work :)
6/17/12 Fall, shatter wrist,surgery to repair/insert plate :(
7/10/12 last Herceptin
7/23/12 Brain Mets %$&#! 3cm and 1cm
8/10/12 Gamma knife surgery, LOTS of steroids;start H/Tykerb
8/23/12 Back to work
12/20/12 Injure back-3 weeks in wheel chair
1/12/13 2nd CANCER-VERSARY!
1/14/13 herniate disk in back - surgery to repair
1/27/13 Radiation necrosis - edema in brain - back on steroids - but not back to work - off balance, poor cordination in right arm
5/3/13 Start Avastin to shrink necrosis
5/10/13 begin weaning steroids
6/18/13 Brain MRI - Avastin seems to be working!
6/20/13 quarterly CT - chest, abdomen, pelvis - All Clear!
7/5/13 finally off steroids!!
7/7/13 joined the ranks of the CHEMO NINJAS I am now Tekuto Ki Ariku cancer assassin!
7/13/13 Symptoms return - back on steroids
7/26/13 Back on Avastin - try again!
8/26/13 Not ready to return to classroom yet :( But I CAN walk without holding onto things! :)
9/9/13 Brain MRI - fingers crossed
“ Life is a grindstone, and whether it grinds you down or polishes you up is for you, and you alone, to decide. ” – Cavett Robert
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Old 02-16-2012, 11:09 PM   #10
Pray
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Re: Off the Bolero Trial

Amanda, I am sorry you are having a hard time. You are in my prayers along with your family. Sheila and Chris are as smart as they come. I do believe they know what they are talking about. I have been looking up to them for some time now!

Peace my Friend,

Nancy
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Old 02-16-2012, 11:51 PM   #11
Bunty
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Re: Off the Bolero Trial

Hi Amanda, so true what everyone is saying on this thread. It's true you still have lots more options yet - I'm also er/pr - (and of course her2+!) and Abraxane worked well for me. It's true what Sheila says about asking and putting forward suggestions. I know that information I learned from this site has benefited my discussions with the onc.

My onc is not one to be particularly effusive, but he came from SABC and was very excited by pertuzumab. We just need to get it approved here in Australia!

If you ever want to chat, send me a PM.

Cheers Marie x
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dx Dec 2000 dcis 2.5cm clear sentinel node, ER/PR- Her-2+
lumpectomy, 6 cycles AC, 6 weeks rads
October 2007 three x 2.5cm lung mets. 8 months Taxol, started Herceptin and continue. Significant reduction in lung mets.
June 2011 3cm x 4cm liver tumour. Started Abraxane and continue with Herceptin.
November 2011. Finished with Abraxane, continue with just Herceptin. Liver tumour now reduced to 15mm x 12mm. Lung tumour now 10mm x 0.5mm
February 2012. Scans show everything stable, and brain scan clear.
July 2012. PET/CT scans show I'm in remission - no active cancer!
]Dec CT brain cllear, lungs stable, liver tumour has increased to 20mm. PET scans showed active liver met and active lung thinglet, and possible bone met.
Jan 2013 recommence Abraxane, continue with Herceptin.
June 2013 finish Cycle 6 Abraxane, continue with Herceptin. 30% reduction in liver tumour, everything stable.
December 2013. CA15-3 on rise.
February 2014. PET and CT scans show single liver tumour has increased to 35mm. No other activity.
March 2014. Planned for SBRT for liver met, but couldn't have treatment as tumour too close to bowel. Continue Herceptin.
April 2014. Surgeon advises that I am a good candidate for liver resection, so will have operation early May (after camping holiday). Tumour now 44mm x 29mm.
May 7, 2014. Two liver tumours surgically removed. Third of liver removed, and gall bladder. Am I NED?May 2014. Pathology of tumour shows it's now ER+ (95% staining).
June 2014. CA15-3 has decreased to 18 from a pre-surgery reading of 59!
June 2014. Started Femara, continue with Herceptin.
July 2014. Stop Femara due to severe Osteoporosis. Commence Tamoxifen, continue Herceptin. Waiting to hear if I can have Aclasta infusion.
August 2014. CA15-3 has decreased further to 12 - YAY!
October 2014. Aclasta infusion for Osteoporosis. November 2014, CA15-3 decreased to 11. Scans of liver all clear, something new showing up on lung, but just watching at the moment.
November 2015. Started SBRT on solitary lung met.
November 2015. Bone density scan showed very good improvement so back on Femara - yay!
December 2016. 6 treatments of SBRT radiation on lung. Seems to have had some effect.
June 2016. CA15-3 still stable and low at 9.
June 2016. Started subcutaneous Herceptin replacing infusion.
Jan 2017. LVEF dropped to 46%. Stopped Herceptin.
Feb 2017. Started ACE Inhibitor and BETA Blocker. Still off Herceptin.
Aug 2017. Two new mets - Portacaval lymph node and mediastinal lymph node.
Aug 2017. Blood tests show extremely elevated liver enzyme levels. Many tests to investigate.
Sept 2017. Portacaval lymph node blocking liver bile duct causing liver enzyme and Bilirubin problems.
Oct 2017. 8cm stent inserted into liver bile duct. Procedure caused pancreatitis, and hospitalised for 3 days. Liver enzymes improving rapidly.
Nov 2017. Commenced 4 weeks of radiation on Portacaval lymph node. 5 week break before chemo.
Jan 2018. CT scan. 11 new small liver mets, and new superclavical lymph node med.
Jan 2018. Start Kadcyla. CA15-3 426.
Apr 2018. First scans since starting Kadcyla. All tumours reducing. CA15-3 dropped to 30 from 426.
Dec 2019. Still on Kadcyla, but two small brain mets have been treated in the past month with SRS. CA15-3 stable for 12 months at 11.
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Old 02-17-2012, 05:40 AM   #12
Lien
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Re: Off the Bolero Trial

Hi Amanda,
During the 8 years I have spent in Cancerland, I found that there is absolutely no way of telling who will run out of options fast and who won't. People who seem to have "slow" tumors that initially respond well to treatment may suddenly get very little mileage out of new combo's. People who can't seem to find the right drug suddenly return to NED status on their third or fourth try. It is a trial and error thing and I agree with others that there are exciting new options. You would do well to ask as many questions as you can think of and make a plan.

Like you said, you have three kids that need their Mom. So you'd better start thinking of possible treatments and discuss them with your onc. If needed, you can ask for second opinions. Or switch doctors. Or do whatever you feel you have to do to survive.

And ofcourse you are in tears today. This is a setback and it is scary. So I'm sending you a big, warm, virtual hug all the way from the Netherlands, Europe.

Love

Jacqueline
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Old 02-18-2012, 02:18 PM   #13
Mandamoo
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Re: Off the Bolero Trial

thank you all so much for your replies. I am in a much better headspace now and hearing from you all has helped me immensely.

Just to clarify - it was my surgeon not my oncologist who was talking like this and I did focus on the negatives - he also had some positive things to say about attitude and treatment advances but... Look I am not going to focus on that now.

My oncologist fortunately never talks prognosis and talks about managing the disease long term. She is very keen for me to get into a TDM1 trial - there is only Marianne and th3resa here - I qualify for neither currently. We didn't do Marianne as first line as I had seemed to progress on Taxol so we didn't want to risk being randomised into the taxol group. I have to try tykerb and xeloda to qualify for Th3resa - I just wish it had a pertuzamab arm. Anyway - we have also discussed Abraxane as our next likely option.

Who knows - maybe Tykerb and xeloda will hold things at bay for a considerable length of time? Dare I dream of NED?

I'm not giving up, I'll face what's ahead of me and for now I feel good and I have three beautiful children to love and care for and create happy memories for. So bring on the Tykerb and xeloda!
Amanda xx
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Amanda xx
40 year old Mum to three gorgeous kids - son 5 and daughters 8 and 11
Wife to my wonderfully supportive husband of 17 years!
22 February 2011 - Diagnosed Early Breast Cancer IDBC Stage2b (ER/PR -ve, Her2+ve +++) - 38 years old
(L) skin sparing mastectomy with tissue expander, axilla clearance (2/14 affected) clear margins.
Fec*3, Taxotere and herceptin*2 - stopped due to secondary diagnosis

June 24 2011 Stage IV - Skin met, axilla node, multiple lung lesions

Bolero3 trial - Navelbine, Hereptin weekly, daily Everolimus/Placebo
February 2012 - July 2012 Tykerb and Xeloda - skin mets resolved, Lungs initially dramatically reduced but growing again
August 2012 (turn 40!) tykerb and herceptin (denied compassionate use of TDM1) while holidaying in Italy!
September 2012 - January 2013 TDM1 as part of the Th3resa trial - lymph nodes resolved, lungs slowly progressing.
January 2013 - herceptin, carboplatin and Perjeta (compassionate access)
April 2013 - Some progression in lungs and lymph nodes - Abraxane, Herceptin and Perjeta
July 2013 - mixed response - dramatic reduction of most lung disease, progression of smaller lung nodules and cervical and hilar nodes - ? Add avastin.
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