Progression on Herceptin.....off it now what?

[Robyn]

I was on Herceptin alone, progressed, then the trial herceptin/omnitarg and progessed....my thought is what IF, the herceptin is at least SLOWING down the cancer?? They consider it a failure....but I don't!! Of course, in Canada they won't continue with it because of the guidelines...it is a bit disappointing, so I am trying to have a logical explanation given to me? Any thoughts out there??

Robyn
xx

[lindaw]

Have you tried lapatinib.If it is approved there soon maybe you could try that with herceptin.


love
lindaw

[tousled1]

Robyn,

Many times when women are on Herceptin only they progress. I've read many posts on this board that when this happens the oncologist will usually add another chemo drug to the mix. I guess what is added is dependent upon where the cancer has progressed. Tykerb is to released this month so perhaps that can be an alternative for you. I'll keep you in my prayers.

[MJo]

I agree with the other ladies. I hope you can get lapatinib I read that some studies are giving lapatinib and Herceptin together, to intensify one another. As I understand it in my nonmedical, nonscientific thinking, Lapatinib gets inside the cancer cell and destroys both her2 and her1 proteins(?) Herceptin wraps around the outside of the cell and destroys Her2 only. I think of Herceptin as a leech, and lapatinib as a borer (I garden). I agree with touseled that Herceptin could be combined with different chemo. If I ever recur, I would expect my doctors to give me a combination of Tykerb and/or Herceptin with the most effective chemo drugs. I hope Canadian doctors have freedom to try different combinations. I hope you have a doctor who won't give up easily. Also, I read a study on Herceptin where some women had "full response" and some women had "partial response" If partial response means slowing down the cancer, I agree with you that it's some kind of success. Please keep the board informed on how you are doing and what your doctors decide to do.

[Lani]

but to repeat myself--here is some "ammo" supporting continued use of herceptin (as part of a combination) in the setting of progression:
Onkologie. 2005 Nov;28(11):582-6. Links
Prolonged survival of patients receiving trastuzumab beyond disease progression for HER2 overexpressing metastatic breast cancer (MBC).

Stemmler HJ,
Kahlert S,
Siekiera W,
Untch M,
Heinrich B,
Heinemann V.
Medical Department III, University Hospital of Munich, Grosshadern, Germany. Joachim.Stemmler@med.uni-muenchen.de
BACKGROUND: The aim of this retrospective analysis was to evaluate the impact of trastuzumab-based regimens on the survival of patients with HER2-overexpressing metastatic breast cancer (MBC). The study specifically focussed on the influence of the continuation of trastuzumab-based treatment despite tumor progression on survival. PATIENTS AND METHODS: Patients with HER2 overexpressing MBC were included in this retrospective analysis. HER2 overexpression was determined by the immunohistochemical staining score (DAKO Hercep Test). Trastuzumab was applied at a loading dose of 4 mg/kg and a maintenance dose of 2 mg/kg. RESULTS: Among 136 HER2 overexpressing patients (DAKO score 3+), 66 patients received first-line trastuzumab, 47 patients received trastuzumab as second-line therapy and 23 patients received trastuzumab beyond disease progression. There was no significant difference regarding the duration of trastuzumab-based treatment (first-line: 29.5 weeks vs. second-line: 25 weeks). Moreover, there was no difference in the response rate (first-line: 37.9% vs. second-line: 35.7%) or the median survival (p = 0.47 log rank). Patients who received = 2 trastuzumab-based regimens for MBC survived significantly longer compared to those who had received only 1 regimen (= 2 regimens: 62.4 months vs. 1 regimen: 38.5 months; p = 0.01 log rank). CONCLUSIONS: Trastuzumab is highly effective in the treatment of HER2 overexpressing MBC. Compared to historical controls, overall survival appears to be markedly prolonged, particularly in patients who received sequential trastuzumab-based treatment beyond disease progression.
PMID: 16249644 [PubMed - indexed for MEDLINE]

[Belinda]

In Australia, Herceptin is only available through the PBS (ie publicly funded) for women whose disease has progressed. I think that was in recognition of its benefit in controlling advanced BC. It was only recently (Oct last yr) that they allowed herceptin to be funded for women with early breast cancer, on condition it was adjuvunct to chemo, heart tests were okay etc, and the limit is 1 yr.


B