Herceptin and Tykerb: synergistic effect if they failed separately????

[Carol W]

I haven’t posted before, but have received many good ideas from reading this wonderful website.

As you can see from the history below, I’ve tried several treatments which all helped for several months and then stopped working.

My oncologist said in March that I my next treatment could be neratinib, pertuzumab, or the combination of lapatinib and Herceptin. However, there are no trials at University of California San Francisco (when I receive treatment) for the first two. When I saw my oncologist a few days ago, she said that the combination of Lapatinib and Herceptin probably won’t work because they previously stopped working when taken separately. Now I’m totally confused and don’t know what to do. I would much rather try targeted treatment than chemo.

I haven’t found any posts from anyone in this situation but hope that someone can give me some ideas. What I want to know is how likely is the combination of Herceptin and Tykerb to help if they previously stopped working when taken separately?

Carol_____________________________________________ ____
· 1/99, original diagnosis of breast cancer, HER2 positive, ER/PR negative; surgery (mastectomy and TRAM flap reconstruction, no lymph nodes removed) no chemotherapy or radiation
· 9/01, malignant lymph node in axilla removed
· 2/03, another enlarged lymph node found in axilla
· 4/03, per CT scan, 4 small lesions in lungs, 1 in pelvis; started Herceptin and Zometa (Zometa has continued with all treatment changes)
· 9/03, per CT scan, all lesions gone except lymph nodes
· 4/6/06, started Xeloda (continued Herceptin)
· 3/1/07, started Avastin and lapatinib clinical trial (1500 mg of lapatinib/day and 10 mg/kg of bevacizumab every 2 weeks)
· 2/13/08, started Trastuzumab-DM1 clinical trial. (Because of liver and platelet side effects, the dose was reduced first and then the treatment interval was increased from 3 weeks to 4 weeks)
· 12/6/08, started lapatinib dose escalation clinical trial (2 week cycle: day 1: 5500 mg in AM, 2500 mg in PM; days 2 to 5: 2750 mg in AM, 2500 in PM; days 6 to 14, nothing)
· The lung and bone mets have not returned, but the lymph nodes become larger or more numerous as each treatment stops working.

[Jackie07]

Welcome Carol,

Glad to meet another Her2 fighter. You have had much more experience on this journey than most of us. And I thank you for joining us and sharing with us your fighting spirit.

I think I've seen some of the long-term survivors who have used the Tykerb/Herceptin combo. I will do a Search using the 'Search' button on top and also glance through people's signature (also do a 'long-term survivor' search - there were a couple of threads by that name)

Have you tried contacting Dr. Slamon - Father of Herceptin? Seems a couple of members have consulted with him.

Here's one abstract I found about Tykerb (Lapatinib) printed in March:

Breast cancer is a global public health burden with more than one million new diagnoses worldwide each year. As a significant proportion of women with early-stage breast cancer experience a relapse and metastatic breast cancer is generally incurable, therapeutic innovations are ongoing. One notable innovation in recent decades has been the identification of a subset of breast cancers that overexpress the transmembrane glycoprotein human epidermal growth factor receptor 2 (HER2) and the consequent development of HER2-targeted therapy. Given the significant benefits demonstrated with the HER2-targeted monoclonal antibody, trastuzumab, in the adjuvant and metastatic settings, investigators have endeavored to develop novel mechanisms for disrupting HER2-mediated signaling. Lapatinib, an orally available HER1- and HER2-targeted tyrosine kinase inhibitor, represents one such notable innovation. Lapatinib is currently being evaluated in both the adjuvant and metastatic settings and was recently approved by the United States Food and Drug Administration in combination with capecitabine, for the treatment of women with HER2-positive, pretreated, metastatic breast cancer. However, the ideal strategy for incorporating novel HER2-targeted agents, including lapatinib, into existing management paradigms is uncertain.

[Kathy T]

Hi Carol,
I had the 2 together after having progression with them alone. It did stop the progression for about 6 months but my markers are increasing so we have added Xeloda to the mix--not sure how this is doing. Good luck.
Kathy T

[Rich66]

Kathy T, any update on your combo?