Advice from learned members pls

[OzzieSue]

A brief history. Bone/liver/lung mets. T’tere/herc till liver prog. Lung mets gone. Tyk/Xel until bone progression. Moved house and Oncs. At initial consultation he suggested trying Caelyx at it was easy tolerated (which it was) and monthy and at some stage he would think of adding Herc. When Caelyx started to fail I asked about Herc and he said I couldn’t have it with Caelyx because of heart problems. He checked for trials but none avail for me (in Aus) because of all the chemo. Changed to Taxol/Gemzar 2 weeks on, 1 off. Have done 2 rounds, start 3rd on Monday. I asked about adding Herc or Tyk to the mix before starting and he said as it had failed before he didn’t think there would be any benefit. I’m not sure whether it is working. In the past my liver function markers have always been a good indicator. They have come down from the 1st treatment and only started to rise when the treatment is failing. On this treatment they are all over the place, down one week, up the next, very unpredictable.

On a thread started by Janet Taylor both Brenda and Chris mention that even if a chemo/herc combo fails you can still benefit from Herc with another chemo.

MY QUESTION IS – I would like to put a case to my Onc for either Herc or Tyk but feel I need some ammunition. I don’t want to push and have it fail. Does anyone have any more info on their benefits, scientific or other wise. Any info would be a help. Thanks.



I am her2+++, er-. If my present combo fails I feel the options are getting thin.



Any info would be a help. Thanks, Sue

[Sheila]

Sue
Move this ppost to the mail board and I am sure you will get some replys. Chris and Brenda are correct, they have found that herceptin can be readded and a person benefit from it.

[Lani]

from ASCO--if you progress on herceptin, don't give up on it, add to it!

Trastuzumab Treatment Extends Time to Progression in HER-2 Positive, Locally Advanced or Metastatic Breast Cancer, Even After Disease Progresses: Presented at ASCO

CHICAGO — June 5, 2008 — Continuation of treatment with trastuzumab in women with human epidermal growth factor receptor (HER2)-positive, locally advanced or metastatic breast cancer achieve extended time to disease progression, even when their disease has progressed while taking the drug.
In a phase 3 study, doctors found that patients who stopped trastuzumab but continued on treatment with capecitabine had overall time to progression of 5.6 months, but it was 8.2 months if they maintained treatment with trastuzumab.
The study, conducted by the German Breast Group, enrolled women with HER2-positive locally advanced or metastatic breast cancer who had previously received trastuzumab with or without chemotherapy as first-line treatment.
They were randomly assigned to receive trastuzumab at a dose of 6 mg/kg every 3 weeks with oral capecitabine at a dose of 2500 mg/m2 on days 1 to 14 every 21 days or capecitabine treatment alone. The final analysis included 156 patients.
"It is rewarding to see that trastuzumab keeps working in women whose aggressive HER2-positive breast cancer progresses," said Gunter von Minckwitz, MD, PhD, University Women's Hospital and German Breast Group, Frankfurt, Germany.
"The GBG-26 study results confirm that trastuzumab continues to target and shrink the cancer even beyond progression when combined with another chemotherapy [agent]," Dr. von Minckwitz said.


ASCO 2008: ABSTRACT #1025: Capecitabine vs. capecitabine + trastuzumab in patients with HER2-positive metastatic breast cancer progressing during trastuzumab treatment: The TBP phase III study (GBG 26/BIG 3-05)
American Society of Clinical Oncology
Background: There is uncertainty, if trastuzumab treatment should be continued beyond progression (TBP).
Methods: Patients (pts) with HER-2 positive, locally advanced or metastatic breast cancer that progressed during treatment with trastuzumab with or without adjuvant and/or 1st-line metastatic chemotherapy were prospectively randomized to capecitabine (X; 2,500 mg/m2 on days 1-14, q21) or X plus continuation of trastuzumab (XH; 6 mg/kg, q3w). The primary end point was TTP. With registration of lapatinib, the slowly accruing trial was closed prematurely.
Results: Between 01/04 and 05/07 156 pts (X=78; XH=78) were randomized and stratified according to pre-treatment: taxane/trastuzumab as 1st-line therapy (111 pts), taxanes/trastuzumab as adjuvant therapy (3 pts), trastuzumab alone or without taxanes as 1st-line treatment (42 pts). 75 (48.1%) pts were pre-treated with anthracyclines. 119 (76.3%) showed visceral metastasis. Current analysis (median follow-up 11.8 months) revealed a progression-free survival of 5.6 months with 53 events for X and 8.5 months with 48 events for XH (HR=0.71). Brain metastases were observed in 4 (X) and 7 (XH) pts. Overall survival was 19.9 months with 31 events for X and 20.3 months with 26 events in XH (HR=0.79). Crude response rates were 24.6% (X) and 49.1% (XH) and primary progressions were observed in 26.3% (X) and 16% (XH) of patients. Grade III/IV toxicities were (%X/%XH): neutropenia (3.3/6.3), febrile neutropenia (0/0), vomiting (6.0/1.6), diarrhea (20.9/14.8), mucositis (3.0/1.6), hand-foot syndrome (23.9/31.1), nail changes (0/4.9), sensory neuropathy (4.5/3.3), fatigue (6.0/4.9), allergic (3.0/3.3), and cardiac (2.9/4.9). No therapy-related death occurred.
Conclusions: Preliminary results of the TBP study suggest a higher efficacy but similar toxicity for continuing trastuzumab beyond trastuzumab progression when 2nd-line chemotherapy with capecitabine is initiated. Final efficacy analysis will be performed in March 2008.

[chrisy]

Hi Sue
here's a link to another article on this topic. As I have said before, my oncologist told me flat out that after herceptin alone fails to keep the cancer at bay, you can get renewed synergy by just adding chemo back to the mix.

Re your other concern with liver function tests, my recent experience with the herceptin DM1 trial is that my liver function numbers have been (for the first time ever) consistently elevated, beginning with my first infusion of this drug, and fluctuate up and down a lot - the biggest jump being right after treatment, but then still bouncing around after that. This is clearly drug related and seems to just show that my liver is working very hard processing this medication. So this could be what's happening with you - you are on a new treatment, so your body may just be handling it differently than it did with other therapies. The fact that you say it is "all over the board" sounds more like that than an indicator of progression.

Hope this helps


http://www.pubmedcentral.nih.gov/art...?artid=1431554

[runtolive]

how is your treatment progressing.. still all good i hope..

run to live

[OzzieSue]

Thanks ladies. I've printed out your info and will keep it for the Onc. I'm also on an Aus breastcancer website and a member there said that here if you've been on Herceptin then Tykerb you can't go back to Herceptin unless you pay for it yourself. I will see my Onc next Mon and see if I can find out all the details. I won't be pushing for it if I have to pay, I don't have that kind of money!

[hutchibk]

Ozzie - perhaps you can qualify for free access to Herceptin through Roche (they are the partner of Genentech and Roche handles Herceptin in Australia).

Ask you doctor, nurse or social worker at your clinic for info about access assistance.