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Old 05-28-2013, 04:26 PM   #1
yanyan
Senior Member
 
Join Date: Apr 2011
Posts: 403
What's in Kadcyla

I am about to restart Kadcyla this Thursday. Since i am the 1st patient getting this drug at my doctors office i want to make sure that everything is done correctly, most importantly the dosage.

My doctor's office ordered Kadcyla for me and my insurance approved a whole bunch of drugs. Intially i thought it was just herceptin + certain chemo drug. None of the approved drugs the pharm rep read me sound familiar. Does any know what this (these ) drugs are? How do i know if i am getting the right dosage? Is there anything i should ask or confirm with my onco's office?

Thanks!
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1/11 age 36 DX
ER/PR-, Her2 +
TCH*6, Herceptin
BMX with immediate recontruction 5/2011 Lattismus Flap- Dx stage 3c 10/23 nodes
9/11 Radiation
3/12 Local recurrence to skin stage IV
Whole body scan CLEAR
4/12 Tykerb & Xeolda Skin mets slowly regressing
8/12 PET & Brain CT Clear
5/13 Skin mets progressing
6/13 PET scan chestwall recurrence in contralateral anxillary,internal mammary and ipsilateral subpectoral nodes
6/13 kadcyla
10/13 whole body scan -clear NED. previously resolved skin rash gone but 3 new lesions. Biopsy confirmed for skin recurrence
11/13 to 02/14 tykerb & herceptin
02/14 add abraxane/gemzar, 2 weeks on 1 week off at reduced dose
05/14 whole body PET clear/ brain CT clear but skin mets are getting worse, ready for new chemo
05/14 navelbine perjeta herceptin
07/14 skin mets progressing red rash worse
08/14 wide local excision with diep flap to close wound. Final path shows 2 positive margins showing inflammatory carcinoma Going back to surgery in 2 weeks
09/01/14 resection- clear margins
3 weeks after 2nd surgery, a new nodular rash found near drain incision with 2 small red spots behind the chest wall biopsy on 10/1. Positive for breast cancer
Radiation 11/2014 with xeloda then weekly cisplatin
11/14 brain MRI clean
12/14 finished 33 radiations burnt and very painful. Bedridden for 1 week
12/14 t current Herceptin and perjeta only
02/15 rash on upper back right side skin mets radiation planned
02/15 staring electron radiation *35
Stopped at 30 due to severe skin burn, resumed 10 days later
05/15 red patches appeared in between previously radiated area, skin mets. Ct and brain Mri clear. Simulation planned, radiation to start after trip to Alaska.
05/24 new spot identified in scar line on previously radiated reconstructed breast- electron on both side chest wall area and scar line
07/15 multiple skin and lung recurrence begin halaven
11/15 cough much better but very tired on halaven and starting to see some new red skin blotches-suspicious
11/15 heading to China for immune therapy
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Old 05-28-2013, 08:21 PM   #2
CoolBreeze
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Posts: 562
Re: What's in Kadcyla

Kadcyla is a combination of herceptin and a chemo called mertansine. I read in a nursing magazine that the main dosing mistake is when they give it in the same strength as herceptin, so they changed the name from trastuzumab to ado-tratuszumab to prevent it from being misread. It is supposed to be 3, not 6, (and I can't finish that sentence because I can't remember the mKGb or whatever it is). But that mistake is rare and you can look online for package insert with the dose and the ingredients and ask before you get it, which is very smart.

Good luck to you, here's hoping it is the answer for you! It will be my next chemo so I'm interested in your experience.

Edited to add the wikipedia page: http://en.wikipedia.org/wiki/Trastuzumab_emtansine
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08/17/09 Dx'd.
Multifocal/multicentric IDC, largest 3.4 cm, associated ADH, LCIS, DCIS
HER2+ ER+/PR- Grade 3, Node Negative

10/20/2009: Right mastectomy, reconstruction with TE
12/02/2009: Six rounds TCH, switched to Taxol halfway through due to neuropathy
03/31/2010: Finished chemo
05/01/2010: Began tamoxifen, the worst drug ever
11/18/2010: Reconstruction completed
12/02/2010: Finished herceptin
05/21/2011: Liver Mets. Quit Tamoxifen
06/22/2011: Navelbine/Zometa/Herceptin
10/03/2011: Liver Resection, left lobe. Microwave ablation, right lobe - going for cure!
11/26/2011: C-Diff Superbug Infection, "worst case doctor had seen in 20 years"
03/28/2012: Progression in ablated section of the liver - no more cure. Started Abraxane, continue herceptin/zometa
10/10/2012: Progression continues, started Halaven, along with herceptin and zometa.
01/15/2013: Progression continues, started Gemzar and Perjeta, an unusual combo, continuing with herceptin and zometa
03/13/2013: Quit Gemzar, body just won't handle it. Staying on herceptin, zometa and perjeta.
04/03/2013: CT shows 50% regression in tumor, so am starting back on Gemzar with dose reduction, staying with perjeta/herceptin/zometa. Can't argue with success!
05/09/2013: Discussing SBRT with Radiology due to inability of bone marrow to recover from chemo.
06/07/2013: Fiducial placement for SBRT
07/03/2013: Chemo discontinued, on Perjeta, Herceptin and Zometa alone
07/25/2013: SBRT (gamma knife) begins
08/01/2013: SBRT completed
08/15/2013: STABLE! continuing with Perjeta, Herceptin, Zometa
06/18/2014: ***** NED!!!!***** continuing with Perjeta, Herceptin, Zometa
01/29/2014: Still NED. continuing with Perjeta, Herceptin. Zometa lowered to every 3 months instead of monthly.
11/08/2015: Progression throughout abdomen and lungs. Started TDM-1, aka Kadcyla. Other meds discontinued. Remission was nice while it lasted.

5/27/18: Stable. Kadcyla put me right back in the barn. I have two teeny spots on my lungs that are metabolically inactive, and liver is clean.

I’m beating this MFer. I was 51 when this started and had two kids, 22 and 12. Now I’m 60. My oldest got married and trying to start s family. My youngesg graduates from Caltech this June. My stepdaughter gave me grandkids. Life is fantastic.
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Old 05-29-2013, 12:12 PM   #3
phil
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Join Date: Nov 2010
Posts: 393
Re: What's in Kadcyla

my wife is on it, doing very well. Coolbreeze is right about it being a combo of herceptin and a chemo called mtansine or emtansine. the FDA recently recommended adding " ado " as a prefix , calling it ado-trastuzumab emtansine to avoid confusion with original herceptin ( trastuzumab). I have not heard of any actual mistakes made, but its a sensible pre-caution.
the starting dose is 3.6 , but its given in mg. per kg. of body weight . theres a formula that i cant exactly remember, 3.6 ? x kg. per meter squared ? i'm not a scientist.
my wife has had a dose reduction to 3.0, to help keep platelets up, and is about 145 lbs. her current doses fluctuate slightly per body wt., from 189- 191 mg. At the start of tx , at a 3.6 dose level , she recieved T DM-1 ( kadcyla) in the 220 mg . range.
We read and record every dose right off the iv bag. she has had 35 doses since 2010, 7 at 3.6 , the rest at 3.0 level. and is ned. Hope this helps, Good Luck ! God Bless, and Heal ...
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