Lani, I need advice too!

[HavahJ]

I did have single skull met for three years. Now I have single liver mets. The onc. did herceptin/abraxane that didn't work. Now I'm on navelbine/herceptin/xeloda/tykerb. I just read the article that you posted on liver mets which recommends liposomal doxorubicin or other such to be the most effective. Should I try to add it? If this chemo doesn't work, I get spheres. Chemo will continue, but I really would like to hit it as hard as I can. The only other chemo I've had is the one right after surgery. Thank you. I'm going crazy with this thinking I'll only have six months. HavahJ (Jan, HavahJ@aol.com)

[Lani]

a synovial sarcoma of the neck the brother of a friend of a friend--I had to review all the literature I could find on the web and then try to find out about where clinical trials are, what types of radiation therapy they have in Denmark, etc

He has to make his decisions by Monday

Will try to do some more reading for you, but in the meantime, please go to search and put in liver met Lani--I think I have listed articles on cryoablation, and other modalities

[Lani]

I don't know what you mean by single liver mets. Do you mean you only have one or that you have many?

[Lani]

before you jump to conclusions, the rates quoted for disease free survival and overall survival include the fact that other metastases can occur in subsequent years in other organs (lungs, brains) which are the problem rather than the liver

Also note that they did not specify the molecular subtype of breast cancer which had metastasized ie, her2+ vs -

61% survival at 5yrs is quoted, not necessarily disease free--they may have a single bone met or other mets..they quote the disease free survival at 5 yrs at 31% AND THESE PATIENTS WERE TREATED BEFORE 2001 SO THEY MAY OR
MAY NOT HAVE BEEN TREATED WITH HERCEPTIN

Ann Surg Oncol. 2004 Sep;11(9):869-74. Links
Long-term survival after an aggressive surgical approach in patients with breast cancer hepatic metastases.

Vlastos G, Smith DL, Singletary SE, Mirza NQ, Tuttle TM, Popat RJ, Curley SA, Ellis LM, Roh MS, Vauthey JN.
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, TX 77030, USA.
BACKGROUND: Metastatic breast cancer is generally believed to be associated with a poor prognosis. Therapeutic advances over the past two decades, however, have resulted in improved outcomes for selected patients with limited metastatic disease. METHODS: Between March 1991 and October 2002, 31 patients had hepatic resection for breast cancer metastases limited to the liver. Clinical and pathologic data were collected prospectively from breast and hepatobiliary databases. RESULTS: Median age of patients was 46 years (range, 31 to 70). Liver metastases were solitary in 20 patients and multiple in 11 patients. Median size of the largest liver metastasis was 2.9 cm (range, 1 to 8). Major liver resections (three or more segments resected) were performed in 14 patients, whereas minor resections (fewer than three segments resected) with or without radiofrequency ablation (RFA) were performed in 17 patients. No postoperative mortality occurred. Of the 31 patients, 27 (87%) received either preoperative or postoperative systemic therapy as treatment for metastatic disease. The median survival was 63 months; a single patient died within 12 months of hepatic resection. The overall 2- and 5-year survival rates were 86% and 61%, respectively, whereas the 2- and 5-year disease-free survival rates were 39% and 31%, respectively. No treatment- or patient-specific variables were found to correlate with survival rates. CONCLUSIONS: In selected patients with liver metastases from breast cancer, an aggressive surgical approach is associated with favorable long-term survival. Hepatic resection should be considered a component of multimodality treatment of breast cancer in these patients.
PMID: 15342348 [PubMed - indexed for MEDLINE]

[HavahJ]

Hi Lani, Thanks so much for responding. I can wait for further response. I have 15 small liver mets; the largest is one and a half cm. My liver is working normally. I don't have other mets at the moment. I started with a single bone met in the skull that the Mayo said I had to die from.I had the one met for three years. I had it removed by a brilliant skull surgeon in Californ. After that surgery I immediately got these liver mets. They're all I have right now. I did hercep/abraxane - no luck. NOw I'm on Navelbine/hercep/xeloda and about to start tykerb. I'm worried the chemo isn't heavy enough. If this chemo doesn't work, the radiologist wants to do spheres. That's the situation. HavahJ

[fullofbeans]

HavahJ

I am confused you are now saying that you have one liver mets but two week ago you said you had many mets in one of your gloomy post entitled "not one mets but many mets"..strange if I may say

[Chelee]

Fullofbeans, In Havah's post above yours she mentioned having "15" small liver mets...not one. You must of mis-understood her first post because of the way it was worded. Her first post kind of made it sound that way but she does have many liver mets. Hope that helps.

Chelee

[PinkGirl]

Hi FOB
I think Havahj meant that she has mets
in only one place - her liver.

[Lani]

Gan To Kagaku Ryoho. 2006 Nov;33(12):1780-4. Links
[Analysis of long-term (5-year) survival in patients with metastatic breast cancer to the liver]

[Article in Japanese]

Kan N.
Kan Norimichi Clinic, Shotokukai-Hiei Hospital.
Patients with metastatic breast cancer to the liver are generally considered to have a poor prognosis. The purpose of this study was to identify factors contributing to long term survival in 11 patients who were 35 76 years old at the time of diagnosis with liver metastasis, and survived for 5 years. No patients were treated with a standard systemic chemotherapy alone. All of the 11 patients received OK 432 combined adoptive immunotherapy (OK-AIT), 5 underwent hepatectomy as an additional local therapy, and 2 were additionally treated by hepatic arterial infusion chemotherapy. The liver was the primary and secondary sites of metastasis in 8 and 3 of the 11 patients, respectively. In all of the 128 patients given OK-AIT at 5 years after diagnosis, the 5-year survival rates with primary and secondary liver metastases were 11.8. and 5%, respectively. Hormone receptors (HR) were undetermined in 4 patients, positive in 6, and negative in 1 patient, who was also positive for HER2. To determine the relationships among the prognosis of the liver metastasis, AIT indications, HR, and HER2, we analyzed our 139 liver metastasis patients encountered in 2001 and onwards. Fifty-one patients with primary liver metastasis had a median survival time (MST) of 31 months, and a 5-year survival rate of 25%, indicating an improved prognosis. In particular, a MST of 50 months (n=18) in HR (+), HER2 (-) patients was in sharp contrast to the poor prognosis (a MST of 6 months, n=2) in HR (-) HER2 (-) patients. HER2 (+) patients had a MST of 27 months (n=31). Eighty-eight patients with secondary liver metastasis had a MST of only 11 months and a 5-year survival of only 6%; however, the MST in these patients showed the same tendency as in the primary liver metastasis patients: ER (+) HER2 (-) >HER2 (+) >HR (-) HER2 (-) (17, 13, and 4 months, respectively). The response rates of OK-AIT in the primary and secondary liver metastasis patients were 52 and 34%, respectively, showing no significant difference. However, there was a significant difference in the response rate between the HR (+) and HR (-) patients, at 52 and 12%, respectively (p=0.0041). Of the patients in the past, 18 with primary liver metastasis underwent hepatectomy in combination with OK-AIT. Of these 18 patients, 5 had concurrent metastases to other sites, but achieved a 5-year survival rate of 56%, suggesting that it is incorrect to conclude that patients with liver metastasis have generally a poor prognosis. Key
PMID: 17212106 [PubMed - indexed for MEDLINE]

[Lani]

http://www.wjgnet.com/1007-9327/11/7057.asp

[fullofbeans]

Ha sorry..hope I have not offended..

[Lani]

A case with complete resolution of multiple liver mets with the combination of capecitabine and herceptin :

Breast Cancer. 2007;14(3):297-301.
Complete remission of recurrent breast cancer with multiple liver metastases after oral capecitabine and injected trastuzumab.

Morohashi S, Odagiri H, Morohashi H, Kimura Y, Sasaki M.
Department of Surgery, Hirosaki University School of Medicine, Hirosaki, Japan. hm2002@cc.hirosaki-u.ac.jp
A 32-year-old woman underwent modified radical mastectomy for right breast cancer (invasive ductal carcinoma, f, INF beta, v0, ly1, pT2, pN1, M0, Stage II B ER (+/-), PR (-), Her2 (3+)) in June 2003, and received postoperative systemic adjunctive chemotherapy using epirubicin combined with cyclophosphamide, followed by paclitaxel. In August 2004, after a disease-free interval of 14 months, liver metastasis appeared, and therefore from September 2004, combination chemotherapy with oral capecitabine (2,400 mg/day) and injected trastuzumab (120 mg/week) was started. After 3 cycles, all the metastases responded and this marked response has been maintained for 16 months. This therapy is currently being continued (19 cycles), and no serious side effects have been encountered. Capesitabine and trastuzumab combination therapy is effective for recurrent breast cancer showing overexpression of HER2 and resistance to taxane, and can be considered as a first-line therapy for this purpose. It is anticipated that many cases treated with this regimen will be reported and discussed in the near future.
PMID: 17690508 [PubMed - indexed for MEDLINE]

[HavahJ]

No problem.

[HavahJ]

Hi Lani, I've just started the second chemo, only been on two weeks.navelbine/hercep/xeloda/tykerb. What do you think this swift rise in tumor marker means? I can't believe what really hasn't been above 100 in 20 years. I think I should just stay on the chemo. I just had aCT a couple of weeks ago and A PET not that long ago. What could such a high marker mean. The CA27, 29 has always been completely accurate for me. Thank you HavahJ@aol.com (Jan)

[Lani]

I am not an oncologist or oncologic nurse or any other professional with experience with chemo, have never had chemo myself and have no idea how quickly markers change

That sort of thing is rarely covered in articles...it seems to be part of the wealth of experience oncologists have from treating patients, which is why you should rely on them.

Have you found one you have faith in? Having faith in someone is not to say you should not to read the literature and not ask others on this board for input and then discuss items with him/her.

Others here can answer your specific questions better. I can just search the published literature.

Hopefully others with similar stories will chime in.

[Lani]

http://her2support.org/vbulletin/forumdisplay.php?f=29