question about IT therapy using herceptin and topotecan

[evlin75]

Daughter is being started on topotecan IT along with the Herceptin 40 mgs. Her latest MRI showed no change in the spinal leptomeningeal areas, but some signs of new brain involvement.
For those who have received this treatment, I ask about side effects. Will there be more problems with them?
She is on Tykerb and IV Herceptin besides the IT therapy. Also newly added Perjeta because of infected Ommaha port preventing systemic chemotherapy.
The Perjeta causes digestive upsets and loose stools that need to be controlled.
Daughter has lost weight from this but her tumor markers are now in the almost normal range.Just wondering what other side effects she might be facing with the topotecan.
Thanks for any input.

[Jackie07]

Glad your daughter's tumor marker has become almost normal. Below is the abstract of an article published almost a year ago when "The combination of lapatinib [Tykerb]plus topotecan was not active and was associated with excess toxicity."

Since then the researchers must have figured out something as it seems to be effective in treating your daughter's Her2 breast cancer. A few of our members have also used Perjeta. You can use the 'Search' button on top to look up previous discussions.

Since it's a fairly new protocol, there might not be much discussion on the nutrition part. My own experience is that rice soup (plain 1/2 cup of rice cooked in 4 cups of water) can help maintain weight as rice = starch and can be dissolved by the enzymes in our mouth water. As her appetite increases, other finely chopped vegies/ground meat can be gradually added to the soup. I've also seen staff in the nursing home putting whole plate of lunch meal into the blender for those who have trouble chewing. You might want to give it a try.

J Neurooncol. 2011 Dec;105(3):613-20. doi: 10.1007/s11060-011-0629-y. Epub 2011 Jun 26.
Randomized phase II study of lapatinib plus capecitabine or lapatinib plus topotecan for patients with HER2-positive breast cancer brain metastases.

Lin NU, Eierman W, Greil R, Campone M, Kaufman B, Steplewski K, Lane SR, Zembryki D, Rubin SD, Winer EP.
Source

Division of Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA. nlin@partners.org

Abstract

Approximately one-third of patients with advanced, HER2-positive breast cancer develop brain metastases. A significant proportion of women experience central nervous system (CNS) progression after standard radiation therapy. The optimal treatment in the refractory setting is undefined. This study evaluated the toxicity and efficacy of lapatinib in combination with chemotherapy among patients with HER2-positive, progressive brain metastases. Patients with HER2-positive breast cancer with progressive brain metastases after trastuzumab and cranial radiotherapy were included. The primary endpoint was CNS objective response, defined as a ≥ 50% volumetric reduction of CNS lesion(s) in the absence of new or progressive CNS or non-CNS lesions, or increasing steroid requirements. The study was closed early after 22 of a planned 110 patients were enrolled due to excess toxicity and lack of efficacy in the lapatinib plus topotecan arm. The objective response rate (ORR) in the lapatinib plus capecitabine arm was 38% (exact 95% confidence interval [CI] 13.9-68.4). No responses were observed in the lapatinib plus topotecan arm. Although the study was stopped prior to full enrollment, some promising indications of CNS activity were noted for lapatinib plus capecitabine. The combination of lapatinib plus topotecan was not active and was associated with excess toxicity.

[evlin75]

Thanks Jackie, for the information.

Also I need to mention that the doctor administering the IT therapy is only giving herceptin 40 mg. per week and now believes he can go with that to every two weeks. That is not reassuring when there is no definite improvement in the meningeal cancer areas....and now some areas noted in the brain with the last MRI. Of course to the Herceptin he would then add topotecan.

I would guess he should not lengthen the interim periods between injections of only 40 mg, when no definite signs of regression are evident.

As you can surmise I am worried.

Ev

[Rolepaul]

Tell your daughter's doctor to get to 1.3 to 1.6 mg/kg of body weight now that the treatment has not shown significant side effects. When Nina went from 40 mg to 80 mg, and then up to 100 mg, we saw a real improvement in the lesions in the brain and spine. It took 60 to 90 days of once per week IT Herceptin and twice per week Topotecan to get the MRI scans clean at 80 mg of Herceptin in a 60 kg (135 pound woman). Nina has just the opposite issue with her treatment, perhaps because of the Navelbine IV. She is constipated and has significant doses of stool softeners. I can tell you that in all probability the doctor is following the protocol that was developed for Nina at MD Anderson as it has gotten rid of the brain and spine lesions. Send a private email and I can give you my aol.com account info. Have hope as this has a great chance of being effective!

[evlin75]

Anoither -question. Daughter is taking oral Tykerb and is scheduled to get IT topotecan. There have been some studies as listed above where a combination of Tykerb and topotecan seemed toxic and the clinical trial was stopped.

Has any one here had the combination of oral Tykerb and IT topotecan without problems- or have knowledge of any one who has had this combination?

Thanks for any input.

Ev

[Rolepaul]

Nina did fine for four weeks and then was asked to stop just because it was felt that it was not beneficial.

[evlin75]

I guess the fact that Tykerb crosses the blood/brain barrier is not as important when the patient is getting IT therapy directly into the spinal column.

thank you. Glad there were no problems.

Ev