Anyone on HERCEPTIN+AROMATASE INHIBITORS?

[marymary]

I was diagnosed in 4/2002 at the age of 42. Large ER+, PR-, HER2+++ tumor w/mets to skin of affected (L) breast.

3 rounds neo-adjuvant A/C
mets continued to grow

Immediate left modified radical mastectomy -
13/13 positive nodes
6 months of Taxotere with i.v. Decadron to inhibit extreme allergic response
5,000 rads of radiation
Oopherectomy in February of 2003
Begin taking Arimidex immediately thereafter

Diagnosed in 4/2005 with two small brain mets, otherwise NED
Gamma knife 5/2005
Began taking weekly Herceptin
Discussed with Oncologist the possibility of staying on Arimidex. He stated that one could argue the Arimidex had failed, due to the presence of two small brain mets. However, I could also argue that since Arimidex may not cross the blood brain barrier, it had been extremely effective in my body but only "failed" in the part of the body it could not adequately infiltrate. Oncologist suggested that studies had been conducted which had not specifically demonstrated increased effectiveness with the combination of Herceptin & Arimidex. Theoretically, one could hypothesise that Herceptin would block the HER2 pathways, and the A/I would block the estrogen pathway and would be a very powerful one-two punch. In small studies, however, there was only a small advantage to the combination.

I like any advantage, however small, and seized it. I have been on Arimidex + Herceptin since metastatic diagnosis and remain NED. Only one lesion is visible on MRI and continues to shrink with each and every MRI. Most likely is necrotic.

I am still trying to get into the U of W vaccine trial and continually seek any promising treatment I can find.

Mary-

You ask, what is our aim? I can answer in one word: It is victory, victory at all costs, victory in spite of all terror, victory, however long and hard the road may be; for without victory, there is no survival.

Winston Churchill

[Marily]

I have been on Herceptin for almost 5 years weekly, It was given with Tamaxophin and then in my third year we added Lupron, until I had my ovaries removed a bit over a year ago. Now I take Aromasin along with my weekly Herceptin. Remain NED : )
Also take fish oil, flax seed oil, and coq10 vit e bcomplex calcium and vit c.
It is really interesting and exciting to see we seem to be on the same path even if we are from all over the world.
Hugs
Marily
Stage IV her2, er pr +++ mets to lymph, liver. lung , bone
r mast, 13 lymph AC/Tax Hercep
tamox-aromasin
ps seem to be getting back to Herceptin ok after my allergic response to it. Remain on weekly dose double diluted and given over 2 1/2 hours with benedry.. no adverse side effects and gradually decreasing benedryl by 1/2 than next week will have only 1/4. or 12.5mgm. Some cramping so restarted the quinine.

[R.B.]

This article gives an idea how complex the whole oestrogen issue is.

It further underlines it is not just a question of oestrogen produced in the ovaries,

BUT as important of even more important the oestrogen produced with the cancer cells and their supporting surrounds.

I have only skimmed bits of it. It will take a while to get to even begin to get to grips with but immediately rasied questions as to the balance of impacts of treatment protocols and whether it would be sufficent to halt local production whilst leaving wider body production alone (Implications for ovarian removal etc. for those to who longer term fertility is important etc) In this case I simply raise the questions as I have not looked sufficiently at the subject subject to do more than have questions.


RB



Sex steroid-producing enzymes in human breast cancer

http://erc.endocrinology-journals.or.../full/12/4/701

ABSTRACT

Biologically active hormones are produced and secreted from the endocrine organs, transported through the circulation, and act on their target tissues where their specific receptors are expressed (Fig. 1AGo). This system is known as the endocrine system, and biological features of hormone-dependent target tissues are generally considered to be influenced by the plasma concentration of the biologically active hormones. In addition, hormones can also act in the same cell (autocrine) (Fig. 1BGo) or neighboring cells (paracrine) (Fig. 1CGo) without release into the circulation. A large proportion of androgens in men (approximately 50%) and estrogens in women (approximately 75% before the menopause, and close to 100% after the menopause) are synthesized in peripheral hormone-target tissues from abundantly present circulating precursor steroids (Labrie et al. 2003), where the enzymes involved in the formation of androgens and estrogens are expressed (Fig. 1DGo). These locally produced bioactive androgens and/or estrogens exert their action in the cells where synthesis occurs without release into the extracellular space. This phenomenon is different from the autocrine, paracrine and classical endocrine action, and is called ‘intracrine’. In classical endocrine systems, only a small amount of hormone is generally utilized in the target tissues, and thereafter the great majority is metabolized or converted to inactive forms. On the other hand, an intracrine system requires minimal amounts of biologically active hormones to exert their maximum effects. Therefore, intracrine is an efficient mode of hormone action and plays important roles especially in the development of hormone-dependent neoplasms. It is also important to note that, in an intracrine system, serum concentrations of hormones do not necessarily reflect the local hormonal activity in the target tissues.



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Figure 1 Summary of endocrine (A), autocrine (B), paracrine (C), and intracrine (D) actions. {701fig1}, inactive hormone; {701fig2}, bioactive hormone; {701fig3}, receptor; {701fig4}, promoter region of the target gene.


Sex steroids, such as estrogens and androgens, play important roles in various target tissues including reproductive organs. A majority of breast carcinoma tissues express estrogen (ER) and androgen (AR) receptors, and estrogens greatly contribute to the growth of breast cancers. Breast carcinoma tissues have been demonstrated to process intracrine activity. Locally produced biologically active estrogens act in breast carcinoma tissues. This mechanism has been considered to play a pivotal role in the proliferation of breast carcinoma cells. The blockade of this pathway potentially reduces cell proliferation of breast tumors, and it is very important to obtain a better understanding of sex steroid-related enzymes in breast carcinoma as potential therapeutic targets of endocrine therapy. Therefore, in this review we summarize the results of recent studies on the expression and regulation of the enzymes related to intratumoral production of sex steroids in human breast carcinoma tissues, and discuss the potential biological and/or clinical significance of intratumoral production of sex steroids in these carcinomas.

[heblaj01]

Robin has posted a very interesting article at http://www.her2support.org/vbulletin/showthread.php?t=24319

In it the researchers describe,among other things, two of the modes of action of Herceptin.
The attaching of Herceptin to the HER protein on the surface of cancer cells & the destruction of this protein is a relatively slow process while the activation of the PTEN (which control cell division) starts within 10 minutes. PTEN also appears necessary for Herceptin to be effective in any case.
So if a patient starts with a high level of PTEN it no only predicts that she likely will respond to Herceptin but also that she may respond very quickly.
This adds an other possible factor which may explain the fast response of some posters in this thread.

[Susan Rankin]

Hi,

I finished Herceptin this past Tuesday. I had been on it for one year, weekly infusions. I started Herceptin and Arimidex at the same time. I have recently changed to Femara hoping it will help my joint pain. I will post to report if I am feeling better after the Herceptin soon. It may be the Arimidex/Femara causing all the side effects. We will see.

Susan

[Bev]

Sadie,

In any case, you shouldn't be on antioxidants during rads. You would be aiding and abetting the enemy cancer cells. After rads, hit the old search key here. Search for Gina Popp's posts as her supplement advice seems reasonable. Good Luck, BB

[sadie]

Bev,
Thanks for THAT info. I had no idea!
I have 4 more rad days to go!

Thanks R.B. for your info too. I'll be checking it out so I can start as soon as I finish with my rad tx
Sadie

[newgg]

Also take Arimidex....started Jan. 05 and now Herceptin q 3 weeks ...started Feb. 06.
Do have joint pain when I first get up but after a few minutes it is fine. Had the joint soreness when on Arimidex along and did not notice any difference when I started the Herceptin a year later.

Have added omega and CQ 10 to the supplements after reading all the info gathered here.
Hugs, Bonnie

[Ruthiema36]

Not on the Herceptin, but taking Arimidex. Am taking a break from it though to see if it is responsible for my moodiness. Am estrogen+ and Her2+ and my onc has decided to treat the estrogen + because I am node negative, but will not treat the Her2+ because I am node negative. Go figure! I am amplified 7.2 on Fish. I am getting a second opinion tomorrow. Why would you treat one and not the other?
Ruth

[Kaye]

I am not sure but it may not have been approved for those who are not yet stage II who don't have any positive nodes?

[kat in the delta]

Why fish oil ??? doesnt it make you gain wt ??kat in the delta

[kat in the delta]

I go to my Onc. tomorrow to see the results of my hormone levels---which I am sure I will be post menop. I had my uterus removed 6 yrs ago, but kept my ovaries. He mentioned either Arimidex or Femara, which my sister took and it make her jts/ ache/ Her Onc changed her to Aromasin and she says it is better altho she liked tamoxifen the best---but was on it for 5 yrs. She was not her2. like me. kat
Is there anything I need to know or ask him about before my visit ???? I just finished my only year on herceptin, but see another study of 2 yrs. What is the difference between the Bayer Serum test and the serum blood test/?, elissa(sp?) blood test etc,,,,,,kat

[kat in the delta]

1 thing my surgeon said last week was that: now they are looking at only giving HERCEPTIN to her2+ people, and not any other chemo. my 2cents, kat in the delta

[fcrcm]

Well, sorry to be on the negative side. I have been on Herceptin, Zeloda and Arimadex since Nov. 2005 for bone, lymph and liver mets. My June scans showed a new bone mets in hip. I'm trying to figure out what to do next, or if this is to be expected.

Would love to hear from any others with experiences like mine.

fcrcm

[sadie]

Kaye & Ruthie & Kat,
Yes they do give Herceptin to those with neg nodes.
I am node negative and I was given Adriamyacin x4, then Taxol w/Herceptin x 12, then started Herceptin alone to go thru Feb 07. Also had 30 days rads. Then started Arimidex for next 5 years.
I heard about the Herceptin-only treatment also. (read it on-line at either ACS or John Hopkins site).
I also heard that they are considering giving Herceptin for only 9 weeks instead of 1 yr.
I've read on this site, that many women took Herceptin for 2 years. I don't know what the dr uses as a deciding factor for how long to give it to you.
Sadie

[kat in the delta]

Sadie et al...,
I have been thru A/C,rad,masc,1yr of herceptin. Now, since my cancer has not spread beyond the Positive lymph nodes, my Onc, wants to give me Arimidex.--[I was slightly er+],[pr-]
HOW HAS ARIMIDEX affected YOU ???
My ONC. wants to also give me a dose of Zometa-as my bone density was not so good.
I know it was the first for postmenapausal women,which I am. (52 &was checked)
There is also Femara, which made my sister's bones & jts. ache, so her Onc. changed her to Aromasin.(She was NOT her2++,luckily).
ANYONE ELSE ON ARIMIDEX ??? HOW HAS IT AFFECTED YOU???

[sadie]

Kat,
I have been on Arimidex for about 20 days now. I've noticed in the past 2 weeks, I have been a little crabby. But that could also be from the heat wave we had last week, plus I have been much busier every weekend this month (fun things,tho) and there is alittle more stress at work right now (end of fiscal year).
So it's hard to say whether or not the moodiness comes from the Arimidex or circumstances. Not to forget, my 1 yr anniv is coming up for when I had my physical & mammogram.
I just noticed today, that I have some peach fuzz on the cheeks (the whole area in front of the ears). I am assuming that is from the Arimidex because it is a hormone blocker, but I can't say for sure. Other than that, I don't think I am having any side effects from it. If my onc asks, I would stay on it. I am also 52 post menopause.

[kat in the delta]

kat in the delta,
I am 52, also and did bloodwork that showed I was postmenapausal.
Does anyone know if Arimidex makes you gain weight ??

My sister gained weight on Tamoxifen and is now on Aromasin as Femara made her ache.
kat in the delta

[kat in the delta]

Sorry to hear of your new site. Zometa is given for bone cancer and also for osteoporosis to stop bone loss.
I am almost osteoporisis and my Onc gave my One 15min IV of Zometa while on Taxol and herceptin.
Now I will be on Arimidex, which causes more bone loss.so my Onc. is going to infuse me with Zometa again soon.
So sorry you have it in your hip--I know that is painful.
Be careful, too, don't fall....I might even get a walker if I were you.........keep me informed......my cousin has it in his vertebrae, hip, legs, lungs.......he is cont..rad and chemo. He first had surgery to put in a plate to support his leg to keep it from breaking on its own. He is a fighter.......was on a walker but finally has gotten a wheelchair, thank God--I worry about him-------he tries to do TOO MUCH--
You need to rest daily.......kat

[Annemarie]

I am stage 4. Diagnosed May 2000. Stage 3b. Her2+++. Single brain mets three times. Now on Herceptin and Femara and have been NED for 2 years.