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Old 09-19-2013, 12:18 PM   #1
'lizbeth
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Post HKI-272 for HER2-Positive Breast Cancer and Brain Metastases

Another option for brain mets - thank heavens, lets hope its a good one!


ClinicalTrials.gov Identifier:
NCT01494662
Purpose

The purpose of this research study is to determine how well neratinib works in treating breast cancer that has spread to the brain. Neratinib is a recently discovered oral drug that may stop breast cancer cells from growing abnormally by inhibiting (or blocking) members of a family of proteins that include Human Epidermal Growth Factor Receptor 2 (HER2).
In this research study, the investigators are looking to see how well neratinib works to decrease the size of or stabilize breast cancer that has spread to the brain. The investigators are also looking at how previous treatments have affected your thinking (or cognition) and how much neratinib reaches the central nervous system.


http://www.clinicaltrials.gov/ct2/sh...stasis&rank=11



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Diagnosed 2007
Stage IIb Invasive Ductal Carcinoma, Pagets, 3 of 15 positive nodes

Traditional Treatment: Mastectomy and Axillary Node Dissection followed by Taxotere, 6 treatments and 1 year of Herceptin, no radiation
Former Chemo Ninja "Takizi Zukuchiri"

Additional treatments:
GP2 vaccine, San Antonio Med Ctr
Prescriptive Exercise for Cancer Patients
ENERGY Study, UCSD La Jolla

Reconstruction: TRAM flap, partial loss, Revision

The content of my posts are meant for informational purposes only. The medical information is intended for general information only and should not be used in any way to diagnose, treat, cure, or prevent disease
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Old 09-19-2013, 04:04 PM   #2
janice
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Re: HKI-272 for HER2-Positive Breast Cancer and Brain Metastases

Great! maybe I'll check it out. we need hope.

-janice
multiple brain mets 8/15/13, just completed WBR
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Old 09-19-2013, 04:36 PM   #3
'lizbeth
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Re: HKI-272 for HER2-Positive Breast Cancer and Brain Metastases

Great, cause I posted the clinical trials with you in mind Janice.
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Old 12-06-2013, 05:44 PM   #4
A. L. Pendley
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Re: HKI-272 for HER2-Positive Breast Cancer and Brain Metastases

I'm interested in the HKI 272 Naratinib + Xeloda + Herceptin trial. I am currently in the Arry 380 trial which has a similar goal - to treat mets in the brain as well as in the rest of the system. I've been in the Arry 380 study now for 5 weeks and get my 6-week scans next week to see if I'm still included in the study (if I'm stable or improved). I want to stay on it, but if I can't, I hope Naratinib becomes another option. I'll be watching what others say on both of these trials! Ann
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Old 12-07-2013, 12:32 AM   #5
'lizbeth
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Re: HKI-272 for HER2-Positive Breast Cancer and Brain Metastases

A.L.P.

Please keep us posted on your scans. Wishing you improvement - after all these treatments are supposed to cure us, not fail us!
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Old 12-07-2013, 07:19 PM   #6
donocco
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Re: HKI-272 for HER2-Positive Breast Cancer and Brain Metastases

I did research on HKI-272 and learned a lot. Ill have to reread the articles as it is very complicated. It involves understanding the dynamics of the Her1 and Her2 receptors.

HKI-272 blocks the epidermal growth factor receptor and the Her2Neu receptor. Also the Her4 receptor but I dont know the exact significance of this. In many ways it is like Lapatanib. It blocks EGFR, it blocks the Her2Neu receptor and it gets into the brain. Like Lapatanib it causes definite diarrhea in a fairly large percentage of those taking it. Nerotinib also causes nausea, vomiting,
fatigue and appetite loss. The clinical studies with the drug are just starting so there isnt too much info yet.
The dosage probably will be 240mg daily and the Maximum Tolerated Dose is about 320mg daily. The dose limiting side effect is diarrhea.

So far its exactly like Lapatanib. Yet there is a big difference between the drugs. This is where the chemistry comes in and makes the situation complicated.
Simply put, Nerotinib binds much more strongly to the active site of the HER1 or Her2 (the ATP binding pocket)
than Lapatanib does. Nerotonib forms a strong, permanent covalent bond (this is chemistry of course) where Lapatanib forms much weaker Hydrogen bonds.
Therefore Nerotinib should act more strongly.

The problem with the Her1 and Her2 receptors is that they mutate and once they mutate, Lapatanib doesnt really work anymore. Because of the stronger chemical bond that Nerotinib forms, it is hoped it will be effective in those mutated situations where Lapatanib is not.

There is one mutation in the Her1 and Her2 receptor that is particularly troublesome. It is called the T790 mutation. Once this T790 mutation occurs Lapatanib loses its effectiveness. Hopefully Nerotinib wont because of the stronger chemical bond.

Paul
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Old 12-08-2013, 12:02 PM   #7
'lizbeth
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Re: HKI-272 for HER2-Positive Breast Cancer and Brain Metastases

Paul,

Thanks for explaining about HKI-272. I found the chemistry interesting.

This will be one to watch - I'm hoping that it will be more effective for brain mets.
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Old 12-11-2013, 12:29 PM   #8
Rolepaul
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Re: HKI-272 for HER2-Positive Breast Cancer and Brain Metastases

Please continue to ask about Intrathecal Herceptin and IT Pertuzumab for brain and spine mets. All I can say is that the ongoing work in this area is remarkable. Read the input from Marvass and myself. It should give you information you can take to your doctor.
Rolepaul
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Old 12-15-2013, 01:50 AM   #9
dchips1
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Re: HKI-272 for HER2-Positive Breast Cancer and Brain Metastases

Do you know who is doing IT perjeta ? For reference for oncologist. How much IT topotecan dose with Herceptin IT? If topotecan is tolerable Thru Omaya that may be the quickest drug to get approved, and get rid of this stubborn one!
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dx 1/06 IDC 2cm 38 at dx
2/06 L mast nodes 3/9+ SNB neg ER-/Pr - her2 + Stg 4 liver/pelvis
3/06-9/06Taxol/Carbo/zometa/Herceptin
3/07 6 brain mets WBR down to c-2
4/07 osteonecrosis jaw
1/08 mri new 9mm lesion right lower side
2/08 gamma knife 1 lesion 11/08 regamma
10/09 latent rad necrosis to brain met,
1/20/10 crani: lesion necrosis w active cells continue her add tykerb
1/11 NED just Ingrown toenail! YEAH GOD
8/11 Tykerb, herceptin weekly, elevated her2 levels, negative scans
oct -march 11 new neuro deficits lower legs
3/12 2 spinal metsTykerb, Herceptin
04/12 4050cGY rads T 2-4 & T7-9
5/12 Brain,cervical lumbar clear/thoracic slight decrease
10/12 t 2-4 shrunk t-9 grew start Xeloda, 02/13 stop xeloda,5/13 on metformin, decadron, Tykerb, iv and IT herceptin 5/30/13 total #11 #2 of 80mg dose weekly.
9/13 100mg of IT her, IV hern, 750 mg tykerb, 3mg dec.
last Mri T--3 SHRUNK t7-9 shrunk no edema. Left shift in CBC bone marrow BX negative.
10/13 Ct has shown Double left ureters with stones/cysts in them, after 3 births and lots and U/S iit takes cancer to figure out you have 2 smaller ureters going into 1 kidney!
12/13 Mri brain no new lesions, cervical and lumbar arthritis.
Tspine lesion at T3 stable, T 7-9 GROWTH lots of pain

1/29/14 HIHO HIHO its off to Neuro surgery I go





Life is Good when you wake up in the morning and take a breath and know that God has given me another day.


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Old 12-15-2013, 04:38 PM   #10
donocco
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Re: HKI-272 for HER2-Positive Breast Cancer and Brain Metastases

I looked up the dosage of intathecal Topotecan. The Maximum tolerated dose was 0.4mg and itwas given twice a week for 4 weeks. This was an experiental study. Im not sure if its FDA approved. The side effects were headache, nausea and vomiting and back pain. This was seen at a dosage of 0.7mg twice a week. The earlier dosage 0.4mg was decided as the maximum tolerated dose. Hope this helps a bit.

Paul
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Old 11-15-2014, 07:44 PM   #11
DBaroch
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Re: HKI-272 for HER2-Positive Breast Cancer and Brain Metastases

Is anyone in this group in this study or consulting about about participating in this study.
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Diag 12/18/12
Stage 3a 5+ cm tumor IDC
HER2 +
BRCA -
4 biweekly AC
12 weekly TH
Mastectomy left breast June 2013
10 months tri-weekly Herceptin
Radiation via Phase II study through Robert Wood Johnson
TRAM reconstruction Dec. 2013
Nipple reconstruction/revisions April 2014
Final Herceptin March 21, 2014
Diag. Stage IV Oct. 20, 2014
Craniotomy 10/22
Gamma Knife 11/14
Waiting to be scheduled for chest/Ab Ct's and then treatment.
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