Retrying chemo-what does your onc say?

[Stephanie]

I am in desperate need of help for my mom. Her PET today shows progression on Gemzar/Herceptin. She just was admitted to the hospital (went straight from the PET via ambulance) b/c her oxygen sat dropped to 83% while on 4 liters of O2.

She's been on, and failed, every chemo there is over the past 5 1/2 years. The onc is willing to try Taxol/Tykerb just to pacify us, but says that once a patient is chemo resistant, she is resistant to ALL chemos.

I know some oncs will retry chemos and some won't, but I don't know what the majority of them say. I don't want to be unrealistic about my mom's situation, but I also don't want to give up too soon.

I appreciate your input.

[janet/FL]

I am sure others will give you examples, but I do know others have gone back on a taxol they have been on. Probably the one that lasted the longest? Others here will have ideas as to what else is available. Have you checked for clinical trials for her? Read the site for further information.
Hugs and prayers for you and your Mother.

[Lolly]

Hi Stephanie; Ask your onc about Ixabepilone (Ixempra), which was just approved by the FDA for breast cancer. It may be next for me, and another member, LOPSIDED, has just started it and if she shows response her onc has talked about adding Tykerb.
Being a new drug, you may have insurance issues, but it is FDA approved so should be covered, however your onc's insurance liason may need to push for you.

<3 Lolly

[Lani]

to herceptin or a taxane?

I know Dr. Pegram had a trial of the former and there are trials of the latter for her2- advanced bc.

There are also trials of pertuzumab...and herceptin plus 17AAG aka tanespin (heat shock protein inhibitor) or the new herceptin-DMM fusion product.

Just thinking about agents/combos she has not been exposed to yet which
work via more than one pathway.

Remember I am in no way qualified to make any suggestions.

Just making comments based on what my literature searching has found are
trials in place which have progressed beyond the Phase I and are perhaps looking hopeful in the Stage II or further so you might ask her Drs about them

Hoping something here helps!

[Sheila]

Stephanie
I would agree to add the Avastin to Taxol Herceptin...but only if your Moms heart and lungs are in good shape...Avastin blocks the blood supply to the tumor...it worked very well for me, but I had lots of B/P problems on it...and it is not yet FDA Approved.

[Mary Anne in TX]

Stephanie, I have no help to offer except prayer, but you're getting that for your mom and for you. This battle is difficult enough when it's us, but must be beyond difficult when it's our mom or child. God bless and I'll be praying for you.

[Lani]

unfortunately it is progression free survival it improves, not overall survival
So theoretically (remember I have no qualifications here, just read a lot) perhaps a combination of targetted agents might do better. Worth asking)(?). Please notice--this study looks at the combination as the INITIAL treatment for metastatic breast cancer (not one after many others):

N Engl J Med. 2007 Dec 27;357(26):2666-2676.
Paclitaxel plus Bevacizumab versus Paclitaxel Alone for Metastatic Breast Cancer.

Miller K, Wang M, Gralow J, Dickler M, Cobleigh M, Perez EA, Shenkier T, Cella D, Davidson NE.
From Indiana University Cancer Center, Indianapolis (K.M.); Dana–Farber Cancer Institute, Boston (M.W.); Puget Sound Oncology Consortium, Seattle (J.G.); Memorial Sloan-Kettering Cancer Center, New York (M.D.); Rush–Presbyterian–St. Luke's Medical Center, Chicago (M.C.); Mayo Clinic, Jacksonville, FL (E.A.P.); British Columbia Cancer Agency–Vancouver Cancer Center, Vancouver, BC, Canada (T.S.); Evanston Northwestern Healthcare and Robert H. Lurie Comprehensive Cancer Center of Northwestern University — both in Evanston, IL (D.C.); and Johns Hopkins Kimmel Comprehensive Cancer Center, Baltimore (N.E.D.).
BACKGROUND: In an open-label, randomized, phase 3 trial, we compared the efficacy and safety of paclitaxel with that of paclitaxel plus bevacizumab, a monoclonal antibody against vascular endothelial growth factor, as initial treatment for metastatic breast cancer. METHODS: We randomly assigned patients to receive 90 mg of paclitaxel per square meter of body-surface area on days 1, 8, and 15 every 4 weeks, either alone or with 10 mg of bevacizumab per kilogram of body weight on days 1 and 15. The primary end point was progression-free survival; overall survival was a secondary end point. RESULTS: From December 2001 through May 2004, a total of 722 patients were enrolled. Paclitaxel plus bevacizumab significantly prolonged progression-free survival as compared with paclitaxel alone (median, 11.8 vs. 5.9 months; hazard ratio for progression, 0.60; P<0.001) and increased the objective response rate (36.9% vs. 21.2%, P<0.001). The overall survival rate, however, was similar in the two groups (median, 26.7 vs. 25.2 months; hazard ratio, 0.88; P=0.16). Grade 3 or 4 hypertension (14.8% vs. 0.0%, P<0.001), proteinuria (3.6% vs. 0.0%, P<0.001), headache (2.2% vs. 0.0%, P=0.008), and cerebrovascular ischemia (1.9% vs. 0.0%, P=0.02) were more frequent in patients receiving paclitaxel plus bevacizumab. Infection was more common in patients receiving paclitaxel plus bevacizumab (9.3% vs. 2.9%, P<0.001), but febrile neutropenia was uncommon (<1% overall). CONCLUSIONS: Initial therapy of metastatic breast cancer with paclitaxel plus bevacizumab prolongs progression-free survival, but not overall survival, as compared with paclitaxel alone. (ClinicalTrials.gov number, NCT00028990.) Copyright 2007 Massachusetts Medical Society.
PMID: 18160686 [PubMed - as supplied by publisher]

[Stephanie]

Thank you all for the responses. The onc did mention Ixempra, but as a last ditch alternative. Avastin is out b/c her lungs are in such bad shape. My mom is willing to try anything at this point, and is annoyed with the onc for giving up.

I personally think the Gemzar has added to her lung problems, and am hoping that now that she's off of it and has a thoracentisis done, she'll be a little stronger.

I appreciate the support.

[Lida]

Stephanie,
Sorry to reply late; I just got your post. Has your mom considered Doxil? It is easier on the heart than Adriamycin; some friends have gotten help from it. Retrying a chemo (with Herceptin) has worked for me and a friend with Taxol; retrying Navelbine has helped another member too. Your mom iis lucky to have an advocate like you; knowledge (from information seeking like you are doing), persistance, and positive frame of mind have helped me. Wishing you and your mom the best, Lida

[Stephanie]

Thanks, Lida. We did mention Doxil to the onc, but she didn't seem to think it was worth trying. I will bring it up again at our next visit.