Question about Zoladex & Arimidex, but no chemo or herceptin

[Lien]

Dear all,

I am trying to find out how effective my present tx is, but can't seem to find much data.

I didn't get chemo (small tumor) or herceptin (wasn't available for adjuvant setting) when I was diagnosed in Jan. 2004.

Presently I'm on Zoladex shots for ovarian suppression and Arimidex, because my onc thought that this was more effective in Her2 positive tumors than Tamoxifen.

So my question is: does anyone know of results that confirm this line of thinking? And although I keep reading that Her2 positivity means a worse prognosis, does anyone know how much worse for early stage tumors?

I'm doing well, so it's mainly curiosity. In two years time I will have to decide whether I want to have my ovaries removed or not. I'm 47, so chances are that I will remain postmenopausal by then. So you see, I'm in no hurry, but would like to know if there's any news.

Wishing you all a nice day.

Jacqueline

[panicked911]

I am in he same position as you - Highly positive er ( 80 %) and pr (70%) as well as her2. i did however get adjuvent herceptain w/out chemo . i was stage 1 no nodes and no vascular invasion. Three oncologists have said the same thing ovarian suppression and arimidex - I am getting Lupron shots vs. zoledex = same thing different shot type.
i have been assured this is the most aggressive way to treat.
Hope this helps

Susanne

[Lien]

Hi Susanne,
Good to hear that you are on the same kind of tx. Thanks for letting me know.
Jacqueline

[sassy]

Jacqueline,

I was stage IIB, with positive nodes, so I did receive chemo and Herceptin. Triple positive, and now on Lupron for ovarian suppression and Arimidex as Susanne is.

I am also 47, and curious why you say you will have to make a decision in two years time about ovary removal.
________
Vaporizerinfo.com

[Erin]

I have almost your same dx, but my onc suggested chemo and I, wanting to be the as agressive as was reasonable in my situation, agreed. You can see my tx in my signature. I have read of several women on this site who have had herceptin "late". Is that a possibility for you? Better late than never? I am not as knowledgeable as most the the women on this site, but I am curious, as most eveyone one here feels herceptin the the miracle drug for hus Her2'ers.

[Lani]

The third abstract presented today also looked 207 HER2 positive breast cancer patients with hormone-dependant metastatic disease, evaluating whether Herceptin (trastuzumab) prolongs progression free survival (PFS). Overall survival (OS) was a secondary endpoint of the trial. Half of the patients were treated with Arimidex (anastrozole) alone, half were treated with Arimidex plus Herceptin. Patients on Arimidex plus Herceptin had 4.8 months of PFS, compared to 2.4 months for patients who received Arimidex alone, and the difference was statistically significant. Overall survival was prolonged in the patients on the combination therapy, but the data on OS were not statistically significant. Side effects were worse on patients who were treated with Herceptin plus Arimidex. In both arms of this trial, time to treatment response was 2 months, and median duration of treatment response was 10 months.

None of these trials was large enough to generate truly meaningful results. In addition, all three of these trials had worthless endpoints. Time to progression (TTP) and progression free survival (PFS) are pretty much meaningless markers for patients. What patients need to know is whether the drug will improve their chances of survival, and for how long. And TTP or PFS don’t necessarily tell patients anything meaningful about survival data. This is pretty clearly from information that Dr. Mackey presented in the Herceptin trial described in Abstract 3. In an unplanned subgroup analysis, patients without liver metastases had better OS on combined therapy (41.3 months) than on Arimidex alone (32.1 months). But the TTP for this group of patients was twice as good (7.7 months) on combined therapy than on Arimidex alone (3.8 months).
^^^^^^^^^^^
The above is not in my words and reflects results for metastatic, not small early breast cancer. Jean had a similar story ie, small her2+ER+ tumor, but had a "highish" recurrence score by oncoDX and flew from NY to California to meet with Dr. Slamon. Perhaps she could relate what he told her.

Hope this helps

[Becky]

Another caveat, I saw this paper given in person and attended an after-hours meeting with Dr. Hudis who personally commented on this study.


Lani is right as there was no study endpoint. That is a problem onto itself. Dr. Hudis' problem with this study is that there was no crossover group. Meaning the women who were only on Arimidex were not given the opportunity to crossover to the Arimidex/Herceptin group. He said that the data from this would have been what oncs are looking for in terms of quality of life issues.

This study used Stage 4 women who were newly diagnosed and had never received any treatment (ie chemo). The premise was can a drug or drugs keep things in check and for how long without the horrible effects of chemo. So, his opinion was - let's say Arimidex alone gives a woman 18 months before there is some progression but then adding Herceptin to the Arimidex at that point gives another 18 months. Then this woman has had 3 years of a very,very normal life before chemo has to be added (versus the study that showed about 2 years before progression if one was on the Arimidex/herceptin blend).

Obviously though, blocking as many receptors as possible is best so if you are Her2+ and ER+ you do want Herceptin and an AI. And if they find other receptors in the future, you'd want those blocked too (much like the article Lani just posted on the gang of 4 genes - blocking 2 was good but all 4 caused almost no tumor growth).

Thanks for bringing this trial up again Lani.