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Old 11-10-2015, 07:54 PM   #1
Debbie L.
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Adjuvant Perjeta/pertuzumab

This discussion started over on SpiritualAbundance's TCH/hair&nail thread but I think it deserves its own thread.

I saw people posting that she should check into Perjeta. The last I had paid attention, it was FDA-approved in the US only for neoadjuvant (before surgery) or metatstatic use. When I googled a bit to try and find out if this is still true, it seems it is (even Perjeta website only lists the two indications).

BUT, I also found this from NCCN last year. NCCN guidelines carry a lot of weight in the US, and I would think would be a strong statement to show both reluctant oncs and insurance companies:

The Panel noted, “Considering the unprecedented improvement in overall survival in the metastatic setting and the significant improvement in pathologic complete response seen in the neoadjuvant setting, the NCCN Panel considers it reasonable to incorporate pertuzumab in … adjuvant regimens, with duration similar to that used in the neoadjuvant setting, if the patient did not receive pertuzumab as part of neoadjuvant therapy.” Pertuzumab may also be part of neoadjuvant treatment in patients with ≥ T2 or ≥ N1 disease."

The above is from this ASCO article

I can't copy/paste from the actual guidelines, but they do include that last sentence as a footnote on their HER2+ (both ERPR negative and triple positive) page.

Does anyone have more current or accurate info on adjuvant Pertuzumab?

Debbie L.

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Old 11-11-2015, 08:18 AM   #2
Carol Ann
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Re: Adjuvant Perjeta/pertuzumab

Thanks so much for starting this thread, Debbie! It seems like the parameters for use are changing ... probably because it is still a relatively new drug. Mostly (from my perspective) I had seen it mentioned in several protocols lately ... and for someone new who is looking for info, you want to make sure you mention anything that might be of benefit.

I know I asked my oncologist (after my chemo was over) why I hadn't qualified for it, and he thoroughly explained it. But, I was diagnosed at a different Stage, etc, all of which makes a difference in determining the course of treatment.

Thanks again! I am so grateful to be on this board with all of you!

Carol Ann
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July 24, 2013: "Infected" Right Nipple and benign cyst removed, pathology report revealed Paget's, DCIS, and ILC 1.25 cm, ER+/Pro+/HER2 equivocal, Grade 2 under benign cyst, previous diagnostic mammo/ultrasound said I was perfectly healthy in both breasts.

Aug 18, 2013: MRI report says Left breast is perfectly healthy "consistent with previous studies".

Sept 2013: I insist on a bilateral mastectomy anyway. Too nervewracking to let left breast remain with higher risk after 3 cancers in right, nipple in right is already gone anyhow.

Sept 18, 2013: Bilateral mastectomy, 11 right nodes removed, ALL negative BUT -- ER+/PRO+/HER2+ tumor, 1.0 cm, Grade 2 found in a piece of "grossly unremarkable" breast tissue from prophylactic mastectomy of left breast, no nodes removed.

Oct 25, 2013: 13 left side nodes removed, ALL negative, Stage 1 across the board, NO RADS needed, YAAAAY! Port also installed.

Nov 25, 2013 Begin 6 rounds TCH.

March 10, 2014 Just finished 6th and LAST Chemo today, YAAAAAY!

March 24, 2014 Echocardiogram to make sure I'm still good for Herceptin every 3 weeks.

March 31, 2014 Echo results NORMAL, first Herceptin all by itself. Now if only my eyes would stop streaming from the Taxotere ... :)

April 21, 2014 Started Arimidex and therapy for "mild" lymphedema in left hand and arm

May 2014 Therapy completed, I have sleeves and gloves for both arms, a Flexi touch lymph pump to hook up to for an hour every day, and I've become an arm bandaging expert. :)

June 2014 Begin Fosamax to prevent osteoporosis; bone scan revealed osteopenia

Nov 17, 2014 FINAL Herceptin!

Dec 4, 2014 My right thigh muscle has been extra achy for days ... I discover a blister rash cluster on the side of my right thigh while taking a shower. Port appointment cancelled until Dec 17, my doc is working me in tomorrow afternoon to see me and the rash. My muscle at least feels less achy.

Dec 5, 2014 Yep, I have shingles. Boo! I start acyclovir and also have a prescription for a painkiller just in case for over the weekend.

Dec 17, 2014 Port is OUT!

January 2016 Shingles again and this time it started where my left breast (where the hidden HER2+++ tumor was!) used to be. My onc nurse got me a same day appointment to see my doc when I called and told her I had a rash on the site. The antiviral meds are working once again, though, so that is good news. :)
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Old 11-11-2015, 07:41 PM   #3
Lisalou
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Re: Adjuvant Perjeta/pertuzumab

I received adjuvant perjetta. There was no problem getting my insurance to pay. The Onc did a prior authorization but no difficulty at all, even though it say neoadjuvant. This is because of the clnical trials were done in the neoadjuvant setting, but does not mean it is less effective adjuvant.
So yes it is being done in the adjuvant setting.
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Routine mammogram 12/20/2013
Call back with repeat films on12/31/2013 Ultrasound with core needle biopsy same day
Dx 1/2/2014 IDC ER/PR+
1/10/14 HER2 +
2/14/14 BRCA results negative
2/17/2014 skin & nipple sparing BMX with reconstruction Tissue expanders placed
IDC Stage 2A left breast. 9mm tumor no other CA 1/4 nodes positive
ER + PR + Her2 +(by FISH)
Right breast no cancer, sclerosing adenosis
3/13/14 Round 1 AC minimal side effects
3/27/14 Round 2 AC
4/10/14 Round 3 a little more nausea
4/24/14 round 4 hurray! Done with phase 1!
5/8/14 THP ( taxol weekly x12, Herceptin & perjeta every 3 weeks x 4)
7/24/14 done with chemo
Continue of Herceptin every 3 wks x 1 yr
5/14 start Tamoxifen x 5 years
8/18/14 removal of TEs silicone implants placed
9/14/14 Cellulitis Right Breast, suspect infected implant. Managed with Oral antibiotics, avoided surgery to remove implant. Whew!
12/17/14 nip & tuck revision of Left breast

We gain strength, courage, and confidence by each experience in which we really stop to look fear in the face. The danger lies in refusing to face the fear, not in daring to come to grips with it. We must do that which we think we cannot do. -Eleanor Roosevelt
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Old 11-12-2015, 04:34 PM   #4
mburkhart
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Re: Adjuvant Perjeta/pertuzumab

I was given neoadjuvant Perjeta starting in January 2015. I was Stage 2b, Grade 3, with one lymph node known to be involved. My chemo was TCHP, six rounds. I finished in May and had a bilateral mastectomy in June with one of nine nodes positive; which an earlier biopsy had already shown. It had greatly reduced the size of the tumor in my breast and the one in my lymph node although I did not have a" complete" response. I am now completing my year of just Herceptin. There was no question from the very beginning that Perjeta would be a part of my chemo and fully covered by my insurance. I had the option for neoadjuvant or adjuvant chemo and it would be the same simply because I am Her2 positive. It was not based on the lymph node involvement.
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Old 11-13-2015, 06:00 PM   #5
Heathcliff4
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Re: Adjuvant Perjeta/pertuzumab

I also had it in the adjuvant setting.
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8/2013 Diagnosed age 42 with boys aged 2.5 and 6, Stage 11b, 1 cm her2+++, 30% ER positive, 5% PR positive, Rt Breast. Also DCIS in second spot of rt breast, high grade.
9/2013 Bilateral mastectomy, 3 nodes positive
10/13 Started AC/TH, Perjeta and Herceptin
1/14 Finished Chemo
3/14 Radiation, 5 weeks
4/14 Started Tamoxifen
6/14 Discontinued Tamoxifen due to extreme joint pain, exhaustion and depression
6/14 Started Exemestane and Zolodex shots to suppress ovaries
11/14 Finished Herceptin
11/14 Discontinued Exemestane due to similar side effects as Tamoxifen.
1/15 Reconstruction
3/15 CT Scan (routine) shows possible liver mets.
3/15 PET/CT scan shows no mets - huge sigh of relief
4/15 Began Letrozole. Knee and hip joint discomfort but minimal. Otherwise, knocking on wood - so far, so good!
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