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Old 04-19-2009, 10:03 AM   #1
Rich66
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FYI AACR conference in colorado till April 22nd

http://www.aacr.org/home/scientists/...ting-2009.aspx

Hopefully good news will come out of this!
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Old 04-19-2009, 07:38 PM   #2
Lani
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am there

lots of her2 agents, mTor inhibitors, HSP 90 inhibitors in trials with really hopeful results.

Her2 bc felt to have been changed from worse prognosis than her2- to better prognosis for many (those who respond and don't develop resistance) New agents for those who don't respond or develop resistance and usually to be ADDED to herceptin or lapatinib.

Herceptin/lapatinib combo felt to be promising as well.

More later!

Lani
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Old 04-19-2009, 10:43 PM   #3
SoCalGal
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Lani,

I am thankful you are there, but I had to laugh because when I read the title to your post I thought that you are like a secret agent. Good thing you "work" for us.

And really glad to hear that tykerb/herceptin = good combo

Flori
__________________
1996 cancer WTF?! 1.3 cm lumpectomy Er/Pr neg. Her2+ (20nodes NEGATIVE) did CMF + rads. NED.
2002 recurrence. Bilateral mastectomy w/TFL autologous recon. Then ACx2. Skin lymphatic rash. Taxotere w/Herceptin x4. Herceptin/Xeloda. Finally stops spreading.
2003 - Back to surgery, remove skin mets, and will have surgery one week later when pathology can confirm margins.
‘03 latisimus dorsi flap to remove skin mets. CLEAN MARGINS. Continue single agent Herceptin thru 4/04. NED.
‘04 '05 & 06 tiny recurrences - scar line. surgery to cut out. NED each time.
1/2006 Rads again, to scar line. NED.

3/07 Heartbreaking news - mets! lungs.sternum. Try Tykerb/Xeloda. Tykerb/Carbo/Gemzar. Switch Oncs.
12/07 Herceptin.Tykerb. Markers go stable.
2/8/08 gamma knife 13mm stupid brain met.
3/08 Herceptin/tykerb/avastin/zometa.
3/09 brain NED. Lungs STABLE.
4/09 attack sternum (10 daysPHOTONS.5 days ELECTRONS)
9/09 MARKERS normal!
3/10 PET/CT=manubrium intensely metabolically active but stable. NEDhead.
Wash out 5/10 for tdm1 but 6/10 CT STABLE, PET improving. Markers normal. Brain NED. Resume just Herceptin plus ZOMETA
Dec 2010 Brain NED, lungs/sternum stable. markers normal.
MAR 2011 stop Herceptin/allergy! Go back on Tykerb and switch to Xgeva.
May-Aug 2011 Tykerb Herceptin Xgeva.
Sept 2011 Tykerb, Herceptin, Zometa, Avastin.
April 2012 sketchy drug trial in NYC. 6 weeks later I’m NED!
OCT 2012 PET/CT shows a bunch of freakin’ progression. Back to LA and Herceptin.avastin.zometa.
12/20/12 add in PERJETA!
March 2013 – 5 YEARS POST continue HAPZ
APRIL 2013 - 6 yrs stage 4. "FAILED" PETscan on 4/2/13
May 2013: rePetted - improvement in lungs, left adrenal stable, right 6th rib inactive, (must be PERJETA avastin) sternum and L1 fruckin'worsen. Drop zometa. ADD Xgeva. Doc says get rads consultant for L1 and possible biopsy of L1. I say, no thanks, doc. Lets see what xgeva brings to the table first. It's summer.
June-August 2013HAPX Herceptin Avastin Perjeta xgeva.
Sept - now - on chemo hold for calming tummy we hope. Markers stable for 2 months.
Nov 2013 - Herceptin-Perjeta-Avastin-Xgeva (collageneous colitis, which explains tummy probs, added Entocort)
December '13 BRAIN MRI ned in da head.
Jan 2014: CONTINUING on HAPX…
FEB 2014 PetCT clinical “impression”: 1. newbie nodule - SUV 1.5 right apical nodule, mildly hypermetabolic “suggestive” of worsening neoplastic lesion. 2. moderate worsening of the sternum – SUV 5.6 from 3.8
3. increasing sclerosis & decreasing activity of L1 met “suggests” mild healing. (SUV 9.4 v 12.1 in May ‘13)
4. scattered lung nodules, up to 5mm in size = stable, no increased activity
5. other small scattered sclerotic lesions, one in right iliac and one in thoracic vertebral body similar in appearance to L1 without PET activity and not clearly pathologic
APRIL 2014 - 6 YRS POST GAMMA ZAP, 7 YRS MBC & 18 YEARS FROM ORIGINAL DX!
October 2014: hold avastin, continue HPX
Feb 2015 Cancer you lost. NEDHEAD 7 years post gamma zap miracle, 8 years ST4, +19 yrs original diagnosis.
Continue HPX. Adding back Avastin
Nov 2015 pet/ct is mixed result. L1 SUV is worse. Continue Herceptin/avastin/xgeva. Might revisit Perjeta for L1. Meantime going for rads consult for L1
December 2015 - brain stable. Continue Herceptin, Perjeta, Avastin and xgeva.
Jan 2016: 5 days, 20 grays, Rads to L1 and continue on HAPX. I’m trying to "save" TDM1 for next line. Hope the rads work to quiet L1. Sciatic pain extraordinaire :((
Markers drop post rads.
2/24/16 HAP plus X - markers are down
SCIATIC PAIN DEAL BREAKER.
3/23/16 Laminectomy w/coflex implant L4/5. NO MORE SCIATIC PAIN!!! Healing.
APRIL 2016 - 9 YRS MBC
July 2016 - continue HAP plus Xgeva.
DEC 2016 - PETCT: mets to sternum, lungs, L1 still about the same in size and PET activity. Markers not bad. Not making changes if I don't need to. Herceptin/Perjeta/Avastin/Xgeva
APRIL 2017 10 YEARS MBC
December 2017 - Progression - gonna switch it up
FEB 2018 - Kadcyla 3 cycles ---->progression :(
MAY30th - bronchoscopy, w/foundation1 - her2 enriched
Aug 27, 2018 - start clinical trial ZW25
JAN 2019 - ZW25 seems to be keeping me stable
APRIL 2019 - ONE DOZEN YEARS LIVING METASTATIC
MAY 2019 - progression back on herceptin add xeloda
JUNE 2019 - "6 mos average survival" LMD & CNS new single brain met - one zap during 5 days true beam SBRT to cord met
10/30/19 - stable brain and cord. progression lungs and bones. washing out. applying for ds8201a w nivolumab. hope they take me.
12/27/19 - begin ds8401a w nivolumab. after 2nd cycle nodes melt away. after 3rd cycle chest scan shows Improvement, brain MRI shows improvement, resolved areas & nothing new. switch to plain ENHERTU. after 4th cycle, PETscan shows mostly resolved or improved results. Markers near normal. I'm stunned but grateful.
10/26/20 - June 2021 Tucatinib/xeloda/herceptin - stable ish.
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Old 04-20-2009, 03:41 AM   #4
Ellie F
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Thanks again for information Lani. Looking forward to further update.Thanks to info on this board I now have the confidence to challenge oncs about synergy between herceptin and other chemo combinations even when they are very negative!!
Praying for us all on this journey. Love Ellie
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Old 04-20-2009, 12:03 PM   #5
Rich66
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"New agents for those who don't respond or develop resistance and usually to be ADDED to herceptin or lapatinib."

Talking about Hsp-90 inhibitor, sheddase inhibitor?
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Old 04-20-2009, 07:14 PM   #6
StephN
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Wink

Lani is right on. We HER2 types seem to be deemed "the chosen ones" these days. I saw a poster on the Lapatinib/Herceptin combo and spoke with the presenter for a bit. Will try to post some abstracts when I get home - unless Lani beats me to it ...
__________________
"When I hear music, I fear no danger. I am invulnerable. I see no foe. I am related to the earliest times, and to the latest." H.D. Thoreau
Live in the moment.

MY STORY SO FAR ~~~~
Found suspicious lump 9/2000
Lumpectomy, then node dissection and port placement
Stage IIB, 8 pos nodes of 18, Grade 3, ER & PR -
Adriamycin 12 weekly, taxotere 4 rounds
36 rads - very little burning
3 mos after rads liver full of tumors, Stage IV Jan 2002, one spot on sternum
Weekly Taxol, Navelbine, Herceptin for 27 rounds to NED!
2003 & 2004 no active disease - 3 weekly Herceptin + Zometa
Jan 2005 two mets to brain - Gamma Knife on Jan 18
All clear until treated cerebellum spot showing activity on Jan 2006 brain MRI & brain PET
Brain surgery on Feb 9, 2006 - no cancer, 100% radiation necrosis - tumor was still dying
Continue as NED while on Herceptin & quarterly Zometa
Fall-2006 - off Zometa - watching one small brain spot (scar?)
2007 - spot/scar in brain stable - finished anticoagulation therapy for clot along my port-a-catheter - 3 angioplasties to unblock vena cava
2008 - Brain and body still NED! Port removed and scans in Dec.
Dec 2008 - stop Herceptin - Vaccine Trial at U of W begun in Oct. of 2011
STILL NED everywhere in Feb 2014 - on wing & prayer
7/14 - Started twice yearly Zometa for my bones
Jan. 2015 checkup still shows NED
2015 Neuropathy in feet - otherwise all OK - still NED.
Same news for 2016 and all of 2017.
Nov of 2017 - had small skin cancer removed from my face. Will have Zometa end of Jan. 2018.
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Old 04-20-2009, 07:54 PM   #7
karen z
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Lani and StephN,
Thanks for your posts and hopeful news.
karen z
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Old 04-21-2009, 06:28 AM   #8
schoolteacher
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Lani and Stephanine,

I am so glad both of you are there. Thanks for posting and letting us know what is going on.

Amelia
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Old 04-21-2009, 10:29 PM   #9
Lani
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am pooped

Attend from 7am -630 everyday without even lunch breaks and view/glance over 1900 posters Sunday, 900 posters Monday, 1900 posters today and will view/glance over 900 posters tomorrow before leaving!!!!

Best talks today by Neal Rosen explaining what "oncogene addiction" means--although this term is used a lot in the literature he feels mostly it is by authors who don't really understand it. Dr. Rosen has done seminal work on Hsp90 inhibitors and feels they are best suited for her2+ breast cancer. He feels PI3K inhibitors will best be used with other targeted agents which block further down the pathway or another pathway altogether.

Also superb was Dr. Max Wicha's talk on breast cancer stem cells and the funniest moment was the playing of a video of Hugh Laurie as Dr. House proclaiming that cancer stem cells ARE for REAL and are truly responsible for everything!!!! Dr. Wicha loved that!

Spoke again with Dr. Scaltriti who works with Dr. Baselga and did the work I reported on last year on how wonderfully herceptin/lapatinib synergize.

Lots of people working on ways to reverse herceptin resistance, new anti her2 agents--all agree to continue on herceptin past resistance, just add things to it!

Interesting posters on topical agents vs. EGFR inhibitor rashes, hand-foot syndrome, how to avoid hair loss with chemo.

I spoke with an investigator re how you ladies have reported losing the outer part of your eyebrows and eyelash length with herceptin. He is doing studies on EGFR inhibitors actions by studying patient's hair follicles from
plucked hairs. I suggested you might be willing to pluck your eyebrows and contribute to medical research??????

I also attended lectures on brain tumors, leukemias, myeloma, neuroendocrine tumors of gut, pancreas, so I was one busy propellerhead!

Gotta go!
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Old 04-22-2009, 01:53 PM   #10
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Wink StephN here

We have broken down the booth, shipped the leftover materials, retrived our luggage, had some lunch and are waiting for the airport shuttle.

Coming from a minimally science-educated background, just speaking with the few people I picked out to discuss their posters was strain enough on the old chembrain. Lani's mention of the work on new targets is truly boggling. There are literally thousands of people working on bits of DNA and cell components, and we know that only a small percentage of that work will bear fruit.

I am being rushed off the hotel computer by others, so there will be more soon!
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Old 04-23-2009, 01:47 PM   #11
fauxgypsy
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I wasn't paying attention so I have started another thread where I will post what I learned at the AACR. We all attended as many posters and as many talks as we could and met many passionate researchers at the booth as well. There was so much information that it became overwhelming. One statement I heard from the researchers was that it was so complex, with so many pathways and targets that it was impossible for them to wrap their minds around the whole picture. One even said that they need a genius, that the ordinary human brain cannot comprehend the sheer complexity of all of this research. I will post more on what I was able to learn as I am sure everyone else will as well.

Leslie
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In the world of destiny, there are no statistics.
Jan. 26- mammogram and ultrasound- suspicious lump
Mid-February- lumpectomy, infiltrating ductal carcinoma ~4.5 cm and a 1 cm DCIS, did not get clear margins, did not check lymph nodes
ER+/PR+, her2 +++, nuclear grade 3 of 3
February 20-PET scan showed something on liver. No biopsy.
March- Started carboplatin, herceptin, taxol on a four week cycle
May 3- Pet scan, with intent to do a biopsy, found nothing, liver or breast- no biopsy because there is nothing to biopsy
June 21- new onc, very concerned that there had been no biopsy,
June 18th-CAT scan, bone scan-negative
August 7th - Brain MRI-negative
August 9th- mastectomy, all pathology negative
January 2008 still NED! New oncologist -herceptin for full year after chemo- until July, and tamoxifen---negative scans since May '07
July 2008-Finished Herceptin!
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Old 04-23-2009, 02:20 PM   #12
Rich66
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There does seem to be an ever evolving number of pathways. What seems pivotal to me is whether cancer stem cells are the critical target. I wonder if that might explain why there can be shrinkage of tumors without overall survival benefit. Especially if some chemos, while killing the majority of cancer cells, leave cancer stem cells behind. Figuring out which chemos attack the "right" target might be a big step. In other words, is there a paradigm shift.
Another part of the cancer stem cell issue, if it holds water, is whether that could mean benefit from local therapy (lung RFA, spheres etc) even when multiple met sites are involved. i.e. does local therapy kill more cancer stem cells than produced by any rescue response. I've never understood why local therapies (with systemic) that you would think would reduce the tumor burden aren't considered beneficial after a certain point.
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Old 04-23-2009, 04:00 PM   #13
StephN
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Rich -
A partial answer to your question about determining the right target does go to the stem cell problem. I had several researchers tell me that in their preclinical models, the stem cells were NOT killed and this is one reason for the prevelance of brain mets and a reason that we can appear to have an early stage cure and then have a switch flipped on new tumors many years later.

I am glad Faux mentioned the "genius" part. Makes me feel better that so much of the science was over my head. Those are some very smart researchers and they say things like "the more we find out, the less we KNOW."

That was a little disconcerting, but on the other hand others were feeling that since our DNA is decoded the research is moving quite rapidly. In what direction is the 64,000 dollar question.
__________________
"When I hear music, I fear no danger. I am invulnerable. I see no foe. I am related to the earliest times, and to the latest." H.D. Thoreau
Live in the moment.

MY STORY SO FAR ~~~~
Found suspicious lump 9/2000
Lumpectomy, then node dissection and port placement
Stage IIB, 8 pos nodes of 18, Grade 3, ER & PR -
Adriamycin 12 weekly, taxotere 4 rounds
36 rads - very little burning
3 mos after rads liver full of tumors, Stage IV Jan 2002, one spot on sternum
Weekly Taxol, Navelbine, Herceptin for 27 rounds to NED!
2003 & 2004 no active disease - 3 weekly Herceptin + Zometa
Jan 2005 two mets to brain - Gamma Knife on Jan 18
All clear until treated cerebellum spot showing activity on Jan 2006 brain MRI & brain PET
Brain surgery on Feb 9, 2006 - no cancer, 100% radiation necrosis - tumor was still dying
Continue as NED while on Herceptin & quarterly Zometa
Fall-2006 - off Zometa - watching one small brain spot (scar?)
2007 - spot/scar in brain stable - finished anticoagulation therapy for clot along my port-a-catheter - 3 angioplasties to unblock vena cava
2008 - Brain and body still NED! Port removed and scans in Dec.
Dec 2008 - stop Herceptin - Vaccine Trial at U of W begun in Oct. of 2011
STILL NED everywhere in Feb 2014 - on wing & prayer
7/14 - Started twice yearly Zometa for my bones
Jan. 2015 checkup still shows NED
2015 Neuropathy in feet - otherwise all OK - still NED.
Same news for 2016 and all of 2017.
Nov of 2017 - had small skin cancer removed from my face. Will have Zometa end of Jan. 2018.
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Old 04-26-2009, 03:15 PM   #14
Rich66
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Any further highlights now that the recon team has had a chance to rest?
I would like to have handy whatever articles there are about continuing Herceptin post progression. Anything further on circulating Her2 and CTCs?
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Old 04-26-2009, 03:32 PM   #15
fauxgypsy
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Rich, I found this conference to be more about basic research. What I saw was more about why Herceptin doesn't work for some HER2+ patients. One of the explanations I saw was that Herceptin works better for patients whose receptors are homodimers rather heterodimers. In other words the receptor is made up of two Her2 proteins rather than a Her2 and a Her3 protein. Most of what I saw was nowhere near clinical trials. Maybe Stephanie has more insight into this than I do.

Several of the researchers that I talked to felt like we were very close to breast cancer being a manageable chronic disease, much more so than many of the other cancers. I will post more later. I have been catching up on my yard and garden this week end.

Leslie
__________________
In the world of destiny, there are no statistics.
Jan. 26- mammogram and ultrasound- suspicious lump
Mid-February- lumpectomy, infiltrating ductal carcinoma ~4.5 cm and a 1 cm DCIS, did not get clear margins, did not check lymph nodes
ER+/PR+, her2 +++, nuclear grade 3 of 3
February 20-PET scan showed something on liver. No biopsy.
March- Started carboplatin, herceptin, taxol on a four week cycle
May 3- Pet scan, with intent to do a biopsy, found nothing, liver or breast- no biopsy because there is nothing to biopsy
June 21- new onc, very concerned that there had been no biopsy,
June 18th-CAT scan, bone scan-negative
August 7th - Brain MRI-negative
August 9th- mastectomy, all pathology negative
January 2008 still NED! New oncologist -herceptin for full year after chemo- until July, and tamoxifen---negative scans since May '07
July 2008-Finished Herceptin!

Last edited by fauxgypsy; 04-26-2009 at 03:35 PM.. Reason: added more
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