Lung met question - Page 2

Raquel · 11-08-2011, 06:28 PM

Hi everyone! I'm back and I have some answers now,but alot of questions too! My biopsy came back that it is indeed cancer,that is it er+,pr-,waiting on the her2 but guessing it's still positive.Met with the surgeon and a radioligist today.Both sound like they can get rid of it.Now I need to make a decision and have no idea which way is better.They either want to do a lobectomy with a scope or radiate the spot 4 times.Of course the second option sounds easier, but I'm wondering which is the better choice long term.They say there is no wrong answer here and not alot of data to fall back on so I'm asking anyone out there that has any experince with this to PLEASE weigh in on this! Any advice is appreciated!

Joan M · 11-09-2011, 07:47 PM

I had a wedge resection, which is usually the procedure for a lung metastasis. Lobectomies are generally reserved for lung cancer. But that might be changing. Also, not sure what you mean by a lobectomy with a scope. I had VATS. After my resection, the tumor reappeared a year later and I had an RFA, and I often wondered whether I should've had radiation to the area after the VATS. But nobody mentioned it, and I didn't think to ask. I was at a metastatic breast cancer conference recently, and I asked a thoracic surgeon whether it would have been possible to do that. He said, yes. However, you seem to be talking about doing either surgery or radiation. What are the side effects of radiation to the lung? Among other things, it probably depends on the location of the tumor. That would be an issue I'd check into.

Raquel · 11-30-2011, 06:36 PM

The tumor is located in the center lower lobe near the heart. I was not impressed with the radiation dr and went with my gut on that one,it seemed like he was over selling it to me. Also my onc preferred surgery to radiation,but no one suggested both.
Did you continue herceptin after your surgery? They want to pull me off and I'm nervous!

Joan M · 12-03-2011, 08:30 PM

Raquel,

I'm glad your're following your gut feeling.

I've been on Herceptin since my cancer advanced in January 2007, and I took the drug off label when I had early stage breast cancer in 2003. (At that time, Herceptin was in trials for adjuvant use, and unbeknownst to me at the time, my onc gave me 1/3 less of the dose of Taxol than was given in the trial.) I've been on only Herceptin since becoming stage 4, no chemo drugs. So, as they say, go figure.

I'm under the impression that it's extremely important to continue Herceptin even after progression. Eric Winer at Dana Farber has said this many, many times, but I can't find a reference at the moment or a link to a web seminar (can anybody find one!). The idea behind continuing Herceptin relates to trials showing that mets patients continue to get some benefit from the drug even if they progress on it.

Joan

Raquel · 12-20-2011, 06:20 PM

Just wanted to let everyone know I had my surgery and they took the lower lobe, all nodes are clear! Looks like they got it! So happy that's over! Thanks so much for all your help!

anna4969 · 12-20-2011, 08:25 PM

Raquel

Wonderful to hear, thank you for updating. Speedy recovery to you

Raquel · 12-27-2011, 08:15 PM

Let me know if you find the article about herceptin so I can show my onc! Thanks! Your inbox is full again!

rhondalea · 12-28-2011, 08:22 AM

This might help, Raquel:

http://breast-cancer-research.com/content/10/4/R60

Abstract

Introduction

We performed a retrospective analysis of HER2-overexpressing metastatic breast cancer patients to describe clinical outcomes of those who, despite progression of the disease (PD), maintained trastuzumab for multiple chemotherapy lines. We also compared survival of these patients with that of those who halted trastuzumab at first PD.
Methods

We identified 101 patients treated between July 2000 and January 2007. Nineteen were still receiving the first-line trastuzumab-based treatment without evidence of PD and were not included in this analysis. Of the remaining 82 patients, 59 retained trastuzumab for one or more additional lines of chemotherapy after PD, according to our institution policy. Twenty-three patients who changed treating institution and stopped trastuzumab at first progression were used as a control group.
Results

For patients retaining trastuzumab, the median follow-up was 39.6 months. Clinical outcomes showed the typical degradation between first and second lines of therapy which we would expect by halting trastuzumab at first progression. Response rates were 35% and 16% and median times to progression were 7.25 and 5.25 months for the first and second lines of trastuzumab therapy, respectively. The median overall survival (OS) rates were 70 months for patients who retained trastuzumab and 56 months for patients who halted the drug (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.51 to 1.18; P = 0.52). If we consider OS from the start of trastuzumab therapy, the figures are 53.9 and 34.8 months, respectively (HR 0.78, 95% CI 0.58 to 1.32; P = 0.2).
Conclusion

A nonstatistically significant trend of improved survival for patients retaining trastuzumab is observed. This is in line with most retrospective analyses and recent randomized data. Retaining trastuzumab after progression is a reasonable option, but further randomized data are warranted to better define its role in comparison with other available options.

This is a very long pdf:

http://www.asco.org/ascov2/Home/Educ...0111000014.PDF

And this is directly to the point:

http://www.medscape.com/viewarticle/713808

There are more out there, but these were representative.

Raquel · 12-29-2011, 08:12 PM

Thanks! Any info I can gather is helpful! I learned on another thread that the trial with tykerb only was not as effective as herceptin and they recommend that I take only tykerb. I'm so glad to have access to this valuable information in making my decisions! Its empowering to be informed and not blindly following advice that may not be right for me.