for Stage IV--if at first you do not succeed (with herceptin combo), try try again!!

Lani · 11-06-2009, 10:34 AM

It seems that the time to progression with the first herceptin based combination therapy given after becoming Stage IV predicts how long one would take to progress on the second herceptin based combo therapy.

Another argument backing "herceptin beyond progression" to use with governments, insurance companies who want to stop herceptin once progression occurs and "throw the baby out with the bathwater"

Herceptin, for now, seems to be the framework upon which other agents are added to achieve the longest possible times to progression. Lapatinib, for now, seems perhaps best added to herceptin rather than replacing it.

All these "for nows" just means until more data comes in from other studies.

hutchibk · 11-06-2009, 11:30 AM

EXACTLY what my onc has been talking about for the last 6-8 months. Thanks Lani.

Ellie F · 11-07-2009, 01:52 AM

Mine to. When mine was stopped by my first bean counter oncologist when I recurred my second opinion was outraged that this had happened. He totally agreed with the opinion on this board that we should add not take away!
Ellie

11-07-2009, 09:04 AM

Lani, thanks for this post. Do you have the article or abstract that says this? I would love to see it.

Thanks,

Jill

Lani · 11-07-2009, 09:13 AM

Sorry I forgot to add it:
Breast J. 2009 Nov 2. [Epub ahead of print]
Time to First Tumor Progression as Outcome Predictor of a
Second Trasuzumab-Based Therapy beyond Progression in
HER-2 Positive Metastatic Breast Cancer.
Metro G, Giannarelli D, Gemma D, Lanzetta G, Ciccarese M, Papaldo P, Gamucci T, Lorusso V, Mottolese M, Magnolfi E, Cognetti F, Fabi A.
Division of Medical Oncology, Regina Elena Cancer Institute, Rome, Italy.
In a previous analysis performed on a cohort of 37 HER-2 positive metastatic breast cancer (MBC) patients treated with trastuzumab beyond progression, we found that a second trastuzumab-based therapy is associated with a considerable response rate and preserved time to progression as compared with a first trastuzumab-based therapy. In the present study, we extended the analysis to a total of 69 patients treated in four different italian Institutions, also trying to identify clinical predictors of sensitivity to a second trastuzumab-based therapy beyond progression. Efficacy results on the overall population confirmed that a second trastuzumab-based therapy beyond progression is an active regimen (27.5% of responses and 6.5 months of time to progression, respectively). Median time to progression to the first trastuzumab therapy (TTP1) identified two groups of patients with different sensitivity to trastuzumab beyond progression (group A, TTP1 >/= 8 months and group B, TTP1 < 8 months) in terms of time to second progression and post-progression survival (group A versus group B showed respectively a time to second progression of 7.6 versus 4.7 months, p = 0.05, and a post-progression survival of 31.7 months versus 21.8 months, p = 0.04). In the multivariate analysis, only TTP1 was a predictor of time to second progression and post-progression survival. Despite the recent approval of lapatinib plus capecitabine for trastuzumab-progressing patients, it is still reasonable to offer trastuzumab beyond progression to HER- 2 positive MBC patients, because these data confirm the potential utility of such a conduct. In the clinic, time to first tumor progression may represent a useful tool to identify patients who are more likely to benefit from trastuzumab beyond progression.
PMID: 19889170