perjeta with gemzar? - Page 2

kk1 · 01-15-2013, 09:56 AM

Cool Breeze;

Looking at your treatment history I am kind of surprised you have not had a Xeloda plus Herceptin, and some type of aromatase inhibitor. Many with liver mets have had good luck with the Xeloda as it is metabolized by the liver to 5FU. As much of the recent research has shown for Her+ and ER+ you have to block both pathways at the same time.

just a thought you might want to discuss with your Onc.

phil · 01-15-2013, 12:00 PM

Sounds like pert / gemz is a good plan , ( it will be combined w/ herceptin , ? ) and you can get it going quicker than t dm-1 . hopefully you can add t dm-1 in after ( before ) end of Feb. I would ask your doc about getting t dm-1. Plan ahead w/ him. , overall its stronger than pert. I cannot see it being delayed any longer than Feb, hopefully before. when it is appr, it will very likely focus on late stage iv, and is particularly effective on liver tumors.
KDR had good response w/ pert /t dm-1 together , and i believe she had some ER+ as well as her2 . so you should get two of the latest strong her2 txs over the next few months. don't be discouraged , Lorraine s cancer was ( is ? ) very aggressive. she blew through more tx's in 2010, thats how cancer can be , for ex. she got nothing out of abraxane, her cancer had already overcome taxotere , so another taxane wasnt going to do it. you have to keep surprising it , and gemzar w/ pert will be a surprise . For Lorraine , t dm-1 blew the cancer away . you rdoc may be good , but i dont like stats you are not astatistic. and pert is way too new for stats anyway.
as far as comp use , its a racket , betw. the FDA and co's . pts can' talk w/ fda , docs are not assertive enough , out of thier comfort zone. anyone should try it if they cant get adrug any other way , but that system needs change big-time. you can ask Darlene Gant about it , ( shes on FB ) she had to go viral to get Gen to move . she is doing well w/ just pert/ herc.
Those on Inspire , can read Lorraines latest ltr to editor about your Rights. under advanced bc discussion titled , " T DM-1 Activism " , i thought she siad it well, but thenagain, I am a little biased . Never Give Up, Keep The Faith !! No Peeking

cheery · 01-15-2013, 01:22 PM

Coolbreeze

My heart goes out to you..a little off topic, the video was very touching and shows your intense love for your family.

I've read that Gemzar is good for triple negative BC so when used with Herceptin and Perjeta, it'll be a multi-pronged approach to hit those crappy HER2+ and any triple negative BC cells hard.

Compassionate use for TDM1 will be tough. Genentech requires you to have done Tykerb, in addition to Herceptin. My doc had tried unsuccessfully for me when my liver recurred recently.

Take care.

phil · 01-15-2013, 01:56 PM

I should have mentioned that Lorraine had a good run on herc/ gemzar , about 1 and 1/2 yrs ! Good luck

Mandamoo · 01-15-2013, 03:03 PM

Hi Coolbreeze.
I too am starting a 'novel' combination having had herceptin and carboplatin yesterday I will add perjeta (compassionate) use next cycle. The have been no studies on this but my understanding is the belief that a dual blockade is more effective than a single agent - adding a chemo is the bonus. I've had no platinum exposure which is the reason for going with this rather than Abraxane.

I just came off trial for tdm1 which was ineffective for me - well it slowed the cancer down but didn't stop it. If I wasn't on trial the onc said he would like to add something to it - perjeta or avastin or tykerb.

My private onc was initially a little apprehensive about the carbo preferring the Abraxane but on thinking said the platinum therapy was worth a try for me despite the luck of study into this combination. I feel we are somewhat limited by the studies as they need large groups that will give them their best results - so of course they are going to try first line and with a taxane - but that doesn't mean those of us who have been heavily pretreated will not have a response too in a different combination. They just have to get the drugs over the line with the FDA. The study just hasn't been done yet and who know may now not be - it will be up to those practicing to be guided as to what will be best for the individual patient. Here in Australia once you had tried herceptin then given tykerb a go, you have only recently been allowed back on herceptin - because there was no study saying it would help. You still have to jump through hoops to get it without a taxane.
I'm glad you are giving it a go. I have a goal to see my son finish school too - the catch for me is he doesn't start prep for a couple of weeks - lofty ambition hey? Who knows - maybe something will work a little better for a bit longer and then something better again. I may be living in the clouds but currently I'd rather that.
I hope the treatment is gentle with you. A xx

ElaineM · 01-15-2013, 03:39 PM

Wow !! Just look at the potential options and choices you have !! See what happens when you put a group of great minds (members here) together.
According to your bio you haven't had alot of different chemo combos even though you have had a considerable amount of chemo. I have another suggestion. You might want to ask about using a chemo you used in one combo with another combo. For example some people use Taxol or Abraxane and Herceptin, but Taxol or Abraxane can also be used with Tykerb instead of Herceptin. Either you or your oncologists can look up different combos on the internet and come up with something that might work if all the other options suggested here do not seem to be workable.
I always believed one doctor does not know everything about everything. Doctors can always learn more about their choosen fields just like other professionals can.
Make a list and chat with your oncologists about all the suggestions here. I bet something good will come out of that chat.
All the best Cool Breeze.

Bunty · 01-15-2013, 05:16 PM

Hi Ann, I can't add any information to this thread, but I can certainly add my good wishes to you for finding the combo that will work best for you!

Thinking of you and all the others here who are forging ahead with these new combos and drugs. It is indeed hopeful times for those with Her2+ BC.

Cheers Marie

cheery · 01-15-2013, 05:36 PM

Hi Mandamoo/Amanda

I was wondering, why not do Abraxane, Carbo, Herceptin & Perjeta combo? TCH is the golden combo for HER2+ BC and Abraxane is part of the taxane family. My onco said he didn't suggest Abraxane as it's expensive compared to Taxol, but Taxol has more side effects.

While a 2nd opinion onco suggested Taxol alone for me, my onco was determined that I do Taxol, Carbo and Herceptin combo to get the maximum benefit in overcoming Herceptin resistance. He said Taxol and Carbo have synergistic effects as does Taxol with Herceptin. Following TCH, the liver met shrank. Of course, I'll never know what did the trick - be it Taxol, Carbo or Herceptin alone or a combination of either/all but I'm just thankful.

Just a thought. Ultimately it's your decision with your oncologist

hope the next treatment will kick those BC cells away!

Mandamoo · 01-15-2013, 11:36 PM

Cheery - I did bring it up with both oncologists I saw but the feeling was that the toxicity was not worth it and that the synergistic effect was questionable. I'm ok with this for now. I have Abraxane up my sleeve too - I guess I've just been on constant chemo - I've always wished I had the TCH combo vs the FEC-HT combo at the beginning but it's too late now for regrets. I think because we are adding perjeta too if we then had the C and T there may not be much benefit - such a guessing a game.
Thanks for your input - I will ask again at my next appointment about the synergies of t and c in combo vs c alone with herceptin.
A xx