2 cents on post-trial adjuvant herceptin

Hi all,

I went with Rachel to her regular oncologist check up yesterday. All is well with her.

It was an interesting appointment because it was the first one back with her original oncologist: this is a woman who Rachel had a great relationship with but who, about two years ago, refused to give Rachel herceptin off-label. She did, to her credit, give us the name back then of the guy who finally did give Rachel the year's worth of herceptin. She's a good doc, but a real traditionalist when it comes to waiting for full results from clinical trials.

Anyway, she started the appointment very warmly saying how glad she was that Rachel had left her behind for a doc who was more "flexible."

When she and Rachel got done with their various discussions I asked her the question about what she was doing with respect to women who didn't get herceptin with or right after chemo. She said that she was just at a meeting of about 30 Boston area oncologists, many from the biggest research places, blah blah blah and George Sledge was there talking to them about the trials.

So anyway, they did an informal poll to see where folks stood on this issue and she said that there was no consensus across the board but that Sledge and most of the rest agreed that they would actively try to get women who were within six months of finishing chemo to come back in to start herceptin.

This doc (who I think was really changed in some fundamental ways by this trial) said that she personally would happily give herceptin to anyone within a year of finishing chemo. And then she paused and said "And if someone was 15 months out and really wanted it I wouldn't say no."

So that's just one person but I hope that all you folks out there who want to get herceptin post chemo and haven't yet will keep trying docs until you find the right one.

All the best,
Jeff

Thanks so much for sharing that info, Jeff. On a cancer conference call recently the same question was asked of one of the panelists talking about hormonal therapies, and the answer was the same there so that is very encouraging.

I'm personally years farther out and that isn't as promising, but I do think it is really important for others to consider.

A question I still have is whether or not it makes better sense to use some kind of chemo-plus-Herceptin instead of only Herceptin, and hope to ask about this when I see a new onc this winter.

A.A.

Firstly, hello to Jeff, I guess we have both been hibernating.

To AA,

It is a proven truth that herceptin + chemo is more effective than herceptin alone but; you pose an interesting argument.

Again, we all know that once you have mets your disease is systemic so............. the question is that if you are NED, should you still take chemo.

Off hand I would think the answer is no because of 2 important reasons: I think almost all chemos are dose limiting either by (1) side effects or by (2) building up an immunity to the drug. The problem that many of our members have over time is that they are "using up their available chemo arsenal". That refers to the cancer cells changing physically and becoming resistant to a particular drug.

I wish it was so easy as once you have discovered a chemo that works, you can stay on it forever.

I hope that answered your question,

Al

I have to keep asking until I understand, so thanks for your patience.

The ability of cancer cells to mutate, then, is why we don't want to "use up" the arsenal too soon...

But when my onc recommended Adriamycin for my first treatment that was exactly MY argument -- i.e., since so many stage I's would never have recurrence without anything but surgery, and if one adds the benefits of radiation to that, and then add any SERM or AI if applicable, why not "save" chemo for the remote possibility of recurrence? The standard response I got was that it was better to be proactive with the chemo because I was HER2+++ and HER2 responds well to Adriamycin.

And now that it has been demonstrated that HER2 responds so well to combination chemo/Herceptin for a fair percentage of those who are strongly HER2 positive, it seems like that would make at LEAST as much sense as for Stage 1 HER2's who are NED to have access to the combo as using up the "biggest gun" in the first place and affecting the immune system and to some degree all cells.

???

A.A.

Alaska Angel,
You mentioned a cancer conference call. This is the second reference I have seen about it. I read about an ASCO hormone related conference call but can't seem to find it on the ASCO site. Is this the same one? I'd appreciate any help!

Thanks!

dberg, the international conference call I listened to was not an ASCO conference. The title was Medical Update on the Hormonal Treatment of Breast Cancer dated 6/23/05, offered by CancerCare with guest speakers. Hope that helps -

A.A.