TX list for liver mets

Rich66 · 09-16-2008, 09:37 AM

I get the sense that Herceptin plus a taxane is the base approach. Differences between the taxanes are not clear to me. I also understand various things like carboplatin are added as a 3rd ingredient at times. It would be great if people could contribute experiences, opinions, anecdotes to help me understand the pros and cons of the various approaches.
Thanks.

StephN · 09-16-2008, 10:46 AM

Hi Rich -

Wish there was an easy answer.

I had Taxotere as part of adjuvent treatment. That plus Adriamycin did NOT work for me. I had raging liver mets within 6 months of ending that combo.

On the other hand, TAXOL WAS a good drug for me, in combination with Navelbine and Herceptin. I had a weekly treatment schedule and this worked for me.

There is a difference in the taxanes. One was made from the Yew tree bark and the other from the needles. But they may be formulated in the lab now.

From Wikipedia: (This also better explains how the drugs work toward the cancer cell, and mentions Vinca alkoloids (Navelbine) so you see how these drugs are synergistic.)

"The taxanes are diterpenes produced by the plants of the genus Taxus (yews). As their name suggests, they were first derived from natural sources, but some have been synthesized artificially. Taxanes include paclitaxel and docetaxel. Paclitaxel was originally derived from the Pacific yew tree.
Taxanes have been used to produce various chemotherapy drugs. The principal mechanism of the taxane class of drugs is the disruption of microtubule function. It does this by stabilizing GDP-bound tubulin in the microtubule. Microtubules are essential to cell division, and taxanes therefore stop this - a "frozen mitosis". Thus, taxanes are essentially mitotic inhibitors. In contrast to the taxanes, the vinca alkaloids destroy mitotic spindles. Both, taxanes and vinca alkaloids are therefore named spindle poisons or mitosis poisons, but they act in different ways. Taxanes are also thought to be radiosensitizing."

Lori R · 09-16-2008, 12:12 PM

Rich,
I had liver mets and only had Taxotere + Herceptin. That combination worked very well for me. It knocked out the tumor I had in just 3 cycles (I had a total of 6 cycles, one every 3 weeks). We completed the remaining 3 cycles.

I've been NED since January 08. I JUST had a scan yesterday and will visit the onc on Thursday. OH Boy....Scan Anxiety....I'm trying to keep myself busy.

I will keep you posted on the results.

As Steph said...no right answer. It is also encouraging to know that there are multiple combos that can do the trick of one fails.

I think of you and your mom often....Lori

Rich66 · 09-16-2008, 12:39 PM

Keep 'em coming. And please include tolerability/toxicity in the discussion. Thanks so much.

StephN · 09-16-2008, 03:04 PM

Hi again -
my combo was a phase 2 clinical trial. Thus, it was the "tolerability" portion of the trial. We started out with high doses and cut from there as necessary. The dosing was adjusted and leveled out early on. I needed both red and white cell booster shots.

I was on weekly plan so the tolerability was not too bad. I never had ANY nausea, but did have some neuropathy, mouth sores and fatigue.

Rich66 · 09-16-2008, 03:32 PM

Anonymous (sent to my e-mail, posted with permission)
I wanted to respond to your posting regarding the study protocol. I was diagnosed with mets from the beginning. They were quite widespread -- liver, most of my spine, and lots of lymph nodes. I was treated with the protocol for the non-experimental arm of your study -- TCH (Herceptin (trastusumab), Taxol (paclitaxil), and Carboplatin) on a three week on one week off protocol, starting in March 2007. (Please excuse my spelling.) I received Herceptin alone on the off week. After 3 months of treatment my scans showed no evidence of disease (NED). We continued for three more months, and then switched Herceptin and hormonal therapy alone. I just had scans today, and don't yet know the results. But my scans three months earlier still showed NED. I think that TCH or TH is the standard of care for women with metastatic Her2 positive breast cancer with organ involvement. So you can rest assured that your Mom will at least get the standard of care on this study, and perhaps adding Avastin (bevatusumab) will even improve the results further. I note that the study is a phase III study. Perhaps you could ask to see the results from the phase II study. At the very least they should have results which indicate whether adding Avastin increases the toxicity.
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Hopefully, you have decided on a treatment regimen for your Mom by now. If not, please note that when I sent you my e-mail, I did not realize that she was 70 and had other health issues. In that case, it is possible that Carboplatin would not be advisable, since some studies show that TH is equivalent to TCH, and Carboplatin could be hard on the body. I think the most important thing is to get an opinion from a breast cancer specialist at a major Cancer Center. They will know the risk/benefit analysis of various treatments. You could always have someone local supervise the actual treatments.
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In terms of the toxicity of the treatments, I did not have much in the way of side effects from the TCH (with T being Taxol). I had this weekly, which is thought to reduce side effects. I worked part time, ran, and biked throughout treatment. But I was an active 45 year-old at the time, without any other health issues. After 3 months or a bit more, I become somewhat fatigued. Also, after awhile on Saturdays (which was two days after treatment) I wouldn't feel so well, and I would need to rest. But by Monday I was pretty much fine.

Joan M · 09-16-2008, 04:37 PM

Rich,

Has your mom started her treatment yet? What's going on?

Joan

Lori R · 09-18-2008, 07:01 PM

Rich,
I had promised to follow up and let you know about my most recent scan results. I am ENORMOUSLY relieved to say that the scan shows NED!!

So....the Taxotere / Herceptin combination bought me another 6 months.

I believe I saw an another thread that you mom's appointment was today (Thursday 9/18). I am hoping that you are comfortable with the Dr. and feel good about the approach they recommend. Wishing you and your mom ALL the best as she must be starting treatment.

doh2pa · 09-19-2008, 12:36 PM

Hi Rich,

My regimens for liver mets have included taxotere, carboplatin (hard to tolerate) with herceptin. I've also had navilbene with herceptin and gemzar with tykerb, which were easier for me, but everyone is different. All worked for a while. I have also added Avastin to the mix and interim scans at 8 weeks showed good response to Avastin, Tykerb and Gemzar.

Keep us posted, there are lots of options out there.

Rich66 · 09-19-2008, 01:25 PM

Anyone heard of Xeloda or Taxol + Avastin for 1st line treatment of liver/lungmets?

Bill · 09-19-2008, 05:03 PM

Hi Rich! I think it's awesome the way you are helping your Mom. My wife, Nicola, was on Taxol, Herceptin and Tykerb for liver mets, and it worked great for her for about 15 months. She had the usual side effects of diarrhea with the tykerb and sinus issues with the Herceptin. Right off the top of my head, I can't think of anyone that has received Xeloda as a 1st line of treatment. It's expensive and could have some rough side effects. Sorry, I know very little about Avastin and lung mets. Keep up the good work. I know it can be tough.

Jackie07 · 09-19-2008, 05:38 PM

Hi,

Sorry to interrupt here. Since everyone here is knowlegeable about liver mets, I thought I could pop my question here.

Last month, when my doctor reluctantly scheduled me for an ultrasound to look for any recurrence on my chest, he also scheduled a blood test, stool sample and urine sample.

I've been having some discomfort on the right side just on the edge (inside) of the lower rib cage. The stool sample I gave them Thursday was unusually dark and glossy. The medical encyclopedia says that the black color is cause by internal bleeding and signals possible cancer in the digestive tract such as stomach, liver...

Shouldn't be trying to self-diagnose here. But it worries me since I do not know what can be done if indeed I have mets to the liver because of my low MUGA score.

I read one of the links provided by Joe on the home page that liver can grow back after resection. Is it true? Has anyone had a new growth of the liver after the partial resection?

fullofbeans · 09-22-2008, 02:00 AM

Hi Rich

taxotere (lots of it) + herceptin was a good combo for me (grade3 aggressive cancer). However I seem to recall that your mum is 71y/o and this may affect choices whether for example she is in good health (except for cancer of course) ; taxane (taxoter or taxol) are very tough drug and some people cannot tolerate it so xeloda may be a better drug sometimes.

Also it would help if in your signature you wrote the dx i.e what grade is your mum for example..where is she at..