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Old 06-26-2018, 08:18 AM   #1
Nguyen
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data to select one of these regiments: L+C; T+C; T+V; T+E

Hello,

Does anyone have data to guide selection from one of these regiments:

Lapatibib + Capecitabine; Trataszumab + Capecitabine
Trastazumab + Vinorelbine; Trastazumab + Eribulin

She (her2+, Er+) is currently on T-Dm1 (Kadcyla).

Thank you very much,

Nguyen
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Old 06-26-2018, 12:18 PM   #2
donocco
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Re: data to select one of these regiments: L+C; T+C; T+V; T+E

If she is currently on Kadcycla I doubt an oncologist would put her on Trastuzumab (herceptin) as Kadcycla is a conjugate of Herceptin plus a chemo drug called Emtansine. I searched to see if these two drugs could be used together ie Traztuzumab (Herceptin) and Kadcycla (Hercepton-Emtansine and found no statements for or against but it doesnt make sense to me. Ask the oncologist if you can use Kadcycla and Herceptin together just to bring it to his or her attention.

I guess that leaves Lapatanib (Tykerb) and Capcitabine Xeloda).

If she is ER postitve she probably would be taking a drug like Tamoxifen, Faslodex, or Zoladex i njections. Is she? Youdidnt mention anything about this.

Hopes this helps a bit

Paul
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Old 06-26-2018, 02:36 PM   #3
Nguyen
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Re: data to select one of these regiments: L+C; T+C; T+V; T+E

Hello,

Linda has been through quite a bit of treatment as indicated in her treatment history below. Currently if T-Dm1 fails, the physician recommends phase 3 randomize trial between SYD985 v.s Physician's choice , L+C; T+C; T+V; T+E. So I am looking for data to narrow down the physician choice.

Nguyen

Linda's treatment history:

04-2018 - current: restart T-Dm1

03-2018: biopsy of the lung: ER+, Her2+++, PR—(chage from PR+)
03-2018: comprehensive genetic profiling by Foundation medicine, numerous genomic alterations.

12-2017 – 04/2018: Pertuzumab + Herceptin
03/2017 – 12/2017: Herceptin + Fulvestrant (take a break from T-Dm1)
07/2014 – 03/2017: T-Dm1
02/2014 – 06/2014: Everolimus (5mg), Exemestane, Herceptin
08/2013 – 01/2014: Femara, Herceptin
12/2012 – 07/2013: 4mg estradiol, Herceptin
08/2012 - 12/2012: Fulvestran 500mg, exemestane, Herceptin (Stop everolimus due to mouthsores)
05/2012 - 08/2012: Everolimus (10mg), Exemestane, Herceptin, Zometa
08/2011 - 05/2012: Herceptin, Tykerb, Femara, Zometa
08/2010 - 08/2011: Herceptin, Femara, Zometa
09-2009 - 08/2010: Herceptin and estradiol (6mg)
09/2008 - 09/2009: Herceptin, Fulvestrant, Femara
03/2008 - 09/2008: Herceptin, Exemestane, Oophorectomy
01/2005 - 03/2008: Herceptin (readded) and Femara
07/2004: It returned again via several small nodules in the lung
10/2002: NED (via CT and CA27.29)!
10/2001 - 01/2005: Femara, (Fosamax)
12/2000 - 10/2001: Herceptin and Navelbine
12/2000: lung metastatic was diagnosed (a few small nodules)
02/1998 - 12/2000: Daily Tamoxifen
05/1997 - 04/1998: Modified Radical Mastectomy, many cycles of chemo regiments (CAF,Taxol, Carpoplatin, Thiotepa, Navelbine, Taxotere), including HDC, and radiation
05/1997: First diagnosed with BC stage 3A, ER+, PR+, HER2 +, poorly differentiated, nuclear grade
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Old 06-26-2018, 09:53 PM   #4
donocco
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Re: data to select one of these regiments: L+C; T+C; T+V; T+E

Well she has been on everything. I dont know what to tell you. Sometimes an old regimen like Cytoxan, Methotrexate and 5-Flurouracil is useful. Xeloda (Capcitabine) is an oral form of 5-Fluorouracil. Xeloda is a prodrug that becomes 5-Fluorouracil in the body. I imagine the CMF regimen could be combined with Lapatanib (Tykerb) but not sure. Ill research SYD985 and try to explain how it works. Of course Ive never heard of it until now.

Sorry I couldnt help more
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Old 06-26-2018, 10:24 PM   #5
Nguyen
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Re: data to select one of these regiments: L+C; T+C; T+V; T+E

Don't say sorry Paul, I am familiar with the working of SYD985, so don't spend time on researching it. I really appreciate you're trying to help!!! From treatment history, 5FU didn't help much, same with Tykerb. Vinorelbine made a difference way back then, but the tumor has not been exposed to Eribulin. So we will ask for T+E if she doesn't get selected into the SYD985 arm. Thanks again Paul!

Nguyen
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Old 06-27-2018, 06:22 AM   #6
Cathya
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Re: data to select one of these regiments: L+C; T+C; T+V; T+E

Nguyen;

Check out ZW25 or even Ibrance/Letrozole.

Cathy
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Cathy

Diagnosed Oct. 2004 3 cm ductal, lumpectomy Nov. 2004
Diagnosed Jan. 2005 tumor in supraclavicular node
Stage 3c, Grade 3, ER/PR+, Her2++
4 AC, 4 Taxol, Radiation, Arimidex, Actonel
Herceptin for 9 months until Muga dropped and heart enlarged
Restarting herceptin weekly after 4 months off
Stopped herceptin after four weekly treatments....score dropped to 41
Finished 6 years Arimidex
May 2015 diagnosed with ovarian cancer
Stage 1C
started 6 treatments of carboplatin/taxol
Genetic testing show BRCA1 VUS
Nice! My hair came back really curly. Hope it lasts lol. Well it didn't but I liked it so I'm now a perm lady
29 March 2018 Lung biopsy following chest CT showing tumours in pleura of left lung, waiting for results to the question bc or ovarian
April 20, 2018 BC mets confirmed, ER/PR+ now Her2-
Questions about the possibility of ovarian spread and mets to bones so will be tested and monitored for these.
To begin new drug Palbociclib (Ibrance) along with Letrozole May, 2018.
Genetic testing of ovarian tumour and this new lung met will take months.
To see geneticist to be retested for BRCA this week....still BRCA VUS
CA125 has declined from 359 to 12 as of Aug.23/18


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Old 06-27-2018, 01:17 PM   #7
Nguyen
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Re: data to select one of these regiments: L+C; T+C; T+V; T+E

Unfortunately pallocilib just fail phase3 for OS benefit, it's also only for her2 negative at this point. ZW25 is still in phase1. Thank you Cathy.
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Old 06-29-2018, 09:46 AM   #8
Cathya
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Re: data to select one of these regiments: L+C; T+C; T+V; T+E

Nguyen; I'm checking into the failed phase 3 but I will say my TM's are now in the normal zone. It is being tested on Her2+'s now and there will a paper out in December from Farber in Boston on this. I'm watching ZW25 as my onc is very excited about it. I'll post more as I see it. My best to your wife.

Cathy
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Cathy

Diagnosed Oct. 2004 3 cm ductal, lumpectomy Nov. 2004
Diagnosed Jan. 2005 tumor in supraclavicular node
Stage 3c, Grade 3, ER/PR+, Her2++
4 AC, 4 Taxol, Radiation, Arimidex, Actonel
Herceptin for 9 months until Muga dropped and heart enlarged
Restarting herceptin weekly after 4 months off
Stopped herceptin after four weekly treatments....score dropped to 41
Finished 6 years Arimidex
May 2015 diagnosed with ovarian cancer
Stage 1C
started 6 treatments of carboplatin/taxol
Genetic testing show BRCA1 VUS
Nice! My hair came back really curly. Hope it lasts lol. Well it didn't but I liked it so I'm now a perm lady
29 March 2018 Lung biopsy following chest CT showing tumours in pleura of left lung, waiting for results to the question bc or ovarian
April 20, 2018 BC mets confirmed, ER/PR+ now Her2-
Questions about the possibility of ovarian spread and mets to bones so will be tested and monitored for these.
To begin new drug Palbociclib (Ibrance) along with Letrozole May, 2018.
Genetic testing of ovarian tumour and this new lung met will take months.
To see geneticist to be retested for BRCA this week....still BRCA VUS
CA125 has declined from 359 to 12 as of Aug.23/18


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Old 08-22-2018, 03:40 PM   #9
SoCalGal
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Re: data to select one of these regiments: L+C; T+C; T+V; T+E

Clinical trial with extremely strong early results in heavily pretreated MBC is DS8201. Having 55% response rate when 20% is more what's expected for MBC population.

There is a lot of data:
https://www.onclive.com/web-exclusiv...-breast-cancer

https://www.daiichisankyo.com/media_...il/006778.html

http://www.ascopost.com/News/57981
About DS-8201

DS-8201 is a “smart” chemotherapy comprising a humanized HER2 antibody attached to a novel topoisomerase I inhibitor (DXd) payload by a tetrapeptide linker. It is designed to deliver enhanced cell destruction upon release inside the cell and reduce systemic exposure to the cytotoxic payload, as compared to the way chemotherapy is commonly delivered.

In addition to Breakthrough Therapy designation, the FDA has granted Fast Track designation to DS-8201 for the treatment of HER2-positive unresectable and/or metastatic breast cancer in patients with disease progression after prior treatment with HER2-targeted therapies including ado-trastuzumab emtansine.
Please check it out! It's also an ADC and there is a cohort for people who had progression on Kadcycla. Minimal side effects. Good luck!
__________________
1996 cancer WTF?! 1.3 cm lumpectomy Er/Pr neg. Her2+ (20nodes NEGATIVE) did CMF + rads. NED.
2002 recurrence. Bilateral mastectomy w/TFL autologous recon. Then ACx2. Skin lymphatic rash. Taxotere w/Herceptin x4. Herceptin/Xeloda. Finally stops spreading.
2003 - Back to surgery, remove skin mets, and will have surgery one week later when pathology can confirm margins.
‘03 latisimus dorsi flap to remove skin mets. CLEAN MARGINS. Continue single agent Herceptin thru 4/04. NED.
‘04 '05 & 06 tiny recurrences - scar line. surgery to cut out. NED each time.
1/2006 Rads again, to scar line. NED.

3/07 Heartbreaking news - mets! lungs.sternum. Try Tykerb/Xeloda. Tykerb/Carbo/Gemzar. Switch Oncs.
12/07 Herceptin.Tykerb. Markers go stable.
2/8/08 gamma knife 13mm stupid brain met.
3/08 Herceptin/tykerb/avastin/zometa.
3/09 brain NED. Lungs STABLE.
4/09 attack sternum (10 daysPHOTONS.5 days ELECTRONS)
9/09 MARKERS normal!
3/10 PET/CT=manubrium intensely metabolically active but stable. NEDhead.
Wash out 5/10 for tdm1 but 6/10 CT STABLE, PET improving. Markers normal. Brain NED. Resume just Herceptin plus ZOMETA
Dec 2010 Brain NED, lungs/sternum stable. markers normal.
MAR 2011 stop Herceptin/allergy! Go back on Tykerb and switch to Xgeva.
May-Aug 2011 Tykerb Herceptin Xgeva.
Sept 2011 Tykerb, Herceptin, Zometa, Avastin.
April 2012 sketchy drug trial in NYC. 6 weeks later I’m NED!
OCT 2012 PET/CT shows a bunch of freakin’ progression. Back to LA and Herceptin.avastin.zometa.
12/20/12 add in PERJETA!
March 2013 – 5 YEARS POST continue HAPZ
APRIL 2013 - 6 yrs stage 4. "FAILED" PETscan on 4/2/13
May 2013: rePetted - improvement in lungs, left adrenal stable, right 6th rib inactive, (must be PERJETA avastin) sternum and L1 fruckin'worsen. Drop zometa. ADD Xgeva. Doc says get rads consultant for L1 and possible biopsy of L1. I say, no thanks, doc. Lets see what xgeva brings to the table first. It's summer.
June-August 2013HAPX Herceptin Avastin Perjeta xgeva.
Sept - now - on chemo hold for calming tummy we hope. Markers stable for 2 months.
Nov 2013 - Herceptin-Perjeta-Avastin-Xgeva (collageneous colitis, which explains tummy probs, added Entocort)
December '13 BRAIN MRI ned in da head.
Jan 2014: CONTINUING on HAPX…
FEB 2014 PetCT clinical “impression”: 1. newbie nodule - SUV 1.5 right apical nodule, mildly hypermetabolic “suggestive” of worsening neoplastic lesion. 2. moderate worsening of the sternum – SUV 5.6 from 3.8
3. increasing sclerosis & decreasing activity of L1 met “suggests” mild healing. (SUV 9.4 v 12.1 in May ‘13)
4. scattered lung nodules, up to 5mm in size = stable, no increased activity
5. other small scattered sclerotic lesions, one in right iliac and one in thoracic vertebral body similar in appearance to L1 without PET activity and not clearly pathologic
APRIL 2014 - 6 YRS POST GAMMA ZAP, 7 YRS MBC & 18 YEARS FROM ORIGINAL DX!
October 2014: hold avastin, continue HPX
Feb 2015 Cancer you lost. NEDHEAD 7 years post gamma zap miracle, 8 years ST4, +19 yrs original diagnosis.
Continue HPX. Adding back Avastin
Nov 2015 pet/ct is mixed result. L1 SUV is worse. Continue Herceptin/avastin/xgeva. Might revisit Perjeta for L1. Meantime going for rads consult for L1
December 2015 - brain stable. Continue Herceptin, Perjeta, Avastin and xgeva.
Jan 2016: 5 days, 20 grays, Rads to L1 and continue on HAPX. I’m trying to "save" TDM1 for next line. Hope the rads work to quiet L1. Sciatic pain extraordinaire :((
Markers drop post rads.
2/24/16 HAP plus X - markers are down
SCIATIC PAIN DEAL BREAKER.
3/23/16 Laminectomy w/coflex implant L4/5. NO MORE SCIATIC PAIN!!! Healing.
APRIL 2016 - 9 YRS MBC
July 2016 - continue HAP plus Xgeva.
DEC 2016 - PETCT: mets to sternum, lungs, L1 still about the same in size and PET activity. Markers not bad. Not making changes if I don't need to. Herceptin/Perjeta/Avastin/Xgeva
APRIL 2017 10 YEARS MBC
December 2017 - Progression - gonna switch it up
FEB 2018 - Kadcyla 3 cycles ---->progression :(
MAY30th - bronchoscopy, w/foundation1 - her2 enriched
Aug 27, 2018 - start clinical trial ZW25
JAN 2019 - ZW25 seems to be keeping me stable
APRIL 2019 - ONE DOZEN YEARS LIVING METASTATIC
MAY 2019 - progression back on herceptin add xeloda
JUNE 2019 - "6 mos average survival" LMD & CNS new single brain met - one zap during 5 days true beam SBRT to cord met
10/30/19 - stable brain and cord. progression lungs and bones. washing out. applying for ds8201a w nivolumab. hope they take me.
12/27/19 - begin ds8401a w nivolumab. after 2nd cycle nodes melt away. after 3rd cycle chest scan shows Improvement and brain MRI shows improvement, resolved areas and nothing new. switch to single agent ENHERTU. after 4th cycle, PETscan shows mostly resolved or improved results. Markers near normal. I'm stunned but grateful. working on QOL and managing nausea.
3/18/20--->Just did cycle #5

Last edited by SoCalGal; 08-22-2018 at 03:43 PM..
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