My onc. sent e-mail about 9 wks. of Herceptin

Before she left for San Antonio, my onc. sent me the following e-mail. I hope some of you will also find it helpful in determining your treatment or finding comfort in it.:

Vicki,
I thought of you when I saw this at San Antonio website-it's abstract # 2. (I think you seemed worried when I told you the current NCCN recommendation was for 1 year of Herceptin).

This abstract will put your mind at ease. It will make for a great discussion. All investigators who have been giving preoperative trastuzumab will agree. These people adminstered only 9 weeks of Herceptin and they are seeing stunning results at 3 years of follow up. I am flying out tomorrow for this incredible event.T stands for trastuzumab(herceptin) T given concomitantly with docetaxel or vinorelbine for 9 weeks was well tolerated, and was not associated with a decrease of LVEFs making monitoring of the LVEFs unnecessary for most patients. Short duration administration of T is highly effective in preventing recurrence of BC with erbB2 amplification when given concomitantly with potentially synergistic chemotherapy, and may be better tolerated than one-year use of T.

[RhondaH]

if when I get my 3 weeks dose (I have been on Herceptin every 3 weeks since 8/18/05) if my onc will say " Your done". Mixed feelings, but it will have to come to an end sometime.

Rhonda Hoffman

[al from Canada]

I heard it too this was a finnish study all part of a trend towards a cost benefit analysis.....my thought was that I would love to see this reproduced. There were also questions on the selection critieria of the cohorts. BUT, if it does pan-out, what a boost to the global medical economies who can't afford 1 year of treatment. Also, I think this was with node negative patients??
Al

[snoopy]

Can't get into the site myself to read the abstract (not sure if the problem is my PC or the SABCS site). But what I have been told is that the Finnish trial was done in node positive or high risk node negative patients (sorry don't have detail as to what high risk node negative meant).

I await my Onc's return from Texas with interest.

Vicki, I found this most interesting.

I was given Herceptin/Navelbine for my mets for approximately 9 weeks and have not had a recurrance of my recurrance for three years!

Ofcourse this does not apply to my brain mets which we know the Herceptin does not effect.

I CHOSE to stop tx when this combination produced a NED state in my body. And, have not been on ANY other treatment/s but those specifically for my brain mets since then.

Thanks to your onc and you!
pattyz

[al from Canada]

Patty,

I believe that this sudy looked at herceptin in the adjuvant setting and not in the metastatic setting.
Regards,
Al

I know that, and that's why I wrote my response the way I did, Al.

thanks,
patty

[Christine MH-UK]

According to a trial description found through google, node-negative patients had to have a greater than 25% chance of recurrence, be progesterone-receptor negative and have a tumour size over 2 cm.

I wish the Finnish scientists had put out a clearer press release. Maybe it was clearer at the conference. It looks like there should be a webscast.

[RobinP]

Hi,

I find the finnish study very interesting, particularly since the media has boosted of the study, noting less Herceptin, 9weeks compared to one year, with less cardiac side effects for those who test positie for her2.However, I would love to see this study reproduced on a larger scale to see if the same findings would results. Additionally, I might add that in the Finnish study, many were on Taxol with herceptin. And it appears that clinically Taxol is more effective than other chemotherapy agents against her2 so we must attribute some of the sucess of the finnish study to Taxol as well.

PS To view the Finnish study, click on main message board, SABC, then on adjuvant herceptin, shortened treatment.

[Christine MH-UK]

Actually, the authors acknowledge that they picked both vinorelbine (navelbine) and docetaxel (taxotere) because herceptin is known to greatly amplify the effect of these drugs. The 50% is the benefit provided by the herceptin, although it is not clear if there was any difference between vinorelbine or taxotere in this regard. Overall, taxotere seemed to work better. From what I have read, taxol is not as synergistic with herceptin.

The length of followup (three years) was good, but the number is small (232). Still, statistically, there was less than a one percent chance that adding the herceptin had not made a difference.

I think it is a good option for patients who can't get herceptin-based chemo by other means.

The weird thing is that the British papers hardly noticed this study, even though there is a massive problem here with her2+++ patients not being able to get herceptin at all.

You are right, RobinP, that scientists generally do think that sequential chemo matters a great deal for her2+ patients, but the Finns did control for that.

[geraldine]

I was on Herceptin/Vinoralbine every week dec-may 2003/2004, then herceptin 3wkly till present day. I have been told I have " TOTAL Regression " but that I will be on Herceptin indefinately
I dont know how I would react if they told me they were taking me off treatment..!
Geraldine x

[al from Canada]

I was at the genetech dinner 2 nights ago and asked one of the company directors about the study and his response was, who would you believe, the national study with thousands of individuals or the Finnish one with a couple hundred? I'm sure that many companies with a socialized health care system will be scrutanizing this study closely and probably designing trials to try to duplicate it but for the time being......

Now as I mentioned before, from a cost-benefit analysis, which I'm sure many of these countries are looking at, the theraputic advantage / difference, will be an issue when weighing the total impact on the National health care system. That said, if further larger studies validate the Finnish study, it will be a true bonus.
Al

[Christine MH-UK]

But don't financial interests cut both ways? I mean the Finnish trial is the first one not funded by Genentech. As great as herceptin is, three weekly herceptin is a pain in the backside and I do worry about cardiotoxicity.

If you can get a statistically strong result from a small number (and this result was very strong) then that is actually much more credible result than one gotten by cobbling two not-entirely-identical studies together and passing this cut and shunt off as if it were standard automobile (the Lancet was right about this aspect of the ASCO presentations unfortunately), although I do wish that the Swedish researchers had done four taxotere+herceptin followed by four FEC 75 (nobody uses FEC60 now). Despite the small numbers (although big enough for a normal distribution) the Finnish trial is pretty close to demonstrating improved overall survival by methodologically impeccable means.