It is a difficult choice and I think you are VERY wise to be considering ALL the options. In very severe cases with massive mets everywhere and very HIGH tumor markers, yes, I think the more frequent the treatment the better. In your case, after just coming off of a pretty standard chemo regimen, hopefully, your CA 27/29 and serum her-2 markers will not be very high and you may very well be able to get by on the once every 3 weeks regimen, as it is very convenient and you really do feel like you are getting "your normal life back" --given all you have just gone through, that is surely a plus.
But it is yet more complex...some folks find the 8mg/kg loading dose for the every 3- week regimen hard to take...hard on the body and possibly hard on the heart. There seems to be some evidence that taking only 2mg/kg weekly is a bit easier on the heart. However, my favorite way to take herceptin is to only take as much as YOUR OWN body requires. To find this "magic dosing schedule" is not easy and requires a lot of trial and error on the part of both the patient and the onc, and unfortunately, most oncs are not comfortable doing anything "unusual", but other dosing situations can be pioneered. Even though I have advanced mets, I was able to manage the 6mg/kg every 6 weeks for over a year and a half. Some folks do well on the less discussed every 2 week schedule...4mg/kg...every 2 weeks instead of the standard 2mg/kg every 3.
Rather than trying to just guess or "pick" a good option, I always think it is better to look at your own individual blood work and case history and try to target the treatment to the REAL you, using something similar to bio-feedback to manage your disease, that is IF you have mets that need to be managed. You do not say if you have mets or are hormonal positive or negative or how many nodes you had or didn't have or how high your tumor markers are...all these things must be taken into consideration, so it is really tough to address your question fully. Given all the variables and all the dangers of her-2 mediated disease, though, I would say it would be best to err on the side of caution and weekly might be the best way to start out, just to be safe.
You also did not mention if you took any Adriamycin in any part of your earlier chemotherapy. That is also hard on your heart and would indicate weekly might be safer. Probably before you make this decision you should get a base line muga or echo of your heart function, if you don't already have one, or get a new test to see how your heart is holding up. (Lots of folks here rely on co-Q10 to support the heart function while on herceptin...although I don't use that alternative, I do rely on adequate magnesium intake and quercetin from foods like onions, leeks, and garlic, to keep my heart strong, plus daily walking. My most recent muga after nearly 7 years on Herceptin was around 68.
So, the short answer is if your muga is good--say over 65...all other things being equal, you could probably handle the 6mg per kg every three weeks and if you have already been on herceptin for a while...you could avoid the 8mg/kg re-loading dose, in MOST cases. However, there is an IMPORTANT exception: if by any measure, your illness is getting worse and worse...pull out all stops, provided your heart and kidney function are still ok and GO FOR THE HIGHEST dose of herceptin (probably the 8mg/kg) that you can access to bring the serum her-2 numbers down very quickly and regain control and management of the disease, particularly if you are her-2 +++ as that is a very effective dosage. In the future, I hope we will all be able to use our tumor markers similarly to how diabetics use their blood sugar counts and then only use as much or as little of herceptin as is needed to keep the serum her-2 numbers in the single digits, the way diabetics use synthetic insulin to keep the blood sugar in check. It is not a perfect analogy, but it is useful. If you would like more specific information, you are always welcome to e-mail me any time at home but you must keep in mind that I am not a doctor and can only advise you based on many years of personal experience with herceptin and the experience of many others I have worked with as a volunteer. But still, it provides you with at the very least, another "take" on a very complex issue. Good luck to you, Gina L. Popp
GPopp@Comcast.net
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