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Old 04-11-2011, 12:50 PM   #1
emmastarr
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Unhappy Herceptin stopped-now what?

Well, I had a call from my herceptin nurse today to say that my herceptin has been stopped due to my low EF score of 48%, I was 64%. I'm not sure yet if I'm on a break or a permanent stop, will find out Weds morning. Am feeling quite nervous about stopping herceptin and how it's going to affect my survival, having had only 9 out of 18 treatments. Is there anyone else who had to stop without completing treatment but is doing well?
Thanks, Emma
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Diagnosed Feb 2010, age 32
IDC 0.5cm & 0.1mm and DCIS
Had mastectomy
Lymph nodes clear, no vascular invasion
Stage 1, grade 1, ER+, PR-, HER2+
Had 5x FEC, on tamoxifen and herceptin
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Old 04-11-2011, 02:00 PM   #2
hutchibk
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Re: Herceptin stopped-now what?

Emma - bringing it up above 50% from 48% can't be terribly difficult. I believe 50% is the minimum they want to see. I would be surprised if they are taking you off for good... I think they skip a treatment from time to time to help your heart rebound. Please ask to see a cardiologist. Also ask about taking an ACE Inhibitor (lisinopril) and a BETA blocker (coreg).

Separate from that, do other things diligently that support the heart muscle. Walk briskly 30 min a day, take Omega 3, take CoQ10, and drop all caffeine and alcohol from your diet. It worked for me!
__________________
Brenda

NOV 2012 - 9 yr anniversary
JULY 2012 - 7 yr anniversary stage IV (of 50...)

Nov'03~ dX stage 2B
Dec'03~
Rt side mastectomy, Her2+, ER/PR+, 10 nodes out, one node positive
Jan'04~
Taxotere/Adria/Cytoxan x 6, NED, no Rads, Tamox. 1 year, Arimadex 3 mo., NED 14 mo.
Sept'05~
micro mets lungs/chest nodes/underarm node, Switched to Aromasin, T/C/H x 7, NED 6 months - Herceptin only
Aug'06~
micro mets chest nodes, & bone spot @ C3 neck, Added Taxol to Herceptin
Feb'07~ Genetic testing, BRCA 1&2 neg

Apr'07~
MRI - two 9mm brain mets & 5 punctates, new left chest met, & small increase of bone spot C3 neck, Stopped Aromasin
May'07~
Started Tykerb/Xeloda, no WBR for now
June'07~
MRI - stable brain mets, no new mets, 9mm spots less enhanced, CA15.3 down 45.5 to 9.3 in 10 wks, Ty/Xel working magic!
Aug'07~
MRI - brain mets shrunk half, NO NEW BRAIN METS!!, TMs stable @ 9.2
Oct'07~
PET/CT & MRI show NED
Apr'08~
scans still show NED in the head, small bone spot on right iliac crest (rear pelvic bone)
Sept'08~
MRI shows activity in brain mets, completed 5 fractions/5 consecutive days of IMRT to zap the pesky buggers
Oct'08~
dropped Xeloda, switched to tri-weekly Herceptin in combo with Tykerb, extend to tri-monthly Zometa infusion
Dec'08~
Brain MRI- 4 spots reduced to punctate size, large spot shrunk by 3mm, CT of torso clear/pelvis spot stable
June'09~
new 3-4mm left cerrebellar spot zapped with IMRT targeted rads
Sept'09~
new 6mm & 1 cm spots in pituitary/optic chiasm area. Rx= 25 days of 3D conformal fractionated targeted IMRT to the tumors.
Oct'09~
25 days of low dose 3D conformal fractionated targeted IMRT to the bone mets spot on rt. iliac crest that have been watching for 2 years. Added daily Aromasin back into treatment regimen.
Apr'10~ Brain MRI clear! But, see new small spot on adrenal gland. Change from Aromasin back to Tamoxifen.
June'10~ Tumor markers (CA15.3) dropped from 37 to 23 after one month on Tamoxifen. Continue to monitor adrenal gland spot. Remain on Tykerb/Herceptin/Tamoxifen.
Nov'10~ Radiate positive mediastinal node that was pressing on recurrent laryngeal nerve, causing paralyzed larynx and a funny voice.
Jan'11~ MRI shows possible activity or perhaps just scar tissue/necrotic increase on 3 previously treated brain spots and a pituitary spot. 5 days of IMRT on 4 spots.
Feb'11~ Enrolled in T-DM1 EAP in Denver, first treatment March 25, 2011.
Mar'11~ Finally started T-DM1 EAP in Denver at Rocky Mountain Cancer Center/Rose on Mar. 25... hallelujah.

"I would rather be anecdotally alive than statistically dead."
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Old 04-11-2011, 02:07 PM   #3
Lien
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Re: Herceptin stopped-now what?

Dear Emma,

Take a look at my signature line. My tumor was bigger, I had extensive DCIS and never had Herceptin. Right now it seems your risk of heart trouble is a lot bigger than your risk of ever having a breastcancer recurrence. You had 9 treatments and as not everybody is convinced that Herceptin should be taken for a year, you may well have had enough. You had chemo too. You were treated very aggressively and it's very likely that you will never have a recurrence. You also have Tamoxifen to protect you and your tumor was grade 1.

Frankly, if you'd lived in the Netherlands in stead of the USA you probably would not have received Herceptin or chemo. Have you had genetic testing for BRCA 1 & 2?

No lymphatic or vascular invasion, small, low grade tumor, those are all favorable. I think you will be fine.

Hope this helps

Hugs

Jacqueline
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Diagnosed age 44, January 2004, 0.7 cm IDC & DCIS. Stage 1, grade 3, ER/PR pos. HER2 pos. clear margins, no nodes. SNB. 35 rads. On Zoladex and Armidex since Dec. 2004. Stopped Zoladex/Arimidex sept 2009 Still taking mistletoe shots (CAM therapy) Doing fine.
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Old 04-12-2011, 01:50 PM   #4
emmastarr
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Re: Herceptin stopped-now what?

Thank you for your advice and support.
Brenda, will speak to the Onc tom and mention what you said re ACE inhibitors/BETA blockers etc.
Jacqueline, another question for you- are you still doing the CAM therapy/how long did you do it for?
Not sure if I can get that therapy here in England on the NHS, but have heard others talk about the mistletoe shots and am quite interested.
__________________
Diagnosed Feb 2010, age 32
IDC 0.5cm & 0.1mm and DCIS
Had mastectomy
Lymph nodes clear, no vascular invasion
Stage 1, grade 1, ER+, PR-, HER2+
Had 5x FEC, on tamoxifen and herceptin
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Old 04-12-2011, 01:51 PM   #5
emmastarr
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Re: Herceptin stopped-now what?

By the way I was BRCA negative.
__________________
Diagnosed Feb 2010, age 32
IDC 0.5cm & 0.1mm and DCIS
Had mastectomy
Lymph nodes clear, no vascular invasion
Stage 1, grade 1, ER+, PR-, HER2+
Had 5x FEC, on tamoxifen and herceptin
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Old 04-12-2011, 02:59 PM   #6
Jackie07
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Re: Herceptin stopped-now what?

Emma,

I did not have Herceptin in 2003 when my breast cancer (Her2+++ and ER 5%) was diagnosed. I did 6 FEC for a total of 18 weeks. In 2007 when the recurrence was finally found, I had 6 rounds of TCH and 4 more weekly Herceptin before having to stop treatment due to cardiac toxicity.

It's been almost 4 years since my recurrence and 8 years after my initial diagnosis. I also have a life-long brain tumor situation which is not related to BC. Look up 'HNPCC' on the Internet and see if you have any other risk factors.

Grade 1 is not as fast growing as Grade III and you've caught it quite early... All of these are factors in your favor.
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http://www.kevinmd.com/blog/2011/06/doctors-letter-patient-newly-diagnosed-cancer.html
http://www.asco.org/ASCOv2/MultiMedi...=114&trackID=2

NICU 4.4 LB
Erythema Nodosum 85
Life-long Central Neurocytoma 4x5x6.5 cm 23 hrs 62090 semi-coma 10 d PT OT ST 30 d
3 Infertility tmts 99 > 3 u. fibroids > Pills
CN 3 GKRS 52301
IDC 1.2 cm Her2 +++ ER 5% R. Lmptmy SLNB+1 71703 6 FEC 33 R Tamoxifen
Recc IIB 2.5 cm Bi-L Mast 61407 2/9 nds PET
6 TCH Cellulitis - Lymphedema - compression sleeve & glove
H w x 4 MUGA 51 D, J 49 M
Diastasis recti
Tamoxifen B. scan
Irrtbl bowel 1'09
Colonoscopy 313
BRCA1 V1247I
hptc hemangioma
Vertigo
GI - > yogurt
hysterectomy/oophorectomy 011410
Exemestane 25 mg tab 102912 ~ 101016 stopped due to r. hip/l.thigh pain after long walk
DEXA 1/13
1-2016 lesions in liver largest 9mm & 1.3 cm onco. says not cancer.
3-11 Appendectomy - visually O.K., a lot of puss. Final path result - not cancer.
Start Vitamin D3 and Calcium supplement (600mg x2)
10-10 Stopped Exemestane due to r. hip/l.thigh pain OKed by Onco 11-08-2016
7-23-2018 9 mm groundglass nodule within the right lower lobe with indolent behavior. Due to possible adenocarcinoma, Recommend annual surveilence.
7-10-2019 CT to check lung nodule.
1-10-2020 8mm stable nodule on R Lung, two 6mm new ones on L Lung, a possible lymph node involvement in inter fissule.
"I WANT TO BE AN OUTRAGEOUS OLD WOMAN WHO NEVER GETS CALLED AN OLD LADY. I WANT TO GET SHARP EDGED & EARTH COLORED, TILL I FADE AWAY FROM PURE JOY." Irene from Tampa

Advocacy is a passion .. not a pastime - Joe

Last edited by Jackie07; 04-13-2011 at 10:36 AM..
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Old 04-12-2011, 05:25 PM   #7
SoCalGal
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Re: Herceptin stopped-now what?

There is a new form of co q 10 called Ubiquinol. It is better absorbed with or without food. Here is the link to the one I use:
https://www.douglaslabs.com/ex_ppe/p...itm=200239-30X
I also walk a minimum of 20 minutes each day and follow a dairy and gluten free diet. And take plenty of Omega and other supplements. Basically my omegas have been balanced for several years. My last LVEF was 70%. I don't drink alcohol but I do DRINK COFFEE every morning and it doesn't seem to bother me.
Hope this helps. Flori
__________________
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, brain MRI shows improvement, resolved areas & nothing new. switch to plain ENHERTU. after 4th cycle, PETscan shows mostly resolved or improved results. Markers near normal. I'm stunned but grateful.
10/26/20 - June 2021 Tucatinib/xeloda/herceptin - stable ish.
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Old 04-13-2011, 09:46 AM   #8
emmastarr
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Re: Herceptin stopped-now what?

Hi again girls! I saw the Onc this morning and I am on an herceptin break at the moment. He will do another Echo in 4 weeks to see if my score improves and I have to see him again in 5 weeks, he did say that he would not give me any more herceptin unless my score is over 60%. I thought they could treat you with scores in the 50's but he kept banging on about the risk of heart failure being greater than that of recurrence, not sure if I completely go with that. I'm not sure if my score can go up 12% points in 4 weeks, what do you gals think?
__________________
Diagnosed Feb 2010, age 32
IDC 0.5cm & 0.1mm and DCIS
Had mastectomy
Lymph nodes clear, no vascular invasion
Stage 1, grade 1, ER+, PR-, HER2+
Had 5x FEC, on tamoxifen and herceptin
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Old 04-13-2011, 10:19 AM   #9
Jackie07
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Re: Herceptin stopped-now what?

You've got nothing to lose to get on a 'walking' plan and 'eating' plan to improve your heart function.

If you reach 60%, you get to continue your treatment. If not, your heart will still be in better shape.
__________________
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http://www.kevinmd.com/blog/2011/06/doctors-letter-patient-newly-diagnosed-cancer.html
http://www.asco.org/ASCOv2/MultiMedi...=114&trackID=2

NICU 4.4 LB
Erythema Nodosum 85
Life-long Central Neurocytoma 4x5x6.5 cm 23 hrs 62090 semi-coma 10 d PT OT ST 30 d
3 Infertility tmts 99 > 3 u. fibroids > Pills
CN 3 GKRS 52301
IDC 1.2 cm Her2 +++ ER 5% R. Lmptmy SLNB+1 71703 6 FEC 33 R Tamoxifen
Recc IIB 2.5 cm Bi-L Mast 61407 2/9 nds PET
6 TCH Cellulitis - Lymphedema - compression sleeve & glove
H w x 4 MUGA 51 D, J 49 M
Diastasis recti
Tamoxifen B. scan
Irrtbl bowel 1'09
Colonoscopy 313
BRCA1 V1247I
hptc hemangioma
Vertigo
GI - > yogurt
hysterectomy/oophorectomy 011410
Exemestane 25 mg tab 102912 ~ 101016 stopped due to r. hip/l.thigh pain after long walk
DEXA 1/13
1-2016 lesions in liver largest 9mm & 1.3 cm onco. says not cancer.
3-11 Appendectomy - visually O.K., a lot of puss. Final path result - not cancer.
Start Vitamin D3 and Calcium supplement (600mg x2)
10-10 Stopped Exemestane due to r. hip/l.thigh pain OKed by Onco 11-08-2016
7-23-2018 9 mm groundglass nodule within the right lower lobe with indolent behavior. Due to possible adenocarcinoma, Recommend annual surveilence.
7-10-2019 CT to check lung nodule.
1-10-2020 8mm stable nodule on R Lung, two 6mm new ones on L Lung, a possible lymph node involvement in inter fissule.
"I WANT TO BE AN OUTRAGEOUS OLD WOMAN WHO NEVER GETS CALLED AN OLD LADY. I WANT TO GET SHARP EDGED & EARTH COLORED, TILL I FADE AWAY FROM PURE JOY." Irene from Tampa

Advocacy is a passion .. not a pastime - Joe

Last edited by Jackie07; 04-13-2011 at 10:45 AM..
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Old 04-13-2011, 10:44 PM   #10
DBingaman
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Re: Herceptin stopped-now what?

Hi, Emma, I had to take a break from Herceptin because my EF dropped to 43%. I was off it for one cycle and re-tested by MUGA after two weeks from (no) treatment and EF raised to 51% (minimum for treatment was 50%, 60% is really high, my baseline before any treatment was 64% I think). My onc says that she has seen this drop happen in other patients and after a short break the EF comes up and they have no Ef problems again.

Also about a month after this I started experiencing high blood pressure and started taking a BETA blocker. Now EF is consistently 60% and only have to have a MUGA every 18 weeks instead of every 9. A little less radiation is a good thing.

Good luck to you. I started riding an exercise bike on low resistance every few days. Could have helped.

Denise
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Old 04-14-2011, 07:55 AM   #11
Jaimieh
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Posts: 126
Re: Herceptin stopped-now what?

WOW, your oncologist wants your EF rate to be 60. I would have never had herceptin than because I started with an EF of 54 but that was according to a sonogram.

I would just do my best start some supplements and a good exercise plan. You were aggressive with your treatment but it doesn't do a lot of good if you hurt your heart in the process of prevention. ((hugs))
__________________
Diag. 12/24/08-
IDC 1.3 er-/pr- HER2+
Grade 3 0/2 lymph nodes
no angiolympathic invasion

Bi-Lat. Mast. 1/8/09
Exchange scheduled for 6/17/09
Lost implants due to unknown reason :(

Hip Flap 1/26/2010 in NOLA :) LOVE EM'

TCH x6 (6 done and I am hoping to never do it again )

Well so much for never...
Local recurrence May 25,2014 is left over breast tissue.
April 2 , 2014 lumpectomy
April 28, 2014- June 9, 2014 start AC x 4
Taxol x12
Perjeta x 6
Herceptin x 18
And 33 rads just for fun. NOT!!!
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Old 04-14-2011, 08:10 AM   #12
emmastarr
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Join Date: Dec 2010
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Posts: 38
Re: Herceptin stopped-now what?

I've taken your advice and been to the pharmacy this afternoon- got Ubiquinol, Omega 3 and Vitamin D, so will give these a shot. I'm jetting off to Malta in the morning so will try to get some exercise in whilst there and continue with my gym plan, albeit in a more rigorous manner, when I get back in a week. Thanks you for all your good advice and support xx
__________________
Diagnosed Feb 2010, age 32
IDC 0.5cm & 0.1mm and DCIS
Had mastectomy
Lymph nodes clear, no vascular invasion
Stage 1, grade 1, ER+, PR-, HER2+
Had 5x FEC, on tamoxifen and herceptin
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