Paul
04-08-2004, 06:55 AM
Chandi,
Great job in handling the IHC testing on your nine year old biopsy. Your doctor is correct in stating that a +2 or +3 measurement of HER-2 status by IHC testing makes you eligible for herceptin. It is generally known that FISH is the most reliable commercially available test for HER-2 status. I believe that a FISH test is important because the highest patient response rate for Herceptin occurs in patients with a true +3 IHC measurement or a "positive" FISH measurement. As you move forward, I would nevertheless demand that a FISH test be performed on the sample, especially given the age of the sample.
I'm still not clear on your exact Stage IV diagnosis. I know you have two tiny lesions on the liver, but it seems that there is still confusion with respect to your lungs? Did any of your current scans clear this matter up with respect to the lungs?
As you have seen posted many times, please make sure that you know your exact diagnosis as measured by diagnostic testing. Again, the ideal testing is a FDG-PET scan from the base of the skull to the mid-calf region of the lower leg. Any uncertainty with respect to the PET scan can be cleared up with a subsequent CT scan or MRI scan. An MRI of the brain should also be performed as a precaution and to create a base-line test for comparison to future tests.
I am happy to hear that you switched to Femara in March 2004. I am assuming that you are on Femara because your HER-2 breast cancer is estrogen positive. It should be indicated on your original or current pathology report. In a very small study conducted by Dr. Matthew Ellis (University of Washington, St. Louis), Femara was shown to specifically slow HER-2 breast cancer cell proliferation. Femara is know as an "aromatase inhibitor" (AIs). The AIs have, in large part, outperformed tamoxifen in three recent major studies (click on cross-link below and read about Arimidex, Femara, and Aromasin). Arimidex and Aromasin (exemestane) are also AI drugs. Tamoxifen blocks the estrogen receptor on Estrogen positive breast cancer cells, thereby depriving the cell of estrogen needed for growth. In contrast, the AIs reduce the amount of estrogen actually produced by the body and made availabe to the cells. Keep in mind that many doctors believe that over time, HER-2 positive, ER+ breast cancer may become resistant to anti-estrogen treatment (i.e., the once ER+ cancer mutates and slowly becomes less dependent on estrogen). Faslodex, an "estrogen receptor down-regulator" (ERD), can also be used for ER+ breast cancer in the event that Femara fails to be effective.
It seems that you are stable on Xeloda, and the addition of Herceptin should help. Other tried and true combinations for advanced breast cancer include:
Herceptin and Navelbine
Herceptin and Taxotere (with or without carboplatin or cisplatin)
Herceptin and Taxol (with or without carboplatin or cisplatin.
Herceptin is also being tested in U.S. clinical trials with other drugs including:
EGFR/HER-1 inhibitors such as Tarceva and Iressa
Angiogenesis inhibitors (which cut-off blood flow to the tumor) such as Avastin
Novel cell cycle inhibitors such as Flavopiridol and Ixabepilone.
When Herceptin fails, drugs like GW572016 (a HER-1 and HER-2 dual kinase inhibitor) and vaccines such as APC8024 are potentially available.
There is much hope Chandi, so keep up the good fight. Let us know as how things go after your next doctor visit.
Great job in handling the IHC testing on your nine year old biopsy. Your doctor is correct in stating that a +2 or +3 measurement of HER-2 status by IHC testing makes you eligible for herceptin. It is generally known that FISH is the most reliable commercially available test for HER-2 status. I believe that a FISH test is important because the highest patient response rate for Herceptin occurs in patients with a true +3 IHC measurement or a "positive" FISH measurement. As you move forward, I would nevertheless demand that a FISH test be performed on the sample, especially given the age of the sample.
I'm still not clear on your exact Stage IV diagnosis. I know you have two tiny lesions on the liver, but it seems that there is still confusion with respect to your lungs? Did any of your current scans clear this matter up with respect to the lungs?
As you have seen posted many times, please make sure that you know your exact diagnosis as measured by diagnostic testing. Again, the ideal testing is a FDG-PET scan from the base of the skull to the mid-calf region of the lower leg. Any uncertainty with respect to the PET scan can be cleared up with a subsequent CT scan or MRI scan. An MRI of the brain should also be performed as a precaution and to create a base-line test for comparison to future tests.
I am happy to hear that you switched to Femara in March 2004. I am assuming that you are on Femara because your HER-2 breast cancer is estrogen positive. It should be indicated on your original or current pathology report. In a very small study conducted by Dr. Matthew Ellis (University of Washington, St. Louis), Femara was shown to specifically slow HER-2 breast cancer cell proliferation. Femara is know as an "aromatase inhibitor" (AIs). The AIs have, in large part, outperformed tamoxifen in three recent major studies (click on cross-link below and read about Arimidex, Femara, and Aromasin). Arimidex and Aromasin (exemestane) are also AI drugs. Tamoxifen blocks the estrogen receptor on Estrogen positive breast cancer cells, thereby depriving the cell of estrogen needed for growth. In contrast, the AIs reduce the amount of estrogen actually produced by the body and made availabe to the cells. Keep in mind that many doctors believe that over time, HER-2 positive, ER+ breast cancer may become resistant to anti-estrogen treatment (i.e., the once ER+ cancer mutates and slowly becomes less dependent on estrogen). Faslodex, an "estrogen receptor down-regulator" (ERD), can also be used for ER+ breast cancer in the event that Femara fails to be effective.
It seems that you are stable on Xeloda, and the addition of Herceptin should help. Other tried and true combinations for advanced breast cancer include:
Herceptin and Navelbine
Herceptin and Taxotere (with or without carboplatin or cisplatin)
Herceptin and Taxol (with or without carboplatin or cisplatin.
Herceptin is also being tested in U.S. clinical trials with other drugs including:
EGFR/HER-1 inhibitors such as Tarceva and Iressa
Angiogenesis inhibitors (which cut-off blood flow to the tumor) such as Avastin
Novel cell cycle inhibitors such as Flavopiridol and Ixabepilone.
When Herceptin fails, drugs like GW572016 (a HER-1 and HER-2 dual kinase inhibitor) and vaccines such as APC8024 are potentially available.
There is much hope Chandi, so keep up the good fight. Let us know as how things go after your next doctor visit.