Combination with Herceptin

[Helle Denmark]

Dear everyone.

I was wondering if any of you have information for me. Years ago I received Herceptin alone for two years. Stopped when I progressed. After six months I started Herceptin again in combination with Navelbine with success for nine months. Progressed again and have tried chemotherapy alone with no success.

Last Monday my onc. and I decided to try Herceptin again because right now I need a brake from chemotherapy. I got first dose of Herceptin alone and we have planned three rounds., and then a combination with chemotherapy when I am fit for it. The chemotherapy possible for me (because I have tried all standard chemotherapy for breastcancer) is Carboplatin and Gemsitabin. I was told that there was no experience in Denmark to combinate Herceptine with one of the two drugs. Therefore, can anybody tell me if it is possible to make that combination ?
Perhaps you have a better idea for me.
I will be grateful for any response.

Helle

[Lolly]

Hello Helle,
I found this article which discusses results from some studies done here in the States, comparing the various chemo combos, and there is a section further down the page which addresses breast cancer and the chemos you are asking about, in combination with Herceptin. Hoping someone will share their personal experience as well. Anyway, hope this is helpful. It was so nice to see a post from you again, and hear you've been continuing to fight the good fight!
hugs, Lolly

[Anonymous]

Helle,
So wonderful to hear from you !! We went to the San Antonio Breast Cancer Symposium last December and met a friend of yours: Dr. Nils Eckardt from Roche and also a Roche representative from Denmark.

Anyway, here is some infromation for you.

Hugs
Christine

ASCO: Addition Of Chemotherapy To Herceptin (Trastuzamab) Improves Response Rate In Patients With Advanced Breast Cancer
Taxol Plus Paraplatin Added to Herceptin Also Helps Improve Disease Control

ORLANDO, FL -- May 21, 2002 -- The addition of weekly Taxol (paclitaxel) plus Paraplatin (carboplatin) to Herceptin (trastuzamab) improves patient response and disease control in metastatic, or advanced, breast cancer that overexpresses the HER2 neu oncogene, according to a study released today at the 38th Annual American Society of Clinical Oncology (ASCO) Meeting.

In this trial, among 58 patients who were evaluable for response, 66 percent demonstrated stable disease or better after first-line Herceptin. Patients who responded continued to receive the HER-2 neu antibody alone, prior to receiving weekly Taxol plus Paraplatin administered concurrently with Herceptin. A 71 percent overall response rate was seen for patients who responded to Herceptin and continued to receive weekly Herceptin concurrently with Taxol and Paraplatin. Patients in the study who had discontinued Herceptin after failing to respond (20 patients) experienced a 63 percent response rate to weekly Taxol and Paraplatin. The median time to progression for those patients with 3+ HER2 overexpression was 17 months; the median time to progression was 12 months for the entire group. Overall survival for the entire group was 29.3 months.

"Results of this study show that in patients with advanced breast cancer, the addition of weekly Taxol plus Paraplatin to Herceptin produces improved responses as compared to Herceptin alone," said Denise Yardley, MD, Director of Breast Cancer Research, Sarah Cannon Cancer Center; Associate, Tennessee Oncology, PLLC; and presenter of this trial. "In addition, the combination of Taxol plus Paraplatin is effective in patients who do not respond to first- line Herceptin."

FISH data has been obtained on 49 patients (28 FISH+ and 21 FISH-) to date. FISH is the evaluation of HER2 genes as amplified by fluorescent in situ hybridization. Three FISH- patients demonstrated a 15 percent response rate to induction Herceptin, while six FISH+ patients demonstrated a 23 percent response rate to single-agent Herceptin.

"Patients with metastatic breast cancer with FISH+ HER2 overexpression, a previously poor prognostic factor, may now actually have better treatment outcomes and survival as compared to those patients who demonstrate normal HER2 expression, following the addition of targeted therapy such as Herceptin," according to Dr. Yardley.

This phase II trial evaluated the activity of Herceptin as a single agent and the benefits of adding weekly Taxol plus Paraplatin to Herceptin. All patients received eight weeks of induction Herceptin. Patients with a minor or better response after induction treatment received another eight weeks of Herceptin alone. Patients with stable disease on Herceptin began weekly Taxol (70 mg/m2/week) and Paraplatin (AUC 2.0/week) in combination with Herceptin (2 mg/kg) for six weeks, with cycles repeated every eight weeks. Patients who failed to respond to Herceptin discontinued this therapy and then began weekly Taxol and Paraplatin according to the above dosing schedule.

The use of weekly Herceptin, Taxol and Paraplatin was well tolerated by patients. Patients experienced neither febrile neutropenia (fever induced by a reduction in white blood cells) nor symptomatic cardiac toxicity. In addition, there were no treatment-related deaths. The trial was conducted by the Minnie Pearl Cancer Research Network in Nashville, TN.

According to the American Cancer Society, more than 203,500 new cases of invasive breast cancer and more than 54,300 new cases of in situ breast cancer will be diagnosed in 2002. An estimated 40,000 women will die of breast cancer. Breast cancer is the second leading cause of cancer-related death in women. Advanced or metastatic disease is cancer that has spread beyond the original tumor site. Treatment for metastatic disease remains a challenge for the oncology community with an average survival rate of two years. Therefore, the goal of treatment for advanced breast cancer is usually to palliate (reduce symptoms of the disease) and to prolong survival.

The Sarah Cannon Cancer Center at Centennial Medical Center is part of TriStar Health System based in Nashville, Tenn. Through its outreach efforts, The Sarah Cannon Cancer Center includes nearly 400 community-based oncologists in 22 states. To date, more than 60 cancer research studies have been conducted in the areas of lung cancer, breast cancer, ovarian cancer, lymphoma, bladder cancer, cancers of the head and neck, prostate cancer and carcinoma of unknown primary. The Sarah Cannon Cancer Center is named for the creator of the beloved character Minnie Pearl. For more information about The Sarah Cannon Cancer Center please call 615-342-1919 or 800-242-5662.

SOURCE: The Sarah Cannon Cancer Center



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[Elisabeth from Ontario]

Helle, I just did a quick search and discovered that the National Cancer Institute in the US has a study using the herceptin and gemcitabine and I know it is also combined with carboplatin. I am currently on taxtotere and herceptin with a good response for lung and liver mets.
Good luck and blessings
Elisabeth (Cananda)

[Jackie]

Hello Helle,
I am er+, her2+++ with mets to the bones and skin. I was on herceptin + navelbine from July 03 to Jan 04, when progression occurred. I continued with herceptin but switched to gemzar (gemcitabine)alone (+zomeda monthly to strengthen the bones). My onc prefers to combine the carboplatin with either taxol or taxotere (I forgot which one), both of which we are saving for later. I am experiencing a positive response for skin mets with the gemzar and will have scans rerun to see what's happened with the bones in May. Hope this helps. Wishing you the best of luck with your treatment!

[Kitty]

Helle,

I have been on the weekly taxol/carboplatin/herceptin regimen since the beginning of November 2003 and have not missed a single week due to low counts or sickness. My hair just finally started to fall out a few weeks ago so that has been the only side affect. I had liver mets which responded within 11 weeks of this treatment. Very good combination I highly recommend. Good luck to you.
Kitty

[Sandy]

Hi Kitty: I have been on this combo since end of Dec. Will have had 12 treatments end of this week. I am very tired and hoping to be able to stop them for a while. The first 4 are fine but then the 5th and 6 really do me in. I am just now having chemo brain really bad getting every thing mixed up with blurry vision on top of it doesn't help. The doctor said he can see a film on my eyes with the light. Hugs, Sandy

[Kitty]

Sandy,

They can wear on you for sure. Will you have a scan after this one? I hope you can take a break if things are going well for you. If you need to hang in there for a few more remember it will all get better for you - take one treatment at a time.
Good luck.
Kitty

[colleen]

My Mom will be starting that combination in 2 weeks for a clinical study. She has had no experience with any chemo at all. She has mets to the liver and bones. I have heard that Gemzar alone has good results and together they are having even better. I will post how she is doing,during the course of the treatment.