Need input--roll call time!

[Lisa]

Friends,

I really need input re: how many of you are on Herceptin weekly v. every 3 weeks and whether this has changed since you started treatment. I need to know if there's any evidence of one course working better than another.

My Herceptin doesn't seem to prevent recurrences without chemo added. But would it do better if I was on weekly vs. 3 weeks?

So let me know, friends...

Love and healing light,

Lisa

[Kathy in NY]

Hi Lisa,
My Herceptin doesn't work without chemo either.. I've considered doing the Herceptin every 3 weeks but the oncologist wants me to have the Navelbine at the same time as the Herceptin and since I get the Navelbine 2 weeks in a row, he has left me on the weekly herceptiin. It is a pain going every week, but hey ya never know, so you do what everyone thinks is best.
Best Wishes
Kathy

[Sheila]

Lisa
First of all it is great to see you posting again...we have missed you. I have been on Herceptin every 3 weeks since I started it over a year ago. I still seem to be having problems with the lymph nodes now there is talk ablout adding Xeloda, but I haven't gotten it yet. Hoping the New Year brings you healing and good news in your battle...and much love and healing light!
Hugs
Sheila

[Sandy H.]

I have Herceptin weekly. I asked my oncologist about 3 weeks because, of the pain of going every week and he said he preferred weekly. He says unless there is data that shows its of more benefit doing 3 weeks he will stay with the weekly. He will do 3 weeks for traveling long distances. He doesn't feel it is working for me either but I am not stage 4 so the chances of it working is slim if at all. Hugs, Sandy

[JKrak1975]

I'm on herceptin weekly..off label for a year. My Oncol. considered putting me on 3 weeks at 6 mo. but he really thinks the evidence shows better result from weekly. I haven't seen any of the data...taking his word for it! Judy

[al from canada]

Hi Lisa,
I read conflicting reports of 1 week vs 3 weeks however I think most oncs still fell that weekly is your best bang for the buck. What makes sense to me is to administer herceptin at the same time as your chemo. I recall that you are on weekly Taxol, so why not have both at the same time? The only down-side I can see is the extra infusion time. Linda is on weekly herceptin + navelbine for 3 weeks, a double dose of herceptine on week 3 and then one week off. If I had a choice of a herceptin dosing schedule, intuitively I would opt for weekly.
I hope this helps and stay strong,
Al

[imported_Joe]

Lisa,

The following was presented in San Antonio.

Regards
Joe



[3042] Updated efficacy and safety analyses of 3-weekly Herceptin® monotherapy in women with HER2-positive metastatic breast cancer: results from twelve months of follow-up to a phase II study.

Baselga J, Carbonell X, Castaneda-Soto N-J, Clemens M, Green M, Harvey V, Morales S, Barton C.. Hospital Val D'Hebron, Barcelona, Spain; Instituto Nacional de CancerologÃ*a, Tlalpan, Mexico; Mutterhaus der Borromaeerinnen, Trier, Germany; Royal Melbourne Hospital, Melbourne, Australia; Auckland Hospital, Auckland, New Zealand; Hospital Arnau de Vilanova, Lleida, Spain; Roche Products Ltd, Welwyn Garden City, United Kingdom

Background: Standard weekly dosing of trastuzumab (H; Herceptin®) is well tolerated and efficacious, but less frequent dosing would be more convenient for patients. A 3-weekly (q3w) schedule was shown to have similar exposure, efficacy and safety as the standard weekly regimen in the main analysis of study WO16229, a phase II study of pharmacokinetics, efficacy, and safety of a q3w regimen of H monotherapy in patients (pts) with HER2-positive metastatic breast cancer (MBC). Results of an updated analysis of efficacy and safety performed after 12-months of additional follow-up (30 months after the last pt entered) are reported.
Methods: 105 pts with previously untreated HER2-positive (IHC 3+ and/or FISH positive) MBC were enrolled. Treatment: H 8mg/kg i.v. loading dose, followed by 6mg/kg q3w until progression.
Results: At the main analysis (18 months after the last pt entered) 11 pts (10%) continued to receive H. 1 pt was lost to follow-up; 10 pts continued H therapy in the follow-up period. Duration of treatment: 8 pts received H for more than 30 cycles (23 months); 5 of these pts received more than 40 cycles (30 months) and, of these, 1 received more than 50 cycles (>37 months) of treatment. 5 pts discontinued treatment in follow-up; 4 withdrew due to progressive disease and 1 pt withdrew to start chemotherapy (paclitaxel); 5 pts continue to receive H. Updated efficacy analysis (30 months after the last pt entered): overall response rate (ORR) in the intent-to-treat population was 20% (3 CR, 18 PR) and the overall clinical benefit rate (CBR) was 33%. In pts with measurable disease and HER2 positivity confirmed by central testing ORR was 24% and CBR was 36%. Median time to response in all evaluable pts was 1.4 (1–20) months and the duration of response was 10.1 (2.8–35.6) months. Extended exposure to H was well tolerated with no serious adverse events (AEs) or AEs leading to death or discontinuation of treatment reported in the follow-up period. 6 patients reported a total of 19 adverse events in the follow-up period; all were mild (14 events) to moderate (5 events) in severity. In the 5 pts who continued to receive H, only 1 pt had a temporary drop in LVEF >15% from baseline (by 16% points; day 286). No other pt had any major LVEF changes during at least 22 months of treatment or developed symptomatic cardiac failure.
Conclusion: Long-term administration of H (>30 months) q3w is a well-tolerated alternative dosing regimen. These data demonstrate the effectiveness and overall feasibility of the q3w schedule.

Date: Thursday, December 09, 2004 04:30 PM
Session Info: Poster Session: Treatment: Antibody-based Regimens (4:30 PM-6:30 PM)
Presentation Time: 04:30 PM

[Lolly]

Lisa, hi! Great to see you. I'm back on weekly now, since recurrence in spring after being on 3 weekly for 2 years. Was able to stop Navelbine in October but remain on weekly as onc does not want to "rock the boat" and neither do I. I personally feel more assured getting it weekly, but that may be a psych issue. I do know that when I was on 3 weekly I had more side effects; fever, achy joints etc lasting for a several days...but also I was stable for a long time on 3 weekly so I think it was as effective or I would have recurred sooner.

Love, Lolly

[JoJo]

Weekly Herceptin, 3-weeks for vacations. Don't know of any evidence, neither...

[Patty H]

lisa, I am on weekly herceptin as long as I am on a weekly chemo. When I am on break from chemo, my Dr. changes me to the three week herceptin, so I don't have to come in for treatment every week and I have more time to enjoy my break. I have not been ned yet and so far we just knock the cancer down, take a break and then back to treatment when it starts growing again. So I can't really say what part my herceptin plays in it. But I am still here after 4 1/2 years and going strong. Patty H

[Celina]

Lisa, my sister's treatment is similar to Linda's (Al's wife), except that she doesn't do the double dosage on the third week.

[Mickey]

I started Herceptin at late stage 2. Did it weekly as that was the protecal at the time. On it for 1 year. Off everything for 11 months until my recent recurrence to lungs. Now on it with regular chemo weekly.
Mickey

[Lisa]

Joe,
If I'm reading the presentation paper correctly, three week HER2 is as effective as weekly. Is that your take?

Love and light,

Lisa

[imported_Joe]

Lisa,
Yes that is correct..

A few years back I read a wonderful explaination on why. I'll try my best to explain it from memory:

In order to be effective, Herceptin has to maintain a minimum concentration in the blood stream. Also, Herceptin has been found to remain in the blood for approx. 28 days.

As it is also non-toxic, Herceptin can be given in a much higher concentration without adverse side effects. The theory is then to administer it in 3X the normal dosage and although it is depleted, it never goes below the minimum concentration.

Warmest Regards,
Happy New Year,
and VERY HAPPY TO SEE YOU BACK

Joe

[Jennifer A]

Hi Lisa,
My sister switched to every three weeks about 2 years ago and has done very well with this regime. I was wondering if you are ER/PR+ or neg? It's nice to see you on the board! Take care.
Jennifer in Colorado

[Lisa]

Jennifer,

When first diagnosed with BC in 1999, I was ER/PR pos. and took Tamoxifen and Arimdex for a time after chemo/surgery. However, my liver mets (my first recurrence) were ER/PR negative. So I didn't have to feel guilty about not doing the 5 year Tamoxifen thing.

Love and light,

Lisa

[Steph N]

Hey Lisa -
Glad to see you up and around. Know the last go round was a tough one.
I have been on Herceptin for just 3 years now. Started at weekly with the chemo at discovery of my liver mets. Once reaching NED (confirmed by PET), I went on every 3 weeks. This has been the routine now for nearly 30 months.
My doctor gave me a similar explanation to what Joe posted about the minimum concentrations, drug half-life, and the overlap time. He feels that I will not have any higher possibility of the cancer again becoming active on this routine. If I miss a treatment by a couple of days, I do not have to do anything different because of the overlap. For quite a while now I do not even usually have any of that slight feverish thing that I would get the evening of my treatment.
Actually, psychologically this timing helps me feel less like a patient as I don't spend as much time at the clinic. I even sometimes almost forget when I have to go now, my life is so normal!
I know this may be a fleeting time, so I make the most of it!

[*_Annemarie_*]

I am on Herceptin once every three weeks. I was diagnosed with bc in May 2000 and have had reoccurance only in the brain which I am told is unusual. I am on Lupron and Femara. I am NED. Does anyone take Zometa w/o bone mets? I had to fight for Herceptin being NED and it was a real hassle!

[Lisa]

Unfortunately, I was on 3 weeks when the cancer recurred to both brain (not that Herceptin matters there) and stomach lymph nodes. So I had to wonder if I'd been on weekly, would it have mattered. Sounds like not.
I'm noticing that many of us are recurring while on Herceptin. Maybe we got a bad batch! Hah!

Love and light,

Lisa

[Cyndy]

I am on weekly Herceptin have been since March 2004. Finished Carbo/Taxol in early Oct. My onc says I'll stay on weekly Herceptin for at least a year and then we will discuss going on Every 3 weeks. My thoughts now are if it's working going weekly then why change. but I may feel differently after a year of weekly trips (1 hour each way) to get my herceptin.

Best of luck to you.

[CathyB]

Lisa - Glad you posted about this - was just wondering myself about one week vs. three weeks. For a little over a year, I was on once a week Herceptin along with other drugs. However, My onc has me on Herceptin/Avastin every two weeks - I notice I am the only one to get it every two weeks. While I don't miss going to chemo every week, I felt I was more proactive in my treatment going every week (purely psychological, I know). However, have been having some cardiac problems this week so am wondering if the double load of herceptin is the culprit or whether the Avastin is playing a part, as well. At anyrate, will be seeing the cardiologist and my onc within the week and will let you know what they have to say. It is truly always something!!!! I wish you well and thank you for raising this subject. CathyB