Frequency of Herceptin dose vs. cardiac risk

[vpfeiffer]

I read Bubblesmom's question and have read that several participants receive Herceptin every three weeks after their other treatments are finished. My doctor will be giving me Herceptin every week after my radiation for 6 to 12 months. He said the only time he has given Herceptin every three weeks under these conditions is for women who had a long distance to travel to the clinic. He said that when he had given it every three weeks it was at an increased dosage and that the cardiac toxicity risks were becoming unacceptable. He highly recommends Herceptin weekly, even post-treatment, to lessen the cardiac risks (I received Herceptin weekly with Taxol and Carboplatin 3 mos prior to surgery and 3 mos post-surgery also).

For those of you who have either discussed Herceptin every three weeks or have received it every three weeks, what has been the rationale given for this frequency? I almost replied to Bubblesmom with a suggestion for her to ask for Herceptin every week to lessen the cardiac toxicity risks, but I am unsure why others have gotten this dose frequency.

[BubblesMom]

Hi vpfeiffer,

Just read your post. I will ask my dr about the reasoning behind the various timeframes for herceptin treatment. Thanks for the additional info.

Denise

[*_Linda in Calif._*]

The first time I took Herceptin I experienced problems with my heart. Once I discontinued the Herceptin my heart was able to repair itself in about 2 months but it took me another 2 years to convince my Onc. to let me try the Herceptin again. He felt, because of my previous problems, that a weekly dose was definitely more prudent than every three weeks. If I do well for 3 or 4 months getting weekly infusions he will then consider going to the 3 week interval. So I guess you could start out "easy" at every week and then if everything goes OK try it every 3 weeks. Best of Luck, Linda in Calif.

[Sandy H.]

My oncologist say he will only give it every three weeks if traveling is a hardship. He feels that a single dose (weekly) is easier on the body then a triple (three weeks). I got it every three weeks at first when I had a different doctor and I was very tired for the first few days. He didn't say anything about toxcity but I kind of figure that is what he was getting at. I don't think he really knows but it is his feeling that weekly is better. Sounds like common sense he is using. Only my opinion! hugs, Sandy

[imported_Joe]

I really agree with the other posts. Try it weekly, then 3 weeks if all goes well. You can always change back.

But I did find the following whixh states that as far as cardiotoxicity, there is no difference.

Regards
Joe


Metastatic Breast Cancer: An Update from SABCS 2004


Date: December 8-11, 2004
Location: San Antonio, TX
Author: Edith A. Perez, MD, Mayo Clinic Jacksonville, FL


Introduction
At the 2004 San Antonio Breast Cancer Symposium (SABCS), several presentations related to management of patients with metastatic breast cancer provided clinically relevant information and many of them built and expanded on targeted approaches to this disease. These involved phase I and phase II trials of targeted therapies, new formulations of existing agents, as well as new combination treatments of already available chemotherapeutic options.
Targeted Therapies
Baselga and colleagues reported on the efficacy and safety of every-3-week Herceptin® (trastuzumab) monotherapy in patients with HER2-positive metastatic breast cancer who had not received prior chemotherapy for MBC. [1]HER2-positivity was defined as 3+ by immunohistochemistry (IHC) or positive by fluorescence in situ hybridization (FISH). One hundred and five patients with a median number of 2 metastatic sites were enrolled (22 were not evaluable, as they did not have HER2-positive tumor or measurable disease). In patients with proven HER2-positive measurable disease (n=83 patients), the response rate to Herceptin® (8 mg/kg loading dose followed by 6mg/kg dose every 3 weeks) was 24%. If patients who achieved disease stabilization for ≥ 6 months are added, then the “clinical benefit rate” was 36%. Median duration of response was 8.3months, with a median progression-free survival of 1.4 months. Safety analysis demonstrated that 16% of assessed patients had decreases of LVEF ≥ 15% and 13% had an absolute value below 50%; only 1 patient had a symptomatic cardiac event. Conclusions from this study included that the safety and efficacy of every-3-week Herceptin® are similar to those reported with weekly Herceptin®, but this new schedule can improve patient convenience, which is especially relevant in patients receiving this treatment for prolonged periods of time.

[Bonnie T]

Hello
I am so glad you brought this up.
I drive 31/2 hours to see my oncologist in MPLS , she started me on Herceptin with an initial loading dose and then the following week I started a 3 week session. I am 42 , my MUGA was 51% when I started herceptin and after just 3 treatments my MUGA went to 36%. So now I see a cardiologist, had an Echo and it is up to 45% , no heart damage. I am on heart meds. I will be off herecpetin for 2 months with a recheck on the echo in October.
I think she started me on 3 weeks because of travel, but I take 2 treatments here and then the 3rd one there. So basically I see her every 9 weeks.
I am going to ask her about the weekly and if a smaller dose might be better.
THANKS !! the people on this site are wonderful and very knowledgeable, I have learned alot.
Bonnie T

[Rhonda4]

I start on the 3 week regimen on 8/18 and my oncologist gave me no specific reason why. I don't believe it's a preference as there is another lady there (she and I have the same oncologist) that receives it weekly (but w/ additional chemo) , but maybe she originally started on the 3 week regimen but, due to problems went to weekly...I'll ask her when I see her.

[triciak]

I have been on herceptin every two weeks for a year now. I wonder if it is because I have had some heart problems. Three weeks was never considered, as far as I know. I will ask my oncologist. I do learn a lot from this website! Hugs, Tricia

[Becky]

I started the weekly regimen on 6/17 and will continue that way until my Sept 16 dose of which I will switch to the 3 week. I am doing it because my job entails intense business travel and with winter coming (and the chance of getting iced out of the NYC airports to come home on Friday afternoons for Herceptin... the stress may take me out before the cancer does). Therefore, the week of Herceptin I just won't go anywhere. My onco is waiting because I have my oophorectomy on 8/29 and I am doing so well on the weekly so he doesn't want to change anything until the surgery is over and I am healed so the weeklies will continue.

I asked the question on cardiac problems with the three week vs the one week and my onco said no difference. He did say that if you get a headache from the one week (or any other side effect like tiredness or nausea - which some women get), it may be more intense or last a bit longer since there is more drug in your system.

Best wishes

Becky

[*_Linda in Calif._*]

I'm glad you mentioned the headache...I have had a "nasty" headache ever since I started my Herceptin 2 weeks ago. It never quite seems to go away and sometimes it feels like an intense pain/ burning sensation all across my forehead and top of head. Usually, if I have a headache 2 Ibuprofin will take care of it but I have to take 4 to manage the kind of pain I have been experiencing lately. Has anyone else had this kind of headache with Herceptin? Did your body ever get used to the Herceptin and the headache go away? Any info would be great. Linda in Calif

[vpfeiffer]

I will be on Herceptin alone for the next 6 to 12 months as a preventative measure. I was on it for a total of six months previously with other chemo meds and never had a headache. Linda, could you have some sort of allergic reaction to Herceptin? You had the heart problems earlier, but with such severe headaches, I wonder. Has your onc ruled out other environmental or diet factors to your headache problem?

[Becky]

Linda

I had a nasty headache with my first Herceptin (which for the weekly is a double dose). I do get a slight headache now. I am expecting that when I switch to the every three week course, I will get a worse headache. I will let you know in a month when I switch over.

Becky

[Fontaine]

I get Herceptin weekly and they always include it with Benadryl and give me two Tylenol. I ususally don't take the Tylenol and substitute my Fioricette since just going in for treatment usually starts up a headache.

Apparently, many people have an allergic reaction to Herceptin which is why my oncologist includes Benedryl and wants me to take Tylenol (or Fioricette which is Tylenol-based).

I haven't had any problems with headaches any more than normal. (I have the Fioricette because I get Fibromyalgia-based migraines periodically).

I get Herceptin weekly and the doc keeps an eye on me since I had BC before (2001) and the adriamycin did do some heart weakening. In fact, I need to go in for another heart test very (MUGA scan) very soon.

Fortunately, most of the dietary recommendations for strengthening your heart are the same ones recommended for breast cancer so that's another avenue to look at.

But if you're not getting either Benedryl or Tylenol during your Herceptin infusion, I'd certainly ask about both of those.

[StephN]

Interesting notes here as so many of us have varying problems OR no problems with the Herceptin schedules.

For me, I have been maintained on Herceptin with Zometa for over 3 years. When I began Herceptin it was on a weekly basis along with Taxol and Navelbine (for raging liver mets and starting into my leg bones). I guess my body adjusted to the Herceptin and found it very synergistic with the 2 chemos as I made it to NED in about 7 months of this treatment.

After my PET confirming that my liver was clean, we started the 3-week routine. I have been fine on this. No headache, just feel a little feverish the night I get my infusion.
We have now cut the Zometa to every 12 weeks from every 6 weeks. I am sure that if I have new mets (aside from my brain) I will go back on weekly Herceptin with some sort of chemo.

I know other women who do well on the 3-week schedule. They are not on trials and are maintained after mets.
My med onc says he finds very little difference in heart functions weekly vs. 3-weekly once a patient has passed a few treatments without problems.