To chemo break or not to break? - Need second opinion!

[Jay]

After 2 yrs w/NED, my wife recently decided to drop Navelbine and continue
with Herceptin only. This was done even if her onc expressed some
reservations, but my wife felt she needed a chemo break. A brief history
below:

- first diagnosed HER2+++, w/mets to liver, in June 2000;
- Herceptin+Navelbine lead to NED by late 2000, Navelbine discontinued in
spring 2001, Herceptin discontinued in August 2001;
- NED lasts until March 2003 when diagnosed w/single brain lesion, which is
removed by craniotomy;
- successful gamma knife in June 2003 to clean new tumor growth around the
margin of the brain tumor area;
- PET scan reveals systemic disease is back in one lymph node in Oct 2003,
she is put back on Herceptin+Navelbine;
- NED again by Jan 2004;
- brain MRIs every 3 mos and PET scans every 6 mos have shown she's
remained NED for the past 2 yrs.

Her onc says that for (breast) cancer patients with past recurrences, going
"on" and "off" chemo is not necessarily advisable, as that can actually
cause resistance to the successful chemo treatment (and lower response) if
it needs to be started again. He prefers that Herceptin be accompanied by
chemotherapy in this case, presumably for an indefinite period of time, as
the results have been so good and she is having only minor side-effects.

We would welcome any reflections and/or personal experiences that anyone
might have on the kind of a bind that she finds herself in. The fact
remains that oncology is not an exact science and either option carries its
own risks, including remaining too long on chemo and building resistance.

Jay

[al from Canada]

Jay,
I would consider Xeloda. This is a pro-drug, ie it is activated to 5FU (theoretically) only by the cancer cells. Many women have taken xeloda, also know as capecitabine, for many, many years. I would think a very low dose for maintenance would do it. Navelbine will cause drug resistance fairly quickly but cells generally lose the resistance after a 6 month holiday. My way of thinking, navelbine is far too toxic to be taken in the prophylactic setting.

Good luck,
Al

[Esther]

Jay, I was diagnosed with liver and bone mets in Feb 2004. My liver was shutting down, it was completely covered in tumors. After 14 months on Herceptin, Navelbine & Xeloda, I was NED.

I've been on just Herceptin for maintenance for a year now. I don't plan to go back on chemo unless I develop new liver or bone lesions. Here in Southern CA, it's considered to be appropriate treatment protocol, to just stay on Herceptin for maintenance unless something pops up to warrant treatment.

[Lolly]

Jay, My onc is one who believes in the "on/off" theory of chemo, and has said in his experience a successful chemo regimen can be used again although he likes to see a year long break from that chemo. I'm on Navelbine/Herceptin for the third time since 2001, with Herceptin maintenance in between, to keep systemic lymph node mets in check. So far this protocol has been successful in keeping mets contained to the lymph system, no spread to major organs, bone or brain. I don't seem to have developed complete resistance to Navelbine yet, but we have discussed moving on to Xeloda if this round doesn't do the trick as my response has been slower this time. I have several chemo buddies who've had good responses with Xeloda/Herceptin combo, one for Her2+ lung mets and one to keep inflammatory Her2+ contained.

>3 Lolly

<3 Lolly

[Lyn]

Hi Lolly, I read your response on one of the posts saying you were going to consider Xeloda, my experience is I haven't been very impressed with it in my situation. The original use was for skin mets to the scar area, this went almost straight away but then I got it in the neck area and it didn't work, I do believe that when I take it before my biopsies it prevented the spread and enlargement, my very first biopsy in 98 lump tripled in a week, but apart from using it before biopsies it hasn't been a magic bullet for anything else. I don't know if it is because I am only on 1000mg per day 14 days on 14 off and it isn't enough, but when I had too much I seem to suffer the consequences with the side effects, I am on on the minimum for this combo but I believe the higher it goes I may get sick, and that I don't want to face, I have been feeling off on the last round but not sure if I got a stomach bug or the pain relief Endones. Have you considered anything else besides Xeloda, I am considering the Navelbine again and will fax my mammo and scan results to my onc Boris tonight, I will be seeing him on Tuesday as well as having triple and also it is the day I am supposed to recommence oral for 2 weeks, I really don't even know what I am treating, at least with the lymphs and skin you can see and feel but this one is under the radar.

Love & Hugs Lyn

[al from Canada]

Lyn,

I have seen low dose xeloda mentioned in a trial where they went 21 days on, 7 days off. That actually makes more sense to me than high doses as you achieve steady state for a longer period of time. To me, 500 mg BID makes more sense than 1000 / day, esp. in light of the fact than xeloda has a half-life of 45 minutes.
BTW, there has been no survival advantage associated with high doses of xeloda.

Al