What's next?

[Helen]

I finished 8 rounds of chemo combination of taxotere and carboplatin with Herceptin last December 28, 2005. I had a PET/CT scan last January 16 and the result came back ........ "Inferior right hepatic lobe focal activity on prior study is notably improved; very mild residual irregular active hypodensity remains" is what the report says. My oncologist told me today that we will continue with Herceptin weekly. I am being given a chemo break. Is that good or bad if I am still not NED? Will Herceptin only help to becoming NED eventually? Should I consider liver resection?
May I have your advice on what I need to do next?
Thanks.

Helen
**********************************
Her2 +++, ER/PR-, Left modified radical mastectomy, 1.7 cm tumor with no lymph nodes involvement.
Originally diagnosed in May 2005, 8 months after giving birth at stage 1, restaged in one month after all CT/PET scans were performed to stage 4 due to one spot in my liver.

[al from Canada]

It sounds like the PET says you have active disease. Going on herceptin alone is OK provided that you have a monitoring process in place, like another PET within 30 days of quiting chemo. If there is progression, I would push for a targetted therapy clinical trial or another chemo like xeloda. From experience: don't wait 2 months for that 2nd scan! The other scenario is quit chemo and go directly into a clinical trial without skipping a beat.
If you are too nervous about going off chemo totally, tell your onc you want to try xeloda, as it is a much friendlier drug.

Good luck,
Al

[eric]

Not to confuse matters but why not take advantage of an opportunity to give your/her body a needed break? Tough call and I certainly don't know what is best but I would consider the toll that chemo might have and the positive impact of taking a break. Just a thougt but I think the best piece of advice is that once you decide, don't second guess yourself. Best of luck with whatever you decide Helen.

Eric

[LauraP]

Helen, I may be asking a silly question, but is the size of the lesion to a point where your doctors would feel comfortable to do a liver resection? Your report sounds like the chemo has helped to shrink it, but I was not sure if that was a decision you could be facing.

I had a 1 cm mass on my liver that was found pre-chemo. It was not determined to be cancerous until I had finished 4 rounds of EC and 12 rounds of Taxol + Herceptin. We had a resection done laparascopically (sp?) in September. Then we started 4 months of carbo, taxotere and herceptin. I just finished that chemo had a PET/CT on Jan 13th and received the news that I am NED. I am moving forward with Herceptin alone, but feel really comfortable with that because the mass is gone.

Although a resection might sound scary, the procedure was not as big of a deal as I thought. The recovery was doable as well. Like I said, I may be asking a silly question if you are not ready for that procedure, but it also might be a viable option and would make you feel comfortable with moving forward with Herceptin alone.

Blessings to you regardless of you decision. I hope my post has helped in some way!

Laura

[Helen]

Hi Laura,
To answer your question ..... the lesion is 1.8 cm based on the CT scan taken in November. It is at the tip of the right lobe of my liver and the liver surgeon I consulted with back in August said it can be removed. He wanted me to finish my chemo first before seeing him again. I am not comfortable with just Herceptin with an active disease. My onc told me that we stop chemo so I was thinking of liver resection as another option to get it out. I am not even sure if this is a good way to do it.
Thanks for your advice.

Helen

[Esther]

Helen in March of 2005, I went on what was to be a short chemo break. I was not NED yet from my liver lesions, I had 3 small ones left. I had my liver enzymes and CA 27-29 checked every 3 weeks.

Within 2 months on just Herceptin, my liver went NED!!! It has remained NED since then with just Herceptin every 3 weeks.

So this may be a viable option for you at this time.

[StephN]

Hi Helen -
With the size of your tumor being what it is, I would think that you may need more than Herceptin to clear that out. (Your discomfort with a monotherapy is well-founded.) This is not very small and there is no question that it is active rather than possible scar left over from dead mets.
Get on some other drug that is synergistic with Herceptin and that should do the trick.
Best healing wishes.

[Helen]

Thanks to all who have responded. Here's my next dilemma .... My case was reviewed by the liver tumor board at Stanford this week. The liver surgeon said that they can do liver resection. The liver lesion shrunk further from 1.8 cm (Nov 2005 scan) to 1.2 cm (Feb 2006 scan). I was told that if I chose surgery, I need to stop herceptin 1 month prior to surgery. My current dose is weekly and I know I can get a dose good for 3 weeks. I have been on Herceptin only since the last week of December 2005. What are your thoughts on this? I am scared to miss my dose of Herceptin. It's like a security blanket for me. For those of you who had liver resection, were you requested to stop Herceptin prior to surgery? I will also discuss other options such as your suggestions of taking other drugs with Herceptin with my oncologist.
As always, thank you in advance for your input.

Helen

[Lolly]

Helen, after being NED on weekly maintenance Herceptin from August 2001 to March 2002, I had my first 3 weekly dose of Herceptin April 1, 2002 and had a right prophalactic mastectomy on April 10 with no complications, then my second 3 weekly dose on April 29. My surgeon was adamant that I needed to have Herceptin in my system to help prevent spread while I healed from surgery.

Perhaps liver resection, being obviously a more serious surgery, is different. But I'd like to know what others did who've had liver resection.

<3 Lolly

[al from Canada]

Helen,

There has been limited and spotty evidence that liver resections actual work in Breast cancer. I would question the doctors on past results and experience before plunging into this.

Is there anyone on our board who has had a liver resection where the cancer hasn't re-ocurred??

This is a very invasive proceedure and I just wonder is you have looked at other options such as radio fequency ablation or cyrosurgery etc. Not trying to trow a wrench into things but this is a big step.

Good luck,
Al

[Gina]

I have had SO many liver lesions from time to time and every time, herceptin ALONE plus good diet and supplement regimen worked to erase them--completely, but it takes some time. Your body needs a chance to heal itself. I know your onc out there "does NOT believe in tumor markers" -- what a shame as your case would be a perfect way to follow what is really going on.

In your place, I absolutely WOULD NOT do any surgury until I gave the Herceptin a month or two to finish cleaning up that spot. But remember, you can help yourself a lot by getting plenty of rest and not pushing too hard...GIVE your body a chance to heal...now that you are OFF the hard stuff...you should bounce back and feel better than you have in months...or at least that was my experience and that I know of others in a position similar to yours....surgery has MANY risks...instead of resection, fight to get regular CA 27/29 and Serum her-2 markers...also, keep an eye on your liver enzymes and alk phos...fyi. In absence of tumor markers...if these numbers start steadily rising, the liver may be reactivating....sounds like whatever is leftover is just lesion debris and it is continuing to shrink...this can be confirmed by seeing the liver enzymes dropping into normal...21/22 is good. Drink lots of fluids and walk, walk walk...flush it out.

Take care GLAD the CHEMO is behind you!!!
Gina