HER2 progression

[Lily]

I have been on Herceptin for almost 3 years, but have been taken off it because my cancer progressed. I am now on Capecitabine (Xeloda). My onc said there is no use staying on Herceptin as it isn't working for me any more. I have read lots of letters from others who have been on Herceptin and whose cancer has progressed but they are still on it, perhaps with some other chemo as well. Why do some people stay on Herceptin when their cancer progresses when it surely isn't working for them either?

Thanks
Lily

[heblaj01]

Lily,
The reason some oncs continue to prescribe Herceptin after progression while others don't is that they can't agree on the pros & the cons.
Those in favor claim (with some backing data) that Herceptin is still helpfull even after progression because it can slow down that progression.
Those against argue that it is putting the patients at risk of serious side effects (such as heart problems) with little chance of getting benefits from continuing Herceptin.
If you would like to read the detailed debate between the oncs I will find back the links.

[Sherryg683]

I have read that they believe that Herceptin when combined with another chemo such as Taxol can make the chemo more effective. ..sherryg683

[Sheila]

Lily
I have been on Herceptin 3 1/2 years with Xeloda on and off for the last 10 months....I am currently off the Xeloda, my mets are to the lymph nodes, and even though Herceptin isn't getting rid of them, they haven't gone elsewhere...I take the Xeloda and it keeps them at bay for awhile, then they are back...

[Ceesun]

I have been on herceptin since Sept. 05 and had a recurrence to the lung at May 06. My onc states that just because there is progression does not mean the herceptin isn't working. I am glad that I was and am on it. i have been on Xeloda and Navelbine since this past August, along with herceptin, with good results so far. Ceesun

[AlaskaAngel]

Lily is bright enough to raise the question. Otherwise people will hesitate to try to move on. Some people will actually be better off not to continue the drug. Some people may move on to trying the drug in combination with another drug. Some people may move on to trying a new drug. But because each one of us has hundreds of genetic differences they can't do expensive, time-consuming clinical trials for each possible variation, and even if they could, drug resistance down the road can develop as well for most.

As patients we don't want to hear the dark side because we need to hang onto hope. But even though as patients we just want it to work, and we want it now, if we aren't cautious enough to evaluate what we are doing for treatment as we go along we probably aren't doing ourselves a favor.

AlaskaAngel

[heblaj01]

Here is a piece of research news issued today which may add support to those oncs believing that continuing Herceptin treatment (alone or more likely in combination with chemo) after resistance sets in makes still sense:

http://www.eurekalert.org/pub_releases/2007-02/aafc-gpp022007.php#
Gene profiling predicts resistance to breast cancer drug Herceptin

Extract:
They also discovered that resistant tumors continue to over-express the HER2 growth factor protein -- an important finding given that many scientists had thought that loss of HER2 was likely responsible for Herceptin resistance.

"Herceptin has revolutionized the care of HER2-positive breast cancer for many patients, but unfortunately, not for some. This work demonstrates that digging deeper into the molecular subtypes of these tumors helps us understand why some tumors are resistant and may point to ways to remedy that," said the study’s lead author, Lyndsay Harris, M.D., associate professor and Director of the Breast Cancer Disease Unit at Yale University Medical Center.

If additional studies validate these findings, it may be possible to select those patients that will be resistant to Herceptin and treat them with additional drugs to restore Herceptin sensitivity, according to Harris. "Our goal is to see what the tumor tells us before any treatment starts and tailor therapy accordingly," she said.

[AlaskaAngel]

I can see how the addition of another chemo drug might be done in the hope that it might help some by providing a boost for dealing with the continued over-expression of HER2.

But in trying to answer Lily's original question, I can't see how that article documents the wisdom of continuing trastuzumab alone if the cancer is progressing, even if the over-expression of HER2 is now known to be there. (I am still concerned about eventual cardiac toxicity as well.)

The over-expression is there; the question is whether or not the traztuzumab is partially working all alone to just slow the growth, but that isn't documented by the article.

AlaskaAngel

[heblaj01]

The links below relate to the medical argumentation for or against continued Herceptin treatment after progression. It should be noted that the commentaries were made at different dates. So it is possible some of their authors might have changed their mind to some extent with advancing knowledge.
FOR:
http://www.abstracts2view.com/sabcs06/view.php?nu=SABCS06L_1099&terms=
[2064] Favourable effect of continued trastuzumab treatment in metastatic breast cancer patients: results from the French Hermine cohort study. SABCS Dec 2006

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15020607&query_hl=4&itool=pubmed_docsum
Safety of treatment of metastatic breast cancer with trastuzumab beyond disease progression
J Clin Oncol. (http://javascript<b></b>:AL_get(this,%20'jour',%20'J%20Clin%20Oncol.');) 2004 Mar 15
One of the researchers of this paper is no other than DJ Slamon the inventor of Herceptin.

AGAINST:
http://www.jco.org/cgi/content/full/23/12/2868
CORRESPONDENCE In Reply: Gabriel N. Hortobagyi
Journal of Clinical Oncology, Vol 23, No 12 (April 20), 2005
The author is one of the Herceptin clinical trial investigators

http://theoncologist.alphamedpress.org/cgi/content/full/11/4/318 april 2006
Outcome of Patients with HER2-Positive Advanced Breast Cancer Progressing During Trastuzumab-Based Therapy

[AlaskaAngel]

Thank you for sharing such information with us all.

AlaskaAngel

[Lily]

I would just like to thank everyone who answered my question about HER2 Progression. I found your emails very interesting and supportive and the links from heblaj01 were very helpful and informative; I didn't realise there was so much information about continuing Herceptin after progression.

Thank you so much.

Lily