Herceptin & Tykerb Together

[IRENE FROM TAMPA]

I know there are some of you on this combo but I cant remember who so thought it would be easier to ask then go through each thread....

I have spent most of my day researching new options and wondered who is on this combo and how you are tolerating and responding.

My onc has always been a bit hesitant to put me on this since not much out on it together, but maybe by now there is.

I did not discuss with him at our last meeting so wanted to get some info to take to him. I like going right to the source to see how people are reacting. I don't know if would work for me but maybe worth a try.

He is talking about Cisplatin with Irinotecan but I just do not have a good gut feeling about it for some unknow reason.

So if I can not get into the DM1 trial, we have to come up with another plan by next week.

Any help on this combo?????

[Sheila]

Irene
I saw this on another post....

ASCO 2008 Abstract - Tykerb alone or Tykerb+Herceptin
A randomized study of lapatinib alone or in combination with trastuzumab in heavily pretreated HER2+ metastatic breast cancer progressing on trastuzumab therapy.

Sub-category:

Metastatic Breast Cancer (http://www.abstract.asco.org/CatAbstView_55_3_AA.html)

Category:

Breast Cancer--Metastatic Breast Cancer

Meeting:

2008 ASCO Annual Meeting (http://www.abstract.asco.org/ConfCatView_55.html)

http://www.abstract.asco.org/abst_files/spacer.gifhttp://www.abstract.asco.org/abst_files/spacer.gifhttp://www.abstract.asco.org/abst_files/spacer.gifAbstract No:

1015

Citation:

J Clin Oncol 26: 2008 (May 20 suppl; abstr 1015)

Author(s):

J. O'Shaughnessy, K. L. Blackwell, H. Burstein, A. M. Storniolo, G. Sledge, J. Baselga, M. Koehler, S. Laabs, A. Florance, D. Roychowdhury

Abstract:

Background: Lapatinib (L) is an oral, small-molecule inhibitor of EGFR and HER2 with a mechanism of action distinct from that of trastuzumab (T). Preclinical data suggest synergy between L and T. We studied L alone and in combination with T in pts with HER2+ MBC who progressed on T. Methods: Eligible women had received prior anthracycline and taxane therapy, had MBC with measurable lesions or bone-only disease, and had progressed on prior T-containing therapy. Pts were stratified by hormone receptor status and visceral/nonvisceral disease, then randomized to receive either L (1,500 mg QD) or L (1,000 mg QD) plus T (2 mg/kg weekly after 4 mg/kg loading dose). If pts progressed on the L arm, they could cross over to the L+T arm. The primary endpoint was PFS (investigator assessment), and secondary endpoints were clinical benefit rate (CBR) at 24 wks, RR, and OS. Results: 296 pts were randomized. All pts had received prior T; the median number of prior chemotherapy regimens was 6. Combination therapy significantly improved PFS and CBR; RR and OS were similar in both arms (Table). Both treatment regimens were generally well tolerated. Grade 1/2 diarrhea was higher in the L+T arm (53% vs 41%); acneiform rash was more common in the L-alone arm, likely due to higher L dose. Asymptomatic decline in LVEF (> 20% and below LLN) occurred in 5% of pts in L+T arm and 2% of pts in L-alone arm. 1 death occurred due to cardiac toxicity in the L+T arm. Conclusions: This is the largest study of 2 targeted agents in HER2+ MBC and the first to demonstrate the synergy of L+T in a phase III setting. Improved clinical outcome was achieved with the combination of L+T in pts progressing on T-based therapy and without a substantial change in the side effect profile. The role of combined anti-HER2 therapy, in combination with chemotherapy, in less heavily pretreated patients with early stage disease is ongoing in the ALTTO (Adjuvant L and/or T Treatment Optimization) study.

(note: This is a table - but it won't format properly.)

EndpointLL + THazard/OR95% CIP valuePFS (median, wks)*8.412.00.770.6, 1.00.029CBR (%)*13.225.22.11.1, 4.20.020RR (%)*6.910.31.50.6, 3.90.46OS (median, wks)3951.60.750.5, 1.10.106*Intent to treat.

[hutchibk]

My gut tells me that Tykerb/Herc has great potential... but I have a very unscientific gut. I know that it is in my tool-box for future consideration. Best of luck with your research, Irene!

[IRENE FROM TAMPA]

Sheila and Brenda -

I will call Baylor on Tuesday to get more infor on their trial and talk to my onc about the Herceptin/Tykerb.

I just pray that I have not run my course out on those two. There are such good results on them and I had such good results with the Tykerb/Xeloda. They feel like family....haha . Who knows maybe my gut does.

[Bill]

Hi Irene! If it's any help, Nicola was on a clinical trial/study of Lapatinib(Tykerb) and Herceptin. She was also on Taxol at the same time, though. Everything worked great for about a year and 3 months, then there was a progression, so they pulled the Lapatinib and Taxol and switched to Navelbine, I think. The Tykerb crosses the BBB and she took 4 pills in the morning. She had the usual diadammitrhea, and during the trial they kept trying to blame it on the Taxol, but she knew it was the Tykerb. I'm not an expert, Irene, but I think its a good combo. You are attacking the cancer cells from the inside and out at the same time, I seem to recall. Thoughts and prayers, Love, Bill

[SoCalGal]

Hi Irene-

It was after a consult w/John Glasby at UCLA and then my new onc concurred to add herceptin to my tykerb. JG explained that if tykerb is serving as a her2 "road block" but some cars are getting in you should add to or reinforce the existing road block instead of removing it and starting over. After reviewing my long history w/br ca - he said that he doubted that any chemo has ever worked for me and that it was only on herceptin that I had success.

So he suggested that I return to it along with tykerb and add in avastin. And zometa for the osteo and bone mets. So that's what I'm doing - those 4. Tykerb daily-Herceptin & Avastin every 3 weeks and Zometa every 6 weeks instead of monthly to save my veins. I don't know if it's all working - but my markers did come down after about 2 months. The only scan I had was a brain mri and that showed the met gone from the Feb gamma knife. I am due for a pet but don't really want to know. (you know:).

Hope this helps.
Flori

[Adriana Mangus]

Hi Irene:

I admire your courage and strenght as you are faced with again having to make a choice regarding your next treatment.

I just finished radiation to rt lung (mets from primary, bc). Thank God radiation worked for me as indicated by the ct scan and the ca 2729.

Onc said that next time around, his choice of treatment will be Herceptin + Tykerb.
I trust my onc, he's open minded, attends educational meetings all over the world, he really cares about my situation and speaks fondly of his other patients.

Based on his experience I think this combo will work very well for you.
Do not despair, there are still a lot of good treatments out there for us.

I will keep you in my prayers. Take care.

[StephN]

Dear Adriana -
You were on my mind yesterday. Was hoping that things are better with you and hubby. Glad the radiation did its work.
Are you still getting Herceptin??

Thanks for the update dear woman - now no need to send out the Mounties!

[Adriana Mangus]

Dear Steph:

Thank you for your nice note. Hope all's well with you.

Hubby is improving, learning to walk and talk all over again- is a long process, but we have to have patience, right? Like I do not know anything about it? Things are pretty good at home.

I'm still on herceptin, onc believes that for the moment I should just receive herceptin and nothing else, since I had such a good response to the radiation. Let me tell you about radiation oh boy! it was such a challenge, I never imagined I was going to be so tired... It was ok at the beginning but it is cummulative so towards the end of the treatment I was feeling really tired. Other than that- as you may know, it does not take long to go through each session. I'm just relieved it's all over for now.

Husband and I are looking forward to more positive things in our lives. We are both now retired, spending every single minute of the day elbow to elbow, like conjoined twins LOL!. We'll be going to Squaw Valley in June to spend time with Kent's brother and wife. They have just finished up building a lodge up there, so am looking forward to that and to having some good wine and a relaxing time.

Let's see... in September we have plans to visit Vermont, hopefully it's not too early to admire the change of colors. Then in October is cruising time to Mexico- Cabo San Lucas, then onto Ensenada where we'll be taking a tour to the famous mexican winery Pedro Domecq and another local one called L A Cetto. You have probably have heard of these two wine producers, since you are in the same line of business. And then.....

Well that's it for us..What are you up to Steph?