for those w brain mets--once again remaining on herceptin improves prognosis but this

[Lani]

study found surgery + rads better than rads alone

I will try to read further and see if SrS (gamma or cyberknife were available/offered)

Onkologie. 2011;34(6):304-8. Epub 2011 May 13.
Management of patients with brain metastases receiving trastuzumab treatment for metastatic breast cancer.
Witzel I, Kantelhardt EJ, Milde-Langosch K, Ihnen M, Zeitz J, Harbeck N, Jänicke F, Müller V.
Source
Department of Gynaecology; University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Abstract
Background: With the more effective control of visceral metastases in patients with metastatic breast cancer (MBC), an increasing number of patients face brain metastases (BM). The aim of this retrospective analysis was to investigate the incidence and factors affecting the prognosis of patients with BM under trastuzumab treatment for MBC. Patients and Methods: A total of 75 HER2positive patients treated with trastuzumab for MBC were included. Results are discussed in the context of the current literature. Results: Patients who developed BM (n = 29) had longer median progression-free survival (PFS) during first-line chemotherapy and longer overall survival (OS) after diagnosis of MBC than 46 patients without BM (PFS: 27 vs. 14 months, p = 0.039; OS: 46 vs. 18 months, p = 0.067). Median survival of patients with continuation of trastuzumab after diagnosis of BM was longer than survival of patients with discontinuation of trastuzumab treatment after BM (18 vs. 3 months, p = 0.006). Survival of patients who were treated with surgery and radiotherapy for BM was better compared with radiotherapy alone (9 vs. 5 months, p = not significant) or best supportive care (9 vs. 2 months, p = 0.049). Conclusions: Continuation of trastuzumab treatment as well as resection of BM seem to give further benefit in the treatment of patients with HER2-overexpressing MBC.

Copyright © 2011 S. Karger AG, Basel.

PMID: 21625183

[mamacze]

KRISVELL! This study is for you! Providential timing...I hope you can show this to your oncologist....Thank you Lani for sharing this.....
Love, Kim from CT

[krisvell]

Kim,
I just logged in before leaving to oncologist in 30 mins; more providential timing!! Going right now and printing it out.
Hugs,
Kris...

THANKS LANI & KIM

[krisvell]

Gave my oncolgist the posting. She feels there's a level of toxcity and doesn't want to treat something that isn't there. The Brain Met has been treated with Gamma. She'd rather treat me with lapitinib.
I haven't let it go yet. Will bring it up at my next visit.

Kris.....

[Joan M]

Kris,

Keep at your onc, because studies have shown that Herceptin continues to work and control the development of mets in the body even when the drug has failed in the adjuvant setting, and also that H and L work well together, as L controls the HER1 pathway, which is linked very closely to the HER2 pathway. H and L are also prescribed together under NCCN guidelines for metastatic bc. What does your onc mean by, level of toxicity? I don't understand what that means.

Hugs,

Joan

[krisvell]

Joan,
I am keeping on my Oncologist. She took the copy of the study that I gave her. Maybe she was just refering to the lapitinib side effects and didn't see the benefit of getting Herceptin. Thank you for mentioning that; gives me more passion to pursue further.
Kris....

[Joan M]

Opps, just realized a typo ... lapatinib controls the HER3, not HER1, pathway. I often get confused, perhaps due to aging!

[Lani]

Jackie--actually lapatinib is a her1 (EGFR)/her2 dual receptor tyrosine kinase inhibitor. Since her3 likes to form dimers with her1, her2 and her4, blocking her1 and her2 leaves less hers available for her3 to form dimers with and as it lacks its own phosphorylation site, it needs to couple with some other her to act.