whole new ballgame--her2+ Stage IVs

[Lani]

In 2005 prior to the release of the adjuvant herceptin data, when herceptin was
approved for Stage IVs only I remember listening to a nationally known oncologist speaking at a conference discussing combined vs sequential treatment with more than one agent for Stage IVs and whether or not to order studies looking for progression ( he has been on national committees who decide what tests are recommended/which turns out to mean may be reimbursed by insurance companies) saying of bc in general (but not excluding her2+ bc)
"these women are going to die in two years anyway so why…"

Here is a collection of data from several hospitals in France showing what a difference herceptin has made for Stage IVs:

Breast. 2013 Dec 21. pii: S0960-9776(13)00315-9. doi: 10.1016/j.breast.2013.12.003. [Epub ahead of print]
Long-term follow-up of patients with metastatic breast cancer treated by trastuzumab: Impact of institutions.
Fiteni F1, Villanueva C1, Bazan F1, Perrin S2, Chaigneau L1, Dobi E1, Montcuquet P1, Cals L1, Meneveau N1, Nerich V2, Limat S2, Pivot X3.
Author information

Abstract
PURPOSE:
Trastuzumab in Human Epidermal growth Receptor 2-positive (HER2+) metastatic breast cancer (MBC) was established as standard therapy since 2001. The objective of this study was to search for significant prognostic factors in patients with HER2+ MBC treated by trastuzumab taking into account the institution where the treatment was given.
PATIENTS & METHODS:
All patients with HER2+ MBC treated by trastuzumab between 2001 and 2010 in the 8 hospitals of Franche Comte region were analysed. Univariate and multivariate analysis were conducted to search for factors related to overall survival (OS).
RESULTS:
Among 1234 patients with MBC treated by chemotherapy between 2001 and 2010, 217 patients received trastuzumab. In this subset, the median age was 60 years, 8% and 38% had brain and liver metastases at first occurrence of MBC, 36% of, tumours were hormonal receptors positive. Patients were treated in 48% and 52% of cases in specialized and in general hospitals, respectively. The median OS length was 45.2 months (IQR 23.2-89.3 months). In univariate analysis the following factors were significantly related to favourable OS: inclusion in clinical trials, treatment in a specialized hospital, positive hormonal receptors status, age <50. In multivariate analysis remained significant: treatment in specialized hospital (aHR 0.78; 95%CI 0.64-0.94; p = 0.03) and age <50 (aHR 0.76; 95%CI 0.59-0.95; p = 0.02).
CONCLUSION:
Exposure to trastuzumab erases all established prognostic factors at the metastatic setting. The fact that patients treated in specialized hospitals presented a longer survival emphasizes the dramatic impact of this therapy and the relevance to optimize its use.
Copyright © 2013 Elsevier Ltd. All rights reserved.
KEYWORDS:
Breast cancer, Metastatic treatment, Trastuzumab

PMID: 24368024 [PubMed -

[sassy]

"Exposure to trastuzumab erases all established prognostic factors at the metastatic setting."

Just wanted to say it again...........!!!!!!

[evlin75]

Herceptin was not available for the early diagnosed in 2003 so Susan did not receive it until the cancer metastasized to her hip making a hole - in less than two years of the first diagnoses of invasive ductal her2neu +++.
But now after all these years the same story about leptomeningeal involvement. They gave her 3 to 6 weeks in June of 2012. Family was not about to settle for that. We began researching immediately and found evidence some spinal cords cleared with Herceptin given directly into the spinal fluid. Her doctor agreed this was a chance and found the clinical trial in Chicago.
She had a ommaya put in the next day and then on the Chicago The ommaya became infected and had to be removed so they gave her the Herceptin lumbar puncture for a while.
To get the higher dose recommended for the best improvement we had to find a doctor willing to do it for her. That was accomplished and then a new ommaya was implanted for easier access and less discomfort. Possibly better perfusion. they also had to add a chemo for a while to shrink the growths.

So a new ball game here too. The expectation of a few weeks has gone to many weeks.
She is getting stronger and feeling better.

None of it has been an easy trip. Some very difficult days, but she enjoyed Christmas with her son. She is driving again and feeling stronger every day.
She finally agreed to the Abraxine for the swollen lymph nodes, lost her hair and bought a wig. She is a joy and we still have her.

Ev

[Bunty]

and I'm going to say it again too...
"Exposure to trastuzumab erases all established prognostic factors at the metastatic setting."

I'm 'living' proof I'm grateful to report. Even though it would appear Herceptin has stopped working for me systemically, I believe, as it seems is shown in others, that Herceptin has some important work it is still doing for me.

Thanks Lani for reporting this.

Cheers Marie

[sarah]

in 1999 I asked for Herceptin and told them about what I had read but it was refused but it was only approved for the metatastic patients. So in 2004 I was a metatastic patient and got it. Luckily they have learnt that all HER2 get it.

[Adriana Mangus]

Hi Marie,

Welcome to the stage IV club. Glad to hear you are still benefiting from Herceptin. I'd like to quote Andi Barnett;
"the hell with the statistics"

Happy New Year! Health, Love and more clinical trial for us.

Love,

Adriana