data to select one of these regiments: L+C; T+C; T+V; T+E

[Nguyen]

Hello,

Does anyone have data to guide selection from one of these regiments:

Lapatibib + Capecitabine; Trataszumab + Capecitabine
Trastazumab + Vinorelbine; Trastazumab + Eribulin

She (her2+, Er+) is currently on T-Dm1 (Kadcyla).

Thank you very much,

Nguyen

[donocco]

If she is currently on Kadcycla I doubt an oncologist would put her on Trastuzumab (herceptin) as Kadcycla is a conjugate of Herceptin plus a chemo drug called Emtansine. I searched to see if these two drugs could be used together ie Traztuzumab (Herceptin) and Kadcycla (Hercepton-Emtansine and found no statements for or against but it doesnt make sense to me. Ask the oncologist if you can use Kadcycla and Herceptin together just to bring it to his or her attention.

I guess that leaves Lapatanib (Tykerb) and Capcitabine Xeloda).

If she is ER postitve she probably would be taking a drug like Tamoxifen, Faslodex, or Zoladex i njections. Is she? Youdidnt mention anything about this.

Hopes this helps a bit

Paul

[Nguyen]

Hello,

Linda has been through quite a bit of treatment as indicated in her treatment history below. Currently if T-Dm1 fails, the physician recommends phase 3 randomize trial between SYD985 v.s Physician's choice , L+C; T+C; T+V; T+E. So I am looking for data to narrow down the physician choice.

Nguyen

Linda's treatment history:

04-2018 - current: restart T-Dm1

03-2018: biopsy of the lung: ER+, Her2+++, PR—(chage from PR+)
03-2018: comprehensive genetic profiling by Foundation medicine, numerous genomic alterations.

12-2017 – 04/2018: Pertuzumab + Herceptin
03/2017 – 12/2017: Herceptin + Fulvestrant (take a break from T-Dm1)
07/2014 – 03/2017: T-Dm1
02/2014 – 06/2014: Everolimus (5mg), Exemestane, Herceptin
08/2013 – 01/2014: Femara, Herceptin
12/2012 – 07/2013: 4mg estradiol, Herceptin
08/2012 - 12/2012: Fulvestran 500mg, exemestane, Herceptin (Stop everolimus due to mouthsores)
05/2012 - 08/2012: Everolimus (10mg), Exemestane, Herceptin, Zometa
08/2011 - 05/2012: Herceptin, Tykerb, Femara, Zometa
08/2010 - 08/2011: Herceptin, Femara, Zometa
09-2009 - 08/2010: Herceptin and estradiol (6mg)
09/2008 - 09/2009: Herceptin, Fulvestrant, Femara
03/2008 - 09/2008: Herceptin, Exemestane, Oophorectomy
01/2005 - 03/2008: Herceptin (readded) and Femara
07/2004: It returned again via several small nodules in the lung
10/2002: NED (via CT and CA27.29)!
10/2001 - 01/2005: Femara, (Fosamax)
12/2000 - 10/2001: Herceptin and Navelbine
12/2000: lung metastatic was diagnosed (a few small nodules)
02/1998 - 12/2000: Daily Tamoxifen
05/1997 - 04/1998: Modified Radical Mastectomy, many cycles of chemo regiments (CAF,Taxol, Carpoplatin, Thiotepa, Navelbine, Taxotere), including HDC, and radiation
05/1997: First diagnosed with BC stage 3A, ER+, PR+, HER2 +, poorly differentiated, nuclear grade

[donocco]

Well she has been on everything. I dont know what to tell you. Sometimes an old regimen like Cytoxan, Methotrexate and 5-Flurouracil is useful. Xeloda (Capcitabine) is an oral form of 5-Fluorouracil. Xeloda is a prodrug that becomes 5-Fluorouracil in the body. I imagine the CMF regimen could be combined with Lapatanib (Tykerb) but not sure. Ill research SYD985 and try to explain how it works. Of course Ive never heard of it until now.

Sorry I couldnt help more

[Nguyen]

Don't say sorry Paul, I am familiar with the working of SYD985, so don't spend time on researching it. I really appreciate you're trying to help!!! From treatment history, 5FU didn't help much, same with Tykerb. Vinorelbine made a difference way back then, but the tumor has not been exposed to Eribulin. So we will ask for T+E if she doesn't get selected into the SYD985 arm. Thanks again Paul!

Nguyen

[Cathya]

Nguyen;

Check out ZW25 or even Ibrance/Letrozole.

Cathy

[Nguyen]

Unfortunately pallocilib just fail phase3 for OS benefit, it's also only for her2 negative at this point. ZW25 is still in phase1. Thank you Cathy.

[Cathya]

Nguyen; I'm checking into the failed phase 3 but I will say my TM's are now in the normal zone. It is being tested on Her2+'s now and there will a paper out in December from Farber in Boston on this. I'm watching ZW25 as my onc is very excited about it. I'll post more as I see it. My best to your wife.

Cathy

[SoCalGal]

Clinical trial with extremely strong early results in heavily pretreated MBC is DS8201. Having 55% response rate when 20% is more what's expected for MBC population.

There is a lot of data:
https://www.onclive.com/web-exclusives/fda-grants-ds8201-breakthrough-designation-for-her2-breast-cancer

https://www.daiichisankyo.com/media_investors/media_relations/press_releases/detail/006778.html

http://www.ascopost.com/News/57981
About DS-8201

DS-8201 is a “smart” chemotherapy comprising a humanized HER2 antibody attached to a novel topoisomerase I inhibitor (DXd) payload by a tetrapeptide linker. It is designed to deliver enhanced cell destruction upon release inside the cell and reduce systemic exposure to the cytotoxic payload, as compared to the way chemotherapy is commonly delivered.

In addition to Breakthrough Therapy designation, the FDA has granted Fast Track designation to DS-8201 for the treatment of HER2-positive unresectable and/or metastatic breast cancer in patients with disease progression after prior treatment with HER2-targeted therapies including ado-trastuzumab emtansine.
Please check it out! It's also an ADC and there is a cohort for people who had progression on Kadcycla. Minimal side effects. Good luck!