Liver Mets Update & maybe some good news re: Perjeta
 

Hi Gang,

Well, I’m finally getting around to posting an update on my return to chemo and Herceptin after deciding to take a Herceptin Holiday after 6 years of being NED.

Quick recap: CA15-3 and Her2 Serum markers started rising in June 2012. Rechecked in July, still rising. Back on Herceptin alone in August. August 15th PET scan doesn’t show any active mets. On Nov. 7th, After 3 months of Herceptin and CA15-3 still not coming down, latest (Nov. 29th) “enhanced “MRI now shows "extensive" mets to liver, decided to add weekly Taxotere since it worked well for me in 2001/2002.

So, I just started my 3rd cycle of weekly Taxotere on Jan 2, and we are really wondering if the Taxotere is going to work for me this time. My CA 15-3 has been sort of bobbing up and down, but finally dropped a bit on Dec. 19th , it is now at 74.7, where as the Her 2 Serum has actually been coming down very gradually, but steadily. It was 14.5 on Dec. 19th. The problem that I am having is that the Taxotere is much harder on me this time around. The side effects after 2 months are as bad as they were at 7 months back in 2002.

In the meantime I had a consultation with a radiologist at UC San Francisco to see if I might be a candidate for cyberknife. Unfortunately I have too many spots for the cyberknife, but he did think I would be a candidate for radioembolization, and gave me the name of the doctor at UC that does it.
So, I’m anxious to discuss all of this with my doctor this week at my next appt., and also push for him to add Perjeta to the mix.

As an aside, our CAL-COBRA coverage will be ending on March 1 (currently through Blue Shield), and we’ve decided to go with Kaiser Pemanente since their premiums will be several hundred dollars less for their Guaranteed Issue/ HIPAA Plan. The good news in all of this, is that I have already met with a woman oncologist at Kaiser (really, really liked her!) to discuss my history and current treatment as a way to reassure myself that I will be able to l receive the care I will need going forward. One of the first things she said to me is that she would put me on Perjeta. This is something that my current oncologist has been dragging his feet about, saying that he doubted he could get it approved.

So…..stay tuned!

Re: Liver Mets Update & maybe some good news re: Perjeta
 

Kim,

If your new oncologist can get you Perjeta, that would be great. In the meantime, I hope your numbers keep dropping.

The radiologist who you consulted about cyberknife probably referred you to an interventional radiologist. These are docs that do radioembolization, chemoembolization, RFA, and cryoablation of liver tumors, and they would know best about whether you'd be a candidate for a local procedure. Such a doc did an RFA of my lung tumor in 2008. Even if you do a local procedure it would still be best to follow up with chemo and of course stay on Herceptin.

Here's a great 2-minute video that explains radioembolization for others to view, as I'm sure the radiologist you spoke with explained the intervention to you.

http://www.youtube.com/watch?v=QmvCbS6xiHA

Good luck with your new oncologist!

Joan

Re: Liver Mets Update & maybe some good news re: Perjeta
 

Kim
I am in a similar situation...my tumor markers starting going up..now 55.. MRI showed tumor in liver doubled in size....have appt on Tuesday with liver surgeon at Sloan....my oncologist doesn't believe in radio ablation, says there is no increase in mortality...but will see what liver surgeon says..My oncologists also favors perjeta...

Re: Liver Mets Update & maybe some good news re: Perjeta
 

Wow - your liver sure flared up! Did not realize it was that much. I am with you - don't think I could stand Taxotere again (did better with Taxol, anyway).

Really glad to hear you have found a new med onc already! That is a biggie! And someone who is a go-getter as far as trying new treatments. Here's hoping that the multi-target approach will do you a lot of good and NED will be back in the nest.

Re: Liver Mets Update & maybe some good news re: Perjeta
 

I would agree, Steph, about a multi-target approach. Sometimes we're able to take advantage of local treatments to supplement chemo and targeted therapies.

I remember when I was at Sloan I had to fly under the radar to get an RFA in 2008. At the time, it was like an RFA was blasphemy to them, or something like that. But the times they are a changin' and more oncs are considering local options for select patients who might benefit them.

Joan

Re: Liver Mets Update & maybe some good news re: Perjeta
 

Kim, Fortunately you are able to continue with coverage for your health care. Hope you are tolerating Taxotere better (or Perjerta if you start it) and that it's very effective in getting the markers down for you. Wishing you continued improvement.

Re: Liver Mets Update & maybe some good news re: Perjeta
 

Hi Kim I am glad you like your new onco. Kaiser does have limited choices of doctors but the good thing is that everything is done within kaiser so u don't have to go different places for different procedures. Good luck with everything!

Re: Liver Mets Update & maybe some good news re: Perjeta
 

Also wanted to mention, that the radiologist did say that Cyberknife might still be an option for me later on if I'm able to reduce the amount of tumors in my liver with systemic treatment first.

The radioembolization sounds like a pretty agressive treatment that I might consider if I find myself running out of options, but definitely not ready to go there yet!

Here is a very informational video from Stanford that details the procedure for anyone who is interested.
http://www.youtube.com/watch?v=3WwSfGPQq9g

Re: Liver Mets Update & maybe some good news re: Perjeta
 

Kim I am sorry you have these stubborn liver mets. I know you wanted to save TDM1 for later but can you get some if you want? It may be an easier option. Michka

Re: Liver Mets Update & maybe some good news re: Perjeta
 

Kim, Thanks for posting Dr. Sze's video. I have had email exchanges with him. Joan

Re: Liver Mets Update & maybe some good news re: Perjeta
 

Hi Kim just wanted to wish you the best of luck in the upcoming year and also to share with you that my Mom Sheila who passed away Dec 10, 2012 youngest brother works at Kaiser Permanente in interventional radiology there in California. His name is James Brown. If you see him please tell him how much his sister Sheila has meant to you and to this site.

Jen

James Brown RT
(R)(CV)
Lead IR Technologist
Kaiser Permanente

Baldwin Park

Re: Liver Mets Update & maybe some good news re: Perjeta
 

Kim i am having Abraxane for liver mets and find it easy to tolerate. Could you swap over? Every week for 3 weeks is the way to go.

Re: Liver Mets Update & maybe some good news re: Perjeta
 

Thank you for posting that video. Really interesting. My doctor, also, is not willing to Cyberknife the liver if there is more than one area of activity. Hopefully you will get the Perjeeta and it will knock those liver mets back. Your new oncologist sounds wonderful, and sounds like she will be aggressive in whatever you need to do to get this under control. So wonderful that you found someone that you feel confident in and communicate well with. Lots of prayers headed your way...