Herceptin or Tykerb ?
Diagnosed in 03/2010 with carcinoma breast (tumor 3 x 3 x 2) post right MRM , with infiltrating duct carcinoma , LN 1/19 + ve , ER & PR – ve and HER – 2 + ve (FISH test) . Received CEF x 3 and Docetexal x 4 and Herceptin . Taken inj Herceptin 360 mg IV 3 weekly for a duration of 1 year , final dose completed on 30/05/2011.
PET scan on 10/08/2011 suggestive of liver metastates and pre caval lymphatic metastates after completing above treatment schedule. Medical oncologist has prescribed Tykerb 250 mg x 5 times daily for 21 days and Xeloda 500 mg x 4 times daily for 14 days. Not prescribed liver biopsy as it will be risky and would be of no use in his opinion . Quiries 01) Should liver biopsy be done ? Can HER – 2 + ve turn HER – 2 – ve ? 02) There will be delay in starting chemo till biopsy wound is healed . Will it be harmful? 03) What are other targeted chemotherapy options available for liver metastates? |
Re: Herceptin or Tykerb ?
Hema had liver mets which got reduced/disappered in the latest PET scan.She is on Tykerb/Xeloda combination after 9 infusions of Herceptin.For her bone mets she is continuing Zoletrust infusion once in 3 montths.Hope for the best from the Tykerb Xeloda combination
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Re: Herceptin or Tykerb ?
Hi Alex
Here's my thoughts, remember I am not a doctor just a patient:) 1. Biopsy or not? This would not be a standard recommendation I think. Yes tumor biology CAN change but it is not all that common and the procedure is not without cost or risk. Your onc may be taking the "proof is in the pudding" approach which is what mine did. Assume the her2 status is unchanged and monitor effect of the treatment. 2. That said, the procedure has a quick recovery time so won't delay treatment. I started xeloda the next day and could have had the biopsy while on treatment. 3. Tykerb and herceptin are the only targeted therapies currently approved in the US. Others are in the pipeline but would only be available on a clinical trial. Nothing wrong with using the tried and true first. |
Re: Herceptin or Tykerb ?
You didn't ask this specifically but tykerb vs. Herceptin? Current thinking is to switch them up to confuse the cancer. This may be what your onc is thinking. Also, tykerb is a smaller molecule so crosses the blood brain barrier thus may be mire protective of the brain than herceptin which is good
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Re: Herceptin or Tykerb ?
@ pibikay@chrisy thanks a ton for your replies.
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Re: Herceptin or Tykerb ?
herceptin already taken for 1 year 12 infusions. Not going for liver biopsy . Started tykerb+xeloda . Review after 2 months.
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Re: Herceptin or Tykerb ?
Tykerb / Xeloda not working
15 Aug 2011 – Oral chemotherapy started – Tykerb 250, Xeloda 500 28 Feb 2012 – PET-CT Scan –hepatic metastasis,lymphatic metastasis,skeletal metastasis I.V. 3 weekly chemo started PacliALL given as suggested by Onco . What are other options ? _________________________________________________ Age 38 years 17 Feb 2010 – Mammography – Mass in right breast suspicious of malignancy 19 Feb 2010 – FNA from right breast – Duct carcinoma cells seen 04 Mar 2010 – Right radical modified mastectomy – tumor 3X3X2, LN1/19 +ve 15 Mar 2010 – Hormone receptor – ER negative, PR negative, c erb B2 – positive score3 25 Mar 2010 – Detection of HER-2/neu by FISH - positive 1 Apr 2010 – Chemotherapy Started – 3 CEF + 4 Docetaxel + Herceptin (3wkly X 17) 30 May 2011 – Course of Herceptin completed 9 Aug 2011 – CT Scan – focal lesion 3.2X2.9cm in segment IV of liver 10 Aug 2011 – PET-CT Scan – solitary hepatic metastasis, precaval LN suspicious mets 15 Aug 2011 – Oral chemotherapy started – Tykerb 250, Xeloda 500 28 Feb 2012 – PET-CT Scan –hepatic metastasis,lymphatic metastasis,skeletal metastasis |
Re: Herceptin or Tykerb ?
See if your doctor will keep you on the Tykerb but add in Herceptin with a chemo. I think you need to reconsider Herceptin.
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Re: Herceptin or Tykerb ?
The article below gives an overview of different treatment options:
"Beyond trastuzumab: novel therapeutic strategies in HER2-positive metastatic breast cancer." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3251862/?tool=pubmed |
Re: Herceptin or Tykerb ?
Herceptin and Tykerb attack the Her2 receptor at different levels, thus they have a potentiated effect. As far as I know there is still no way to determine at which level it will work for you except after seeing the effects. It's not unusual to prescribe both with or without Xeloda.
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Re: Herceptin or Tykerb ?
Onco suggested Navelbine + Gemcitabine . As per onco disease not responding to aggressive traetment being given .What are other options at this stage ?
_________________________________________________ Age 38 years 17 Feb 2010 – Mammography – Mass in right breast suspicious of malignancy 19 Feb 2010 – FNA from right breast – Duct carcinoma cells seen 04 Mar 2010 – Right radical modified mastectomy – tumor 3X3X2, LN1/19 +ve 15 Mar 2010 – Hormone receptor – ER negative, PR negative, c erb B2 – positive score3 25 Mar 2010 – Detection of HER-2/neu by FISH - positive 1 Apr 2010 – Chemotherapy Started – 3 CEF + 4 Docetaxel + Herceptin (3wkly X 17) 30 May 2011 – Course of Herceptin completed 9 Aug 2011 – CT Scan – focal lesion 3.2X2.9cm in segment IV of liver 10 Aug 2011 – PET-CT Scan – solitary hepatic metastasis, precaval LN suspicious mets 15 Aug 2011 – Oral chemotherapy started – Tykerb 250, Xeloda 500 28 Feb 2012 – PET-CT Scan –hepatic metastasis,lymphatic metastasis,skeletal metastasis 03 Mar 2012 - I.V. 3 weekly chemo started PacliALL (Paclitaxel ) given 05 May 2012 - PET CT Scan " Hypermetabolic hepatic , lymphatic and osseous metastates . Paclitaxel ineffective. |
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