Confused about Tykerb
 

Hi all,
Whenever I am confused I always come here and try to get answers. And thats what I am doing today.
This time the confusion is about Tykerb.

So let me first explain my diagnosis and treatment.
December 2004 found a lump in right breast
Right breast mastectomy: December 2004.
Stage 3C with 12 out od 22 nodes postive. 9cm lump Grade 3, ER+, PR+ (10%), her2+++
4 DD AC, 4DD Taxol
2 years of Herception every 3 weeks (now finished)
Tamoxifen and zoladex started in 2005 when my periods returned

SO I am done with Herceptin now and soon will be switching to AI with zoladex.
Now comes the new drug Tykerb.
My husband does his research and finds that Tykerb is a good medicine and can cross blood brain barrier.
I have 2 oncs, one is at a big cancer research center in Boston and the other is a community oncologist.
What I am confused is that is Tykerb something I should take now or keep it as an ammunition in case I need it at a later time.
If I was to take Tykerb now then would it be with Xeloda or tykerb alone. The community onc said there is no need of xeloda and she would not agree for it.

Is it a good idea to just take tykerb for 3-6 months?

My EF is down to 45-50% right now and is that sufficient to start tykerb?

Does anyone know how cardiotoxic is tykerb?

Please answer, I am all confused.

Dear Rupali,
Yes, lots of people are asking this same question - MicheleU is also Stage III and is in the process of trying to get it (and deal with the insurance issues). In the US, the FDA approval is for Stage IV in combination with Xeloda. So any other use, such as in your case without metastatic disease, would be considered "off label" and therefore a tougher decision and more difficult. But possible as Michele has found out.

Because Tykerb also targets HER2, there is still a concern with cardiac toxicity - maybe not as much but I don't know that there is a lot of data in this regard. I know that part of the qualification for the trial I am going into (Tykerb/Avastin) is, you guessed it, LVEF in normal range. So having an LVEF of 45-50% may put you at risk or preclude you from getting this drug. Might be better to get your heart back up to full strength first.

Also, remember you have had a lot of herceptin - seems like double the normal course of treatment.

It's a tough decision in your situation, I know. My advice would be to get your heart function back up before thinking about hitting it again with the Tykerb.

Is anyone considering taking tykerb just for 3 or 6 months?