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Rich66 · 11-20-2009, 10:49 AM

Ahdubose,
I haven't heard of any problems with painkillers other than opiate based as Lani posted. It may just be morphine at high doses in surgical setting. But it might make sense to minimize/avoid opiates until this settles out. The pre-med issue seems easier since one could just get the non-steroidal flavor.

Carolyn, Herceptin at 3 weeks may be just fine since it is such a different animal than other "chemos". But when I think of antibiotics, more frequent seems to be better. I was just floating the hypothetical..just me yapping.

I have to mention 3 of the forum's liver mets success stories that I'm aware of got to NED and stayed there by way of MTD. Steph (Taxol), Andrea (Taxotere) and MamaCZ (Navelbine). So it's pretty hard to get dogmatic about any of this. It seems all 3 were pretty sturdy going in so they might have been good candidates for that approach. It would be good to know if they made it through without unscheduled breaks or growth factors. The continuity part seems to be the key to metronomic therapy. I am currently confused on the growth factor issue, having seen it portrayed as everything from detrimental to a therapy option in its own right. Not sure if it has to do with the difference between G-CSF and GM-CSF. Becky researched this heavily for her adjuvant therapy and went with GM-CSF. If you have info at hand, serve it up.

Ellie brings up an interesting (to understate it) concept: Oncs being peer pressured into treatment decisions. Oncs don't work in isolation and may feel like they have to go by the book even when their judgement says otherwise. There are probably liability concerns lurking in their decisions as well. Do what 9 out of 10 oncs would do and avoid controversy. From the perspective of career protection (hard to think of things this way), it wouldn't surprise me. I think an onc has to be pretty secure in their career to follow their own judgement to that degree.

Ellie, did the patient who did secret metronomic Xeloda do continuous days or the 1 wk on/1 wk off schedule? Did she take around 500mg? I would love to know more about her specifics. It seems similar to one of the case studies in the metronomic thread.

I think the most intriguing aspect of the metronomic approach is the idea it might give new life to previously "failed" treatments in patients who are really beat down and thinking they are out of options. Maybe a couple are reading this right now. There are also numerous drug approaches to reverse resistance..seems we never hear of anyone using either one of these approaches to replenish the toolbox. It's just..had that, got use out of it..step through the list and don't look back. And when a treatment is revisited, it seems to be done in the MTD setting. How many folks could be bettered if they used schedule and/or drug approaches to regain sensitivity with manageable toxity? There seems to be the idea out there that in metastatic setting, sequence or combination of drugs don't change survival, only toxicity. Have they employed all the tools in the best way when they arrive at that assertion?

11-20-2009, 10:49 AM	#16
Rich66 Senior Member Join Date: Feb 2008 Location: South East Wisconsin Posts: 3,431	Re: Toolbox makeover? Ahdubose, I haven't heard of any problems with painkillers other than opiate based as Lani posted. It may just be morphine at high doses in surgical setting. But it might make sense to minimize/avoid opiates until this settles out. The pre-med issue seems easier since one could just get the non-steroidal flavor. Carolyn, Herceptin at 3 weeks may be just fine since it is such a different animal than other "chemos". But when I think of antibiotics, more frequent seems to be better. I was just floating the hypothetical..just me yapping. I have to mention 3 of the forum's liver mets success stories that I'm aware of got to NED and stayed there by way of MTD. Steph (Taxol), Andrea (Taxotere) and MamaCZ (Navelbine). So it's pretty hard to get dogmatic about any of this. It seems all 3 were pretty sturdy going in so they might have been good candidates for that approach. It would be good to know if they made it through without unscheduled breaks or growth factors. The continuity part seems to be the key to metronomic therapy. I am currently confused on the growth factor issue, having seen it portrayed as everything from detrimental to a therapy option in its own right. Not sure if it has to do with the difference between G-CSF and GM-CSF. Becky researched this heavily for her adjuvant therapy and went with GM-CSF. If you have info at hand, serve it up. Ellie brings up an interesting (to understate it) concept: Oncs being peer pressured into treatment decisions. Oncs don't work in isolation and may feel like they have to go by the book even when their judgement says otherwise. There are probably liability concerns lurking in their decisions as well. Do what 9 out of 10 oncs would do and avoid controversy. From the perspective of career protection (hard to think of things this way), it wouldn't surprise me. I think an onc has to be pretty secure in their career to follow their own judgement to that degree. Ellie, did the patient who did secret metronomic Xeloda do continuous days or the 1 wk on/1 wk off schedule? Did she take around 500mg? I would love to know more about her specifics. It seems similar to one of the case studies in the metronomic thread. I think the most intriguing aspect of the metronomic approach is the idea it might give new life to previously "failed" treatments in patients who are really beat down and thinking they are out of options. Maybe a couple are reading this right now. There are also numerous drug approaches to reverse resistance..seems we never hear of anyone using either one of these approaches to replenish the toolbox. It's just..had that, got use out of it..step through the list and don't look back. And when a treatment is revisited, it seems to be done in the MTD setting. How many folks could be bettered if they used schedule and/or drug approaches to regain sensitivity with manageable toxity? There seems to be the idea out there that in metastatic setting, sequence or combination of drugs don't change survival, only toxicity. Have they employed all the tools in the best way when they arrive at that assertion? __________________ Mom's treatment history (link)