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al from Canada · 01-30-2006, 08:07 PM

Dear Lisa,

Adding navelbine to the mix certainly will increase cyto-toxicity. Xeloda + navelbine + herceptin is an excellent combination! This could be your lucky day because, as I was reading your post, I was thinking ERB-1 and here you are: offered a trial with just that! This sounds like a very interesting study and the drug sounds like it could be a cousin of lapatinib, which is also an HER1 & HER2 inhibitor. The question is: can you get this drug WITH herceptin? I don't know if this matters but lapatinib has shown expodentially increased effacy when combined with herceptin. Also, will you be able to continue at least one cyto-toxic drug; like xeloda or navelbine, with the ERB inhibitor??

I know you are scared to death but: you must give this your best shot! Two reasons herceptin fails are #1, HER2 has a low over-expression and #2, the cancer sneaks through the back door as in the ERB-1 pathway.

I would consider the doing one of the following:

1. consider taking the HER2 serum test. I don't know if it is available in canada but it would give you and indicator of HER2 activity
2. find out your IHC and / or fish results fron your primary tumor, are you really a candidate for herceptin? If not, there is a very successful trial combining taxol and avastin (E-2100) you could consider
3. If you are strogly HER2 over-expressed, that is one more reason why the trial drug would probably work in you. Given your tumor load, I'm not convinced I would totally abandon the xeloda or navelbine.
4. can you get tested for VEGF over-expression? This would indicate if you would respond to avastin. Lapatinib is not approved therefore is not available outside of clinical trials. Avastin is approved for CRC therefore you may be able to get it "off-label"
5. If you really feel things are spinning out of control, call a U.S. center and get a second opinion asap. The five that immediately come to mind are: University of Philadelphia (Dr. Kathy Miller); Dana Faber (Dr. Eric Winer); UCLA (Dr. Mark Pegram); University of Washington State, (Dr. R. Livingston);and Cleveland Breast Cancer clinic.

You have taken a step in the right direction by finding this Board as there are may others here who have already walked in your shoes.

Good Luck,
Al

ps, where in Canada do you live?

From Canada you say?

01-30-2006, 08:07 PM	#2
al from Canada Senior Member Join Date: Jul 2005 Location: Ontario, Canada Posts: 722	could be better than a good day Dear Lisa, Adding navelbine to the mix certainly will increase cyto-toxicity. Xeloda + navelbine + herceptin is an excellent combination! This could be your lucky day because, as I was reading your post, I was thinking ERB-1 and here you are: offered a trial with just that! This sounds like a very interesting study and the drug sounds like it could be a cousin of lapatinib, which is also an HER1 & HER2 inhibitor. The question is: can you get this drug WITH herceptin? I don't know if this matters but lapatinib has shown expodentially increased effacy when combined with herceptin. Also, will you be able to continue at least one cyto-toxic drug; like xeloda or navelbine, with the ERB inhibitor?? I know you are scared to death but: you must give this your best shot! Two reasons herceptin fails are #1, HER2 has a low over-expression and #2, the cancer sneaks through the back door as in the ERB-1 pathway. I would consider the doing one of the following: 1. consider taking the HER2 serum test. I don't know if it is available in canada but it would give you and indicator of HER2 activity 2. find out your IHC and / or fish results fron your primary tumor, are you really a candidate for herceptin? If not, there is a very successful trial combining taxol and avastin (E-2100) you could consider 3. If you are strogly HER2 over-expressed, that is one more reason why the trial drug would probably work in you. Given your tumor load, I'm not convinced I would totally abandon the xeloda or navelbine. 4. can you get tested for VEGF over-expression? This would indicate if you would respond to avastin. Lapatinib is not approved therefore is not available outside of clinical trials. Avastin is approved for CRC therefore you may be able to get it "off-label" 5. If you really feel things are spinning out of control, call a U.S. center and get a second opinion asap. The five that immediately come to mind are: University of Philadelphia (Dr. Kathy Miller); Dana Faber (Dr. Eric Winer); UCLA (Dr. Mark Pegram); University of Washington State, (Dr. R. Livingston);and Cleveland Breast Cancer clinic. You have taken a step in the right direction by finding this Board as there are may others here who have already walked in your shoes. Good Luck, Al ps, where in Canada do you live? From Canada you say? __________________ Primary care-giver to and advocate for Linda, who passed away April 27, 2006.