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Nguyen · 07-09-2021, 09:25 AM

Perhaps you should list your treatment history and tumor’s pathology. I recommend thread titled “Current and Future Management of Her2 Positive Metastatic Breast Cancer” (diplomatically get your oncologist to read this article if he/she is not up-to-date). In “Letter to a friend …” thread I listed my wife’s treatment history. Both are in section “Articles of interest”. Also, most members have their treatment histories as part of their signatures. Anyway here is the list from memory, therefore incomplete.

Endocrine (or hormonal): tamoxifen, raloxifene, letrozole, anastrozole, exemestance, faslodex, Everolimus,

Chemo: taxane family (taxol, taxotere, docetaxol, paclitaxol, nab-paclitaxol), vinca alkaloid family (navelbine, vinorelbine), 5-FU, capecitabine/xeloda, gemcitabine, anthracyclines family, eribulin, ixabepilone, I am sure there are a couple more.

Her2-targeted: trastuzumab, lapatinib, t-dm1, enhertu, margetuximab, pertuzumab, syd-985 (still in phase-3 trial), ZW-15 phase 2.

TKI inhibitors: tucatinib, neratinib, pyrotinib,

CDK 4/6 inhibitors: abemaciclib, palbociclib, ribociclib

PIK3 inhibitors: alpelisib, there are a few more in P1/P2 trials.

Immune check point inhibitors: atezolizumab, pembrolizumab. These are approved for triple negative bc, but remember bc is extremely heterogenous. If your tumour biology is highly positive for PD-L1 and there are CD8 T-cells in your tumour cluster, and you run out of options, perhaps your oncologist (need to be very up-to-date) can do something with these drugs in combination with others.

Some info that I glim from reading: a drug can be reused if there had been multiple years (can’t remember how long) since its last used. Most (perhaps all) drugs will change the tumor’s biology particularly if it has been used for long period. With two drugs with very similar mechanism of actions such as anastrozole and letrozole, usually only one is used, however if one reads closely the slight difference in their mechanism of action might enable the “unused” one to work especially in combination with another class (biologically synergistic) of drug. Metronomic chemotherapy, some chemo (or combination) is too toxic, metronomic method is the use of very low dose with short interval to exploit the angio genesis effect. The goal is to slow progression hopefully long enough for new treatment. If one runs out of option then perhaps discuss ideas in this paragraph with your oncologist.

If it’s been a while and particularly if the tumor suddenly progress very fast or to another organ/site, seriously discuss with your oncologist to re-biopsy to get the latest pathology information to guide treatment.

IF ANYONE RECOGNIZES ANY INACCURATE INFORMATION FROM ABOVE PLEASE CORRECT ME ASAP! THANKS.

Nguyen

07-09-2021, 09:25 AM	#3
Nguyen Senior Member Join Date: Nov 2005 Posts: 516	Re: treatments Perhaps you should list your treatment history and tumor’s pathology. I recommend thread titled “Current and Future Management of Her2 Positive Metastatic Breast Cancer” (diplomatically get your oncologist to read this article if he/she is not up-to-date). In “Letter to a friend …” thread I listed my wife’s treatment history. Both are in section “Articles of interest”. Also, most members have their treatment histories as part of their signatures. Anyway here is the list from memory, therefore incomplete. Endocrine (or hormonal): tamoxifen, raloxifene, letrozole, anastrozole, exemestance, faslodex, Everolimus, Chemo: taxane family (taxol, taxotere, docetaxol, paclitaxol, nab-paclitaxol), vinca alkaloid family (navelbine, vinorelbine), 5-FU, capecitabine/xeloda, gemcitabine, anthracyclines family, eribulin, ixabepilone, I am sure there are a couple more. Her2-targeted: trastuzumab, lapatinib, t-dm1, enhertu, margetuximab, pertuzumab, syd-985 (still in phase-3 trial), ZW-15 phase 2. TKI inhibitors: tucatinib, neratinib, pyrotinib, CDK 4/6 inhibitors: abemaciclib, palbociclib, ribociclib PIK3 inhibitors: alpelisib, there are a few more in P1/P2 trials. Immune check point inhibitors: atezolizumab, pembrolizumab. These are approved for triple negative bc, but remember bc is extremely heterogenous. If your tumour biology is highly positive for PD-L1 and there are CD8 T-cells in your tumour cluster, and you run out of options, perhaps your oncologist (need to be very up-to-date) can do something with these drugs in combination with others. Some info that I glim from reading: a drug can be reused if there had been multiple years (can’t remember how long) since its last used. Most (perhaps all) drugs will change the tumor’s biology particularly if it has been used for long period. With two drugs with very similar mechanism of actions such as anastrozole and letrozole, usually only one is used, however if one reads closely the slight difference in their mechanism of action might enable the “unused” one to work especially in combination with another class (biologically synergistic) of drug. Metronomic chemotherapy, some chemo (or combination) is too toxic, metronomic method is the use of very low dose with short interval to exploit the angio genesis effect. The goal is to slow progression hopefully long enough for new treatment. If one runs out of option then perhaps discuss ideas in this paragraph with your oncologist. If it’s been a while and particularly if the tumor suddenly progress very fast or to another organ/site, seriously discuss with your oncologist to re-biopsy to get the latest pathology information to guide treatment. IF ANYONE RECOGNIZES ANY INACCURATE INFORMATION FROM ABOVE PLEASE CORRECT ME ASAP! THANKS. Nguyen