[chrisy]

Karen Z: over the past months with so many failures and treatment delays dur to my surgery issues, a lot of chemos have been tossed in the ring as far as ideas for "what next". The Perjeta/taxotere/H option was sort of a no brainer if I could get it. All other options for me generated the "why this vs. that?" question. So when she suggested carbo/Gemzar I tossed in what about navelbine. I've noticed this has had good activity in liver and lung mets (although true, as a much earlier treatment). Rugo felt in her experience it works better earlier in the game but also said they use it a lot at one of the east coast centers (I think Dana Farber). So maybe some personal or regional preference. We discussed (well, i asked and she explained) that both taxanes and vinca alkaloids (incl navelbine) hit cell division at the same point and are micro tubular disrupters, but they use different pathways and do not have cross resistance.

We didn't get in as deep with carbo/Gemzar other than I think they work differently from the taxanes, I had carbo (TCH) as part of my initial chemo with great response,and the dumb cancer hasn't seen Gemzar yet.

The interesting thing was I tried to toss it back to her in terms of which she thought was the better choice, and she did not really push back to the carbo/Gemzar option. In a way it was discouraging that at this point there are no clear and obvious choices, no "TDM1, absolutely!" game changers. On The other hand, navelbine is an "easier" treatment and I'm still pretty beat up by 5 cycles with a taxol followed by a one month break due to the surgeries then 2 taxotere cycles. And if navelbine works earlier rather than later, maybe not put it behind yet another chemo.

Her last words were "one step at a time". Which as usual, is wise advice.