Tykerb and Herceptin update....shrinkage...but..

[Ceesun]

Greetings to All, Wanted to provide some info on this combo I have been on for a year now. The lung met continues to shrink...when I had a first check last March there was shrinkage, this past July no change, and now shrinkage again. I know that I was off the combo for about 6 weeks this summer while out of the country. My onc says this is a good report and I am pleased. However, last July he said there was a few millimeter area on the other lung which he would watch. It appears that one has grown so he mentioned possible cyberknife as our hospital has a new machine, the largest in Michigan. He also said that there were "newer techniques now" so if it is BC I am in favor of that. I think it probably is BC since when I was on the trial in 2006 there was something "non-target" on the right noted by the trial nurse-- once I was on chemo just cleared up. The part I don't get is when I asked my onc if it is BC how come the larger area is shrinking and then this shows up. He said "sometimes it happens that way." I will ask him again after he confers with the tumor board. Any thoughts on this? Thanks Ceesun

[Jackie07]

Ceesun,

So nice to hear the good 'shrinking' news.

Your doctor is right - there are many ways to 'zap' the small tumor now. While researching for the treatment of brain tumor late last year, I was surprised to find the several newer, more precise radation platforms available - many of them I'd never heard of before!

We are fortunate to live in this day and age when many different tools are available to treat the menance of [breast] cancer. Enjoy the New Year - you are in good hands.

[schoolteacher]

Ceesun,

Glad to hear from you. Please keep us updated. I am really interested in your treatment since I also have lung mets.

Amelia

[Delaney]

Ceesun, maybe you have a 'partial response' to the treatment and that is why one area shows shrinkage and the other growth. Just a thought. I have been told I am showing a 'partial response' as the lung mets are shrinking but the skin mets are slowly growing, going to zap them with radiation soon. Hope the treatment works well for you, best wishes.

[Mary L]

Delaney, I am so sorry you are still dealing with those skin mets. I really thought the Herceptin would zap them. I hope the radiation works. Best wishes. Mary L

[Lani]

not only may your tumors be different than tumors in any other her2+ breast cancer cases, but each of your tumors/mets may be different from each other.

Each time the tumor mutates, either in response to a new treatment or to a change in the microenvironment or whatever else the new tumor may seed another area, or it may mutate after it is "planted" or it may be this met was from one of a large number of heterogenous clones in the original tumor or it may be that the breast cancer stem cell/progenitor cell of that met differentiated differently from another.

This is why mets when biopsied often end up having different hormone and her2 receptor status than the primary.

Makes it hard to fight your enemy when it is constantly changing...a reason to get biopsies of mets whenever possible--so you know what you are fighting!

Also a reason to use multiple modalities in the fight--surgery, focused ultrasound, various ablation procedures for the liver, perhaps radioactive iodine if met has Na-I symporter receptors on it(search my previous posts for Irene Wapnir, MD who may be doing this study), intrathecal therapies etc

Sorry to make this so complicated--but it IS complicated, that is the problem!

Glad the armory has a variety of ammunition!

[Ellie F]

Makes a lot of sense Lani!

Pity we don't have a one size fits all cure yet!!

The difficulty here in England is often there is a standard treatment that oncs follow and the options for alternatives are not available on the NHS. Maybe thats one of the reasons our survival rates are relatively poor!

Ellie