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		|  03-03-2012, 07:26 PM | #1 |  
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				TDM1-Are my Side Effects Normal?
			 
 
 Hello Everyone,
 
 I have recently finished my second treatment of TDM1 and am experiencing some symptoms I am wondering are normal.  Below is a list of them...
 
 -migraine/headache in left temple (uncomfortable pressure inside head)
 -chest pressure
 -joint pain (mild)
 -heavy and multiple periods (during 1st treatment)
 -blood work showed extreme elevation in liver enzymes (one wk/post treatment)
 -low white cells and platelets
 -shedding(very light but noticeable)
 
 I would appreciate it if anyone can chime in with their TDM1 experiences.  Not sure if this drug is as tolerable as I had initially thought.
 
 Nelly
 
				__________________Feb/2010-Diagnosed with IDC ER+, PR+, Her2+++(age 28)
 Mar 2010- 6 Rounds of FECT (made me sick as a dog)
 Jun 2010- Finished chemo
 Jul 2010- Mastectomy +12 lymphs (4+)
 Oct 2010- Radiation/Begin Herceptin (Her2 was overlooked by my Onco!)
 Sep 2011- End of Herceptin
 Nov 2011- Recurrence-->Chest Wall, muscle, and possible lymph (ER+, PR-, Her2+++)...WTF!!!???!!!
 Feb 2012-Randomized for Clinical Trial
 Feb 2012- Begin blind study either TDM1 w/Pertuzumab or TDM1 w/Placebo Pertuzumab
 Jan 2013-2nd Recurrence, off TDM1...what next?
 Feb 2013-chest wall resection
 Feb 2013-Begin Zoladex :(
 Apr 2013-Begin Femara
 Jul 2013-Oopherectomy + both tubes
 Oct 2013-Chest wall recurrence same spot...Dr monitor
 Nov 2013-New nodule on chest...restaging...bone/ct   clear...continue to monitor
 Mar 2014-Surgeon fr/dif hospital confirms lung metasis based on review of CT scan from Nov...Onc recommends Aromasin/Affinitor...
 Apr 2014-Start Herceptin+Vinorelbine
 Sep 2014-New pain in lower back, MRI confirms metastasis
 Oct 2014-SBRT to lungs
 Nov 2014-SBRT to lower back
 Dec 2014-Restaging confirms two new nodules to lungs and lower spine :(
 Jan 2015-Xeloda and Tykerb (good response)
 Aug 2015-Xeloda/Tykerb not working...Dr wants to try Taxol/Herceptin combo...problem, Herceptin not covered by OHIP
 Sep 2015-Begin Taxol continue Xgeva
 Oct 2015-Add Herceptin
 Nov 2015-CT stable but MRI shows new mets to spine :(
 Jan/Feb 2016-Start Erubulin (Halavan)
 May 2016-Progression...Stop Erubulin
 June 2016-PMH to explore Clinical Trial options...consideration for Immunotherapy
 July 2016-Screening for Trial...Still without treatment, experiencing low appetite, low energy, pain, and rapid wieght loss...cachexia???
 
 
 
 You never know how STRONG you really are...until being strong is the only CHOICE you have...
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		|  03-04-2012, 01:04 PM | #2 |  
	| Senior Member 
				 
				Join Date: Nov 2005 Location: Ireland 
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				Re: TDM1-Are my Side Effects Normal?
			 
 I'm sorry to read you're finding this tough to tolerate Nelly, I have no personal experience but hope someone else can help you and just wanted to wish you well on this study. 
				__________________Tricia
 Dx July '05 IDC 1.9cm Triple positive 3/9 nodes positive
 A/C X 4 ..Taxol/Herceptin x 12 wks then herceptin 1 yr
 Rads x 36 ..oophorectomy August '06
 Currently taking Arimidex..
 June 2011 osteopenia/ zometa x1 yearly- stopped Zometa  2015 as Dexa show normal bone density.
 Stopped Arimidex July 2014- Restarted Arimidex 2015  for a further two years on the advice of my Onc.
 2014 Normal Dexa scan
 2018 Mammo all clear, still NED!
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		|  03-04-2012, 01:23 PM | #3 |  
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				Join Date: Sep 2005 Location: Central Coast, CA 
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				Re: TDM1-Are my Side Effects Normal?
			 
 Hi Nelly, 
I was on TDM1 for a long time, and experienced many of the S/E you describe.  Low platelets is probably the most common one.  Many people (myself included) also have elevated LFT's.  I'll comment below by line on my experience:
 
-migraine/headache in left temple (uncomfortable pressure inside head) - Not exactly, but I did have mild headache/flulike symptoms 2-3 days after infusion. 
-chest pressure I did not experience this 
-joint pain (mild) - I did have this 
-heavy and multiple periods (during 1st treatment)  I was post menopausal, so don't know 
-blood work showed extreme elevation in liver enzymes (one wk/post treatment)  Whoa baby, yes I did.  AST was off the chart, with ASL and ASP also elevated. 
-low white cells and platelets  WBC not so much, but platelets yes 
-shedding(very light but noticeable) Well, I didn't NOTICE it   
I also had, day 4 of my first infusion, pain at tumor site.  I wonder, does the chest pressure seem like it might be that?  I'd get that checked out if not.
 
Overall, in the grand scheme of things, TDM1 is NOT as easy as plain vanilla Herceptin, but is far far more tolerable than traditional chemos.   Also to consider, if you are in the Pertuzumab arm there could be additional side effects.
 
Hang in there!
				__________________Chris in Scotts Valley
 June 2002 extensive hi grade DCIS (pre-cancer-stage 0, clean sentinal node) Mastectomy/implant - no chemo, rads. "cured?"
 9/2004  Diag: Stage IV extensive  liver mets (!) ER/PR- Her2+++
 10/04-3/05 Weekly Taxol/Carboplatin/Herceptin , complete response!
 04/05 - 4/07 Herception every 3 wks, Continue NED
 04/07 - recurrence to liver - 2 spots, starting tykerb/avastin trial
 06/07 8/07 10/07 Scans show stable, continue on Tykerb/Avastin
 01/08 Progression in liver
 02/08 Begin (TDM1) trial
 08/08 NED! It's Working!  Continue on TDM1
 02/09 Continue NED
 02/10  Continue NED.  5/10 9/10 Scans NED 10/10 Scans NED
 12/10 Scans not clear....4/11 Scans suggest progression 6/11 progression confirmed in liver
 07/11 - 11/11 Herceptin/Xeloda -not working:(
 12/11 Begin MM302 Phase I trial - bust:(
 03/12 3rd times the charm? AKT trial
 5/12 Scan shows reduction!  7/12 More reduction!!!!
 8/12 Whoops...progression...trying for Perjeta/Herceptin (plus some more nasty chemo!)
 9/12 Start Perjeta/Herceptin, chemo on hold due to infection/wound in leg, added on cycle 2 &3
 11/12 Poops! progression in liver, Stop Perjeta/Taxo/Herc
 11/12 Navelbine/Herce[ptin - try for a 3 cycles, no go.
 2/13 Gemzar/Carbo/Herceptin - no go.
 3/13 TACE procedure
 
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		|  03-05-2012, 09:41 AM | #4 |  
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				Join Date: May 2011 
					Posts: 137
				 
		 
		 
		
		 
		
		
	
		
	
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				Re: TDM1-Are my Side Effects Normal?
			 
 Hi Nelly,  
I just came off tdm1 after it kept me stable for 10 months. 
 
Headaches- no
 
chest pressure- yes... mild to begin with, but after awhile it became uncomfortable at some point and had a complete heart/lung work up.  For me it was coming from a distressed GI tract.  I was put on a proton pump inhibitor (prilosec) and given a round of carafate.  The symptoms eased up after that.  But definitely mention to your onc!  
 
joint pain- yes, especially the first few days after treatment
 
Heavy periods, YES- not multiple in my case, just very heavy complete with PMS and cramps    
Liver enzymes elevated- yes, but not drastically so...
 
Low blood counts- yes, again not drastically so, except for my platelets which were close to the cut off for not being able to do chemo, but I was given the go ahead by the study.
 
I did shed initially- not a lot, but some.  But then as treatment went on, my hair became lush and thick and people kept asking if it was a wig!! Ha    
Chrisy was right on about the fact that Pertuzumab could also be combining with the tdm1 to give some of the symptoms.  
 
Just keep holding on!  tdm1 totally wiped out my liver mets after 3 treatments and shrunk the remaining tumors.  They then stayed stable for 10 months.   Fingers crossed you will see a similar response!
				__________________3-16-11 dx IDC 4.4 cm tumor, right breast,HER-2 neu 3+++, Stage III
 3-25-11 PET scan shows 3 mets to liver and 1 to spine, Stage IV
 4-12-11 start clinical trial of TDM1 infusion 1x every 3 weeks.
 6-14-11 CT scan after 3 cycles shows NO liver spots, reduced spinal met from 18mm to 13mm and right breast mass from 4.4 to 4.2 cm.
 8-12-11 Mastectomy rt. breast.
 10-11 scans reflect stable cancer
 12-11 MRI reveals area of concern in brain, CT scan reveals 3mm spot on lung.  Watch and wait and rescan in a few weeks.  Round 13 TDM1 complete.
 2-21-12 Scans reveal progression in lungs with 4 new small mets.  Officially off tdm1.  Start halaven and radiation for single brain met, 1 spot in spine.
 3-13 stereotactic radiosurgery for single brain met.
 5-31-12 Halaven stopped due to low blood counts. Start tamoxifen and cont. Herceptin 1x3 weeks.
 7-11-12- brain mri shows shrinking brain met and no new lesions. Cont. Herceptin and Tamoxifen
 10-2-12 Stable tumor markers.  Continue Herceptin and Tamoxifen
 4-9-13 progression in lymph node under arm and new lung spots.  Stop Tamoxifen. Add Xeloda to Herceptin.
 6-10-13 Stereotactic radiosurgery to two new brain mets. Stop Xeloda due to lung mets progression. begin Tykerb 7-2-13.
 10-29-13 Begin radiation to my lungs and one lymph node under my arm.  Stop Tykerb until completion and then recommence.
 1-31-14 Progression in lungs.  Oophorectomy performed.
 2-18-14 Begin Arimidex and continue Herceptin
 7-7-15 progression with spots on colon, in pelvic region, and in lungs.  Begin Taxotere, Perjeta and Herceptin.
 11-15 Switch to weekly Taxol, and continue with Perjeta and Herceptin.
 12-23-16 PET scan shows Complete Response with no new spots.  Continue on with TPH indefinitely.
 3-16-16 Still no evidence of disease, break from Taxol.  Continue on with Perjeta and Herceptin.
 
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		|  03-07-2012, 04:48 PM | #5 |  
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				Join Date: Mar 2011 
					Posts: 8
				 
		 
		 
		
		 
		
		
	
		
	
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				Re: TDM1-Are my Side Effects Normal?
			 
 Hi Nelly,
 I've been on T-DM1 since May, and will finish my clinical trial of treatments in April.
 
 My experience was that many of the side effects you mentioned lessened over time.  My LFTs were so high initially that I had to have my dose knocked down at first, but after a few treatments they stabilized, and I was allowed to re-escalate the dose.  They are still high, but have slowly dropped over the months.
 
 My white cells & platelets are low, still.  Some nosebleeds in winter, but not too much.
 
 Headaches - only during the first week - better as the months have gone by.
 
 Chest pain - only the first few treatments, then stopped.
 
 Periods - non-issue - they stopped back with Adriamycin before I even started T-DM1.
 
 No shedding.  My hair seemed to be growing slowly at first, but it has sped up over the past couple of months.
 
 Joint pain and muscle aches - this has been the most annoying for me, and the side effect that has not lessened over time.  I take lots of Advil - particularly during the first week after a treatment.
 
 Still, as Chrisy said, it sure beats regular chemo!  I hope things improve for you.
 
				__________________ 
				Karen 
Age 49 1/24: dx IDC in right breast2/16: lumpectomy, axillary node removalpath: Stage 3 grade 3 IDC, ER+, PR+, Her2+++, 5/13 nodes3/10: began 4x AC5/12: began 17x T-DM18/1: 6 weeks rads9/20: started Tamoxifen4/12: Last T-DM1 infusion!!!!
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		|  03-12-2012, 09:44 PM | #6 |  
	| Senior Member 
				 
				Join Date: Jan 2012 Location: Toronto 
					Posts: 64
				 
		 
		 
		
		 
		
		
	
		
	
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				Re: TDM1-Are my Side Effects Normal?
			 
 Thank you ladies for sharing your experiences with me.  I had my second treatment March 1 and unfortunately, it's taken me much longer to recover.  I actually felt feverish and thought I was about to come down with something but somehow I managed to stave it off.  However, now I have laryngitis!!!  It started with a sore throat a couple days ago and then bam, my voice just cut out.  Its been like this for two days now.  A dry cough is slowly developing now...I hope it's nothing serious.  My family DR is away till Thurs...I'm hoping that I will be better by then.
 Wishing you all the best in your treatments,
 
 Luv,
 
 Moi
 
				__________________Feb/2010-Diagnosed with IDC ER+, PR+, Her2+++(age 28)
 Mar 2010- 6 Rounds of FECT (made me sick as a dog)
 Jun 2010- Finished chemo
 Jul 2010- Mastectomy +12 lymphs (4+)
 Oct 2010- Radiation/Begin Herceptin (Her2 was overlooked by my Onco!)
 Sep 2011- End of Herceptin
 Nov 2011- Recurrence-->Chest Wall, muscle, and possible lymph (ER+, PR-, Her2+++)...WTF!!!???!!!
 Feb 2012-Randomized for Clinical Trial
 Feb 2012- Begin blind study either TDM1 w/Pertuzumab or TDM1 w/Placebo Pertuzumab
 Jan 2013-2nd Recurrence, off TDM1...what next?
 Feb 2013-chest wall resection
 Feb 2013-Begin Zoladex :(
 Apr 2013-Begin Femara
 Jul 2013-Oopherectomy + both tubes
 Oct 2013-Chest wall recurrence same spot...Dr monitor
 Nov 2013-New nodule on chest...restaging...bone/ct   clear...continue to monitor
 Mar 2014-Surgeon fr/dif hospital confirms lung metasis based on review of CT scan from Nov...Onc recommends Aromasin/Affinitor...
 Apr 2014-Start Herceptin+Vinorelbine
 Sep 2014-New pain in lower back, MRI confirms metastasis
 Oct 2014-SBRT to lungs
 Nov 2014-SBRT to lower back
 Dec 2014-Restaging confirms two new nodules to lungs and lower spine :(
 Jan 2015-Xeloda and Tykerb (good response)
 Aug 2015-Xeloda/Tykerb not working...Dr wants to try Taxol/Herceptin combo...problem, Herceptin not covered by OHIP
 Sep 2015-Begin Taxol continue Xgeva
 Oct 2015-Add Herceptin
 Nov 2015-CT stable but MRI shows new mets to spine :(
 Jan/Feb 2016-Start Erubulin (Halavan)
 May 2016-Progression...Stop Erubulin
 June 2016-PMH to explore Clinical Trial options...consideration for Immunotherapy
 July 2016-Screening for Trial...Still without treatment, experiencing low appetite, low energy, pain, and rapid wieght loss...cachexia???
 
 
 
 You never know how STRONG you really are...until being strong is the only CHOICE you have...
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		|  03-13-2012, 05:06 AM | #7 |  
	| Senior Member 
				 
				Join Date: Apr 2011 Location: Michigan 
					Posts: 1,173
				 
		 
		 
		
		 
		
		
	
		
	
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				Re: TDM1-Are my Side Effects Normal?
			 
 Dear Moi, I do believe you are living up to your saying! You are so strong keep up the good fight. I'll be praying for you. |  
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