"WE are confident vaccine prevents bc by preventing her2+ DCIS shows efficacy

[Lani]

I review Pub Med five days a week (they don't add anything Sunday or Monday) on breast cancer, as well as Breast cancer research and periodically Artemis (from Johns Hopkins), aacr publications, nci publications, and get on the list for various newsletters.

I look when conferences are being held and try to look up abstracts, news releases resulting from the conferences.

I read the BBC site daily and health information in the Wall St. Journal (lets me know when applications are made for fast-track approval, when FDA approvals occur) as well as Medscape News.

And that is just for breast cancer. I am helping several people with other problems research treatment possibilities including prostate cancer, esophageal cancer and avascular necrosis of the hip at the moment (it changes as different people ask me to research different things for them)

Tonight I just returned from a webcast simulcast of Dr. Mark Pegram and Dr. Cliff Hudis on her2 breast cancer--including the discussion of a lot of planned clinical trials of lapatinib with and without herceptin, Lapatinib and an AI, avastin and a taxane etc for early breast cancer.

They also discussed how they might treat the very elderly with herceptin and antihormonal therapy without chemo (I am trying to inform an 84 year old with her2+ breast cancer of her options).

They made it sound like there are going to be lots of important new revelations in San Antonio.

Let's hope so!

[skibunny]

Dear Lani,

Thank you for your information. Perhaps you can guide me on how to relieve back pain for my 87 year old mom who has breast cancer that has metastized to her back. My sister is with her in Florida and told me the x-rays show black dots along her spine which are tumors pressing on her bones which have caused them to crack. She just finished 16 days of radiation which was supposed to relieve pain and shrink the tumors. It has not done so. She was on Arimidex for 1/12 years after her bilateral mastectomy and the Dr. has switched her to Tamoxifin saying the Arimidex didn't work. She had a CAT scan of her body and the cancer has not spread anywhere else. She is taking oxycontin which is not helping. She was like the energizer bunny taking care of my 87 year old dad before this back pain started 2 months ago. Do you know of any treatments, medication, Dr. specialists, etc. for this? She lives in south Florida near Hollywood and Fort Lauderdale.

Thank you ,

Skibunny

[Lani]

I am not an oncologist, radiation therapist, oncology nurse, pharmacist or other with personal treatment experience but I can tell you from my reading:

1) when there are but a few of these there is a procedure by which orthopaedic surgeons inject bone cement into the vertebral body (the shape of a marshmallow normally) after an instrument has "jacked" up the height of the vertebra prior to injecting the cement. I suppose sometimes they don't jack it up much and just inject the cement in. It is called a vertebroplasty and keeps the bone from collapsing further IF this is the source of the pain rather than the nerves or spinal cord being impinged upon. Jacking up the vertebral body to its old height can relieve some symptoms of of impingement, but I don't know how many vertebral bodies can be involved before they decide it is too many to try to treat them all. It is a minimally invasive surgery, but a surgery and if you mom's condition is not that great that might influence whether they would consider it.
I will see if I can find any articles discussing how many might be too many

2) I am not a pharmacist but there are several papers on intravenous bisphosphonates for hypercalcemia from bone mets and that they seem to relieve bony pain from the mets as well sometimes.

I was trying to post some but this 2500 character rule botched it up.

Will have to return to do this later....

[Lani]

Lancet Oncol. 2006 Nov;7(11):894. Links
Zoledronic acid palliation in bone-metastatic breast cancer.

Furlow B.
PMID: 17099983 [PubMed - in process]

[Lani]

Drugs. 2004;64(11):1197-211. Links
Zoledronic acid: a review of its use in patients with advanced cancer.

Perry CM,
Figgitt DP.
Adis International Limited, Auckland, New Zealand. demail@adis.co.nz
Zoledronic acid (Zometa), a parenteral bisphosphonate, is an inhibitor of osteoclast-mediated bone resorption and is used in the management of patients with cancer. Zoledronic acid 4 mg is administered as an intravenous infusion over 15 minutes. In the treatment of bone metastases, zoledronic acid is the first and only bisphosphonate to demonstrate efficacy in patients with a broad range of tumour types and in multiple myeloma. In well-designed trials, a single 4 mg dose of zoledronic acid showed good efficacy in the treatment of patients with hypercalcaemia of malignancy. Zoledronic acid 4 mg was superior to pamidronic acid 90 mg, administered as a 2-hour infusion, as assessed by normalised serum calcium concentrations 10 days after administration. In conjunction with antineoplastic therapy, zoledronic acid was an effective long-term (up to 25 months) treatment for skeletal-related events in patients with bone metastases associated with multiple myeloma or solid tumours. In patients with bone metastases secondary to breast cancer or bone lesions from myeloma, zoledronic acid was at least as effective as pamidronic acid, based on assessments of skeletal-related events 25 months after the start of treatment. In addition, compared with pamidronic acid, the overall risk of developing skeletal complications, including hypercalcaemia of malignancy, was significantly reduced in recipients of zoledronic acid. Compared with pamidronic acid, zoledronic acid reduced the risk of patients with breast cancer developing a skeletal-related event by an additional 20%.

[Lani]

Zoledronic acid was significantly more effective than placebo on most efficacy measures in patients with bone metastases secondary to other solid tumours (e.g. lung, prostate) and showed sustained efficacy for up to 15 months. Preliminary data indicate that its efficacy in these patients is sustained for up to 24 months. Estimates of the cost effectiveness of zoledronic acid in the treatment of prostate cancer were consistent with those of other bisphosphonates, and cost-effectiveness ratios were within limits considered acceptable economic value. Zoledronic acid was generally well tolerated, with a tolerability profile similar to that of pamidronic acid and placebo. As with other bisphosphonates, deterioration of renal function has occasionally been reported in patients receiving zoledronic acid and monitoring of serum creatinine is recommended during treatment. The efficacy of zoledronic acid is therefore well established in patients with hypercalcaemia of malignancy and, for up to 25 months, in the treatment of complications arising from metastatic bone disease in patients with multiple myeloma or solid tumours. The clinical profile of zoledronic acid compares favourably with that of pamidronic acid in patients with cancer and zoledronic acid has a more convenient administration schedule with the potential for better compliance. Thus, zoledronic acid is an effective bisphosphonate and is positioned to play an important role in the management of advanced cancer patients with bone metastases.
PMID: 15161327 [PubMed - indexed for MEDLINE]

[Lani]

It may not be possible to do the vertebroplasty at any site that was already irradiated (radiation makes wound healing very slow) but it is unclear how wide the radiation field was (do you know?)

Also, if your mother's kidney function is not tip-top they may feel bisphosphonates are too risky;

Here is an article recommending radiating less times with a higher radiation dose:

ABSTRACT: Prospective randomised multicenter trial on single fraction radiotherapy (8 Gy X 1) versus multiple fractions (3 Gy X 10) in the treatment of painful bone metastases [Radiotherapy & Oncology]
Background and purpose: To investigate whether single-fraction radiotherapy is equal to multiple fractions in the treatment of painful metastases.

Patients and methods: The study planned to recruit 1000 patients with painful bone metastases from four Norwegian and six Swedish hospitals. Patients were randomized to single-fraction (8 Gy x 1) or multiple-fraction (3 Gy x 10) radiotherapy. The primary endpoint of the study was pain relief, with fatigue and global quality of life as the secondary endpoints.

Results: The data monitoring committee recommended closure of the study after 376 patients had been recruited because interim analyses indicated that, as in two other recently published trials, the treatment groups had similar outcomes. Both groups experienced similar pain relief within the first 4 months, and this was maintained throughout the 28-week follow-up. No differences were found for fatigue and global quality of life. Survival was similar in both groups, with median survival of 8-9 months.

Conclusions: Single-fraction 8 Gy and multiple-fraction radiotherapy provide similar pain benefit. These results, confirming those of other studies, indicate that single-fraction 8 Gy should be standard management policy for these patients.

[Lani]

especially since she lives in Florida

One thought: Get her in a pool. If it is above shoulder height it will mostly likely greatly reduce the force of gravity on her spine and relieve that part of her pain that is from the bone being too weak or the nerves being pinched. If there is something from the metastasis itself causing her pain (chemical rather than mechanical) this may not relieve her pain, but warm water is quite soothing and may give her some emotional relief.

Press her doctor on what pain relief methods may be available--I read about people abusing "fentanyl patches" which were meant for cancer patients. Many of these may be too strong for people of her age, especially if her liver or kidney function are not optimal.

If nothing else, you might ask to try a TENS machine. It works on the principal that, if you stub your toe AND THEN bite your finger, the latter relieves some of the pain of the former, as the brain cannot process two signals approaching it simultaneously from two places very well--it dampens the pain. The electrodes need to be placed between "the pain and the brain" so I guess up below her neck??? A pain specialist or physical therapist may be able to help you.

Again, I am just sharing information not making recommendations. I do
not claim ANY expertise. Just trying to pick my brain to see if I can impart any helpful information.