Brain mets...a plan, (T/X now, rads later?)

[julierene]

I asked my onc specifically about some protective notions of the tykerb/xoleda and he said that it didn't cross the blood brain barrier. (I feel like I get dizzy a lot more frequently, and headaches.) Is there something that is showing that it is?

[bailey]

That is weird because everything you will read about tykerb will tell you that it does cross the brain barrier - that's what is so great about tykerb to hopefully protect the brain from tumors. I have not heard of having headaches with tykerb/xeloda. The biggest side effects I know of are diarhea, nauseau, some vomiting,fatigue, rash on hands and feet - if you look up the drugs you will beable to see the side effects for yourself. You should let your Dr. know about the headaches because you should beable to get something for that. Also, sometimes it takes a few days till your body adjusts - do you have other side effects?

[hutchibk]

In my conversation with my doc on friday he assured me that Tykerb and Xeloda do cross the blood brain barrier. But we don't know if the Ty will eradicate the mets that we see. We have to go after those another way and hope that the Ty helps protect the brain from future mets.

[Esther]

When I spoke with Dr. Pegram at UCLA, he specifically said that for responders the Tykerb had a very high rate of success in preventin new brain lesions, and that the success rate in decreasing the size of existing lesions was in the single digits.

So some responders even see reduction in size in lesions already there. Tykerb and Xeloda do cross the BBB, that was evident in the clinical trials. You can do a search and get access to the trial results for further evidence.

[Lolly]

Here's an excerpt from GSK's web page on the data from Tykerb trials released last summer, along with the link to the site:

Tykerb Activity in Brain Metastases Associated with Breast Cancer
http://www.gsk.com/ControllerServlet?appId=4&pageId=402&newsid=843
"...analysis from the EGF100151 study (Late-Breaking Abstract) suggests that Tykerb may play a role in decreasing the occurrence of brain metastases. Indeed, in the interim analysis, only 4 patients experienced CNS relapse in the Tykerb -capecitabine arm versus 11 in the capecitabine alone arm.1
Another study (abstract #503) being presented today at ASCO provides preliminary evidence suggesting that Tykerb may be effective in treating brain metastases associated with breast cancer. The Phase II trial was conducted by investigators at the Dana-Farber/Harvard Cancer Center, the Universityof North Carolina, and Georgetown Universityand was sponsored by the National Cancer Institute’s Cancer Therapeutic Evaluation Program (CTEP). The trial evaluated Tykerb in 39 patients with ErbB2 positive breast cancer who had developed CNS metastases while on trastuzumab. As reported in the abstract, two patients achieved partial response as measured by RECIST, a linear measure of solid tumors. An additional five patients achieved stable disease for ≥ 16 weeks. Volumetric analysis, which is a more precise three dimensional measure of tumor volume, was performed in 20 patients. Eight of the patients (40 percent) showed volumetric decline in CNS lesions – five patients showed ≥ 30 percent volumetric decline and an additional three patients showed 15-30 percent volumetric decline. Although the trial did not demonstrate the hypothesized level of activity as assessed by RECIST, the study concludes that there is sufficient evidence of preliminary clinical effect to suggest that Tykerb can penetrate the CNS.2 The most common adverse events with Tykerb were diarrhoea (grade 3, 21 percent), fatigue (grade 3, 16 percent), and rash (grade 3, 5 percent).

Following the encouraging results from the CTEP trial, Tykerb is now being studied by GSK in a large, international, randomized Phase II study designed to assess the impact of Tykerb monotherapy on brain metastases by monitoring lesions in the brain using magnetic resonance imaging, a volumetric measure."