|
sorry I have been travelling (20 hours Tuesday, 14 hours today)
I spent over 1.5 hour producing a lengthy suggestion response, only to have my computer shut itself off and lose it). You do not mention your mother's age, concurrent medical problems or much information beyond what she was treated with--arimidex only. Considering the weird hours I might be able to respond, it is best if you list your concerns/questions and I will see if any of my reading of the literature could provide you with helpful suggestions as to what directions/info to pursue
In the meantime, I will just copy and paste something you might find interesting and suggest you go to the Clinical trials website, search liver mets+ Lani, metronomic chemotherapy+Lani in the search bar above
It is easiest to attempt to find treatments already approved (perhaps in new combinations) and trials rather than hoping new modalities (several of the articles you have cited) will come online in time to treat your mother's problem which is here-and-now and won't wait for the availability of some of these really hopeful treatments. If you chose the best treatment available for your mom's liver mets, perhaps they won't recur, or do so in five years or so when some of these potentially curative treatments might be more readily available. Sorry to be a downer, just a realist. But the good new is that a lot of these treatments are working and working well ie, radiofrequency ablation of liver mets when there are only a few.
Here are some ideas on metronomic chemo (giving tiny amounts, far below those usually associated with side-effects):
Metronomic Therapy
This exciting development was presented by Harold Burstein (Dana-Farber Cancer Institute) at 28th SABCS on "Emerging Therapies for Advanced, Metastatic Breast Cancer" (Burstein et al., 28th Annual San Antonio Breast Cancer Symposium (SABCS, 2005): Metronomic chemotherapy with and without bevacizumab for advanced breast cancer: a randomized phase II study). Metronomic therapy uses low doses of chemotherapy - often too low to have direct activity on the growth of the tumor cells themselves - given more continuously rather than intermittently (no prolonged drug-free break periods), often to cancer patients who can't tolerate or have already progressed on other therapies, including high-dose chemotherapy. Studies show that this "gentler" form of chemotherapy works not by direct antitumor action, but by directly effecting the vasculature of the tumor (the supportive blood vessel network penetrating into the tumors and supplying them with nutrients and oxygen) by blocking angiogenesis - the sprouting of new blood vessels that feed growing tumors. On the foundations of metronomic therapy, see Kaur & Budd (Curr Oncol Rep (2004): Metronomic Therapy for Breast Cancer); Kerbel & Kamen (Nat Rev (2004): The Anti-Angiogenic Basis Of Metronomic Chemotherapy) and Ferrara & Kerbel (Nature (2005): Angiogenesis as a therapeutic target); see also Emmenegger et al. (Cancer Res (2006): Low-Dose Metronomic Daily Cyclophosphamide and Weekly Tirapazamine: A Well-Tolerated Combination Regimen with Enhanced Efficacy That Exploits Tumor Hypoxia) and Bocci et al. (Ann Oncol (2005): Cyclophosphamide-methotrexate ‘metronomic’ chemotherapy for the palliative treatment of metastatic breast cancer. A comparative pharmacoeconomic evaluation).
The Burstein trial of metronomic therapy (MT) used a low-dose oral combination, CM (cyclophosphamide 50 milligrams daily + 2.5 milligrams methotrexate) with the addition of bevacizumab (Avastin), known to have anti-angiogenic activity. This MT + Avast regimen achieved significantly higher response rates than MT alone: MT alone only showed about a 10% response rate, while the MT + Avast regimen yielded about 3 times as high a response (29% response rate), with extraordinarily minimal increases in toxicity. And Colleoni et al. (Ann Oncol (2006): Metronomic low-dose oral cyclophosphamide and methotrexate plus or minus thalidomide in metastatic breast cancer: antitumor activity and biological effects) found that metronomic low-dose CM (cyclophosphamide (50 mg/daily) and methotrexate (2.5 mg twice daily on days 1 and 4)) induced a drop in VEGF, and was effective and minimally toxic; the addition of thalidomide did not improve results.
More recently, Laura Orlando and colleagues (Anticancer Drugs (2006): Prolonged clinical benefit with metronomic chemotherapy in patients with metastatic breast cancer) reported results and long-term follow-up for patients with metastatic breast carcinoma (MBC) who obtained prolonged clinical benefit with metronomic administration of CM (cyclophosphamide and methotrexate), finding that such metronomic chemotherapy can induce prolonged clinical benefit in MBC.
Feel free to put metronomic chemotherapy into pubmed, especially + ERBB2 breast cancer
Good luck!
|
Linear Mode
