Treatment Question

[phil]

You both have had a lot going on , as many of us have/ had too. As I read it all, I keep thinking about an independent second opinion w/ a bc specialist at a top research hospital. is your onc and ob/gyn at that type of hospital, like johns hopkins.? I am always skeptical of a doc " consulting " w/ a " friend ". No scans . or other data is exchanged, etc. my wife was stage iv in 06 , w/ liver mets. Shes been on herceptin almost the whole time, incl herceptin t dm-1. had TAC , then herc, w/ navelbine, ( 9 mos of stability ), herc w/ gemzar, ( 18 months of good effect ), then went to tykerb/xel ( 6 months good effect , awful s/e, ) , back to herc / carbo , briefly tried abraxane avastin, then to herceptin t dm-1.
Stopping herc is a ?, no scan since Oct is a ?, mis -diagnosis is a ? - could a tissue biopsy have been done ? maybe not , surgery is done , have to move on, but... We are always politely assertive , asking ? , docs see 12 -18 pts a day, very busy,
We are very glad to be at MGH , we left the suburbs because we knew we had to be aggressive . The first suburban onc was going too conservative. He wasnt even a bc specialist ! MGH is a top research hospital with a BC specialist center .
T DM-1 seems to work best w/ over -expression of her2 , not as well w/ estrogen, other hormonal influences. My wife has high her2 , ( FISH scale of 6 , anything over 3 is significant for gageing t dm-1 effectiveness, in my opinion ) she has no other known hormonal factors . I think it should be tried w. Stage IV Her2 w/ ER , PR +, as well , and will probably be even more effective when approved , w/ those types ,it then can be given at low doses w/ a greater variety of other drugs . Right now its in trials, "Theresa ", w/ a 2 out of 3 chance to get it, and a great trial at Sloan in NYC, and Farber in Boston, , where its first paired w/ taxol, and pertuzumab, then taxol gets dropped, and lower dose t dm-1 is continued . That one has randomized pert , 50/50, but EVERYONE gets the real cancer killer , t dm-1. I know theres alot of hype this yr about pert,. and it appears good , hopefully beter than herc., but its genetic . probably neds chemo to work at stage iv level. genetic drugs like herc./ pert keep cancer cells from repairing htemselve. I think my wife and other s have yet un-discovered sub-types of her 2 , where even if herc blocks the receptor, the cancer finds other pathways. pert seems to block more receptors ,and thats progress, but i like t dm-1 just blowing it all up , to make sure !
My advice is go w/ tykerb/ xel. It will surprise the cancer , ( thats part of the basic tx. theory ) hopefully for a long while , but always look ahead, frequent scans, a second opinion, trials ... best wishes always