Anyone on HERCEPTIN+AROMATASE INHIBITORS?

[R.B.]

SADIE

Re fats - use the search facility on the bar above right and check out the posts on omega three six.

Flax oil is high in omega three.

There are not many substitutes for fish oil. There are some supplements made from algae. A google search using algae DHA and EPA should produce some suppliers.

RB

[snoopy]

Saw this earlier - http://www.nelm.nhs.uk/Record%20View...aspx?id=565643 Link is a little short in detail, but more to be revealed at the appropriate conference.

Was on a combiation of herceptin and arimidex - herceptin year has now finished so its arimidex alone (didn't want Tamoxifen from what I read about it in HER2 disease, so had oophorectomy). Currently NED

[MJo]

I have had 12 Heceptins and this is my third day on Arimidex. When I think about it, I'm amazed that I am taking a daily pill to prevent cancer. No side effects from Arimidex yet. MJo

[heblaj01]

Thanks to all for the answers.
I am quite please by this short survey (hope more replies to come).
Even if this is not a double blind clinical trial statistical results, one can be optimistic since of 7 women taking Herceptin & one aromatase inhibitor (5 on Arimidex,one on Faslodex,one on Femara) none has reported resistance & 2 (ROZ & Lisa) said they had fast & very good response to this combo.(one with Arimidex the other with Femara). These two cases of quick & strong response must be added to that of Taffy who was the trigger to this survey.
Also impressive is the variety of stages in which the combo works: both early non metastatic & later metastatic settings.
Those who are taking supplements such as fish oil seem to be OK

Mjo is not include in these figures as she just started on Arimidex

The other good news is the phenominally opportune scoop by snoopy in finding today's press release on the results of the clinical trial in Europe of the combo.
http://www.nelm.nhs.uk/Record%20View...aspx?id=565643
Roche announces results claiming trastuzumab combination with anastrozole increases progression-free survival for patients with advanced breast cancer. (Extract)
The TAnDEM study, conducted by Roche is a randomised, Phase III trial, which evaluated trastuzumab in combination with anastozole versus anastrozole alone as first-line therapy (or second line hormonal therapy) in 208 postmenopausal women with advanced (metastatic), HER2-positive and hormone receptor-positive (ER-positive and/or PR-positive) breast cancer. Patients received anastrozole at a dose of 1 mg daily until progression. Trastuzumab was administered in 2 mg/kg weekly doses (after an initial loading dose of 4 mg/kg) until disease progression.

This is not comparing Herceptin+Arimidex to Herceptin alone but it at least demonstrates that there is no antagonism between Herceptin & Arimidex ( which may be the case between Herceptin & Tamoxifen).

The press release has no details. Full reporting awaits the sept 29-oct3 2006 ESMO conference in Turkey.

[marymary]

I was diagnosed in 4/2002 at the age of 42. Large ER+, PR-, HER2+++ tumor w/mets to skin of affected (L) breast.

3 rounds neo-adjuvant A/C
mets continued to grow

Immediate left modified radical mastectomy -
13/13 positive nodes
6 months of Taxotere with i.v. Decadron to inhibit extreme allergic response
5,000 rads of radiation
Oopherectomy in February of 2003
Begin taking Arimidex immediately thereafter

Diagnosed in 4/2005 with two small brain mets, otherwise NED
Gamma knife 5/2005
Began taking weekly Herceptin
Discussed with Oncologist the possibility of staying on Arimidex. He stated that one could argue the Arimidex had failed, due to the presence of two small brain mets. However, I could also argue that since Arimidex may not cross the blood brain barrier, it had been extremely effective in my body but only "failed" in the part of the body it could not adequately infiltrate. Oncologist suggested that studies had been conducted which had not specifically demonstrated increased effectiveness with the combination of Herceptin & Arimidex. Theoretically, one could hypothesise that Herceptin would block the HER2 pathways, and the A/I would block the estrogen pathway and would be a very powerful one-two punch. In small studies, however, there was only a small advantage to the combination.

I like any advantage, however small, and seized it. I have been on Arimidex + Herceptin since metastatic diagnosis and remain NED. Only one lesion is visible on MRI and continues to shrink with each and every MRI. Most likely is necrotic.

I am still trying to get into the U of W vaccine trial and continually seek any promising treatment I can find.

Mary-

You ask, what is our aim? I can answer in one word: It is victory, victory at all costs, victory in spite of all terror, victory, however long and hard the road may be; for without victory, there is no survival.

Winston Churchill

[Marily]

I have been on Herceptin for almost 5 years weekly, It was given with Tamaxophin and then in my third year we added Lupron, until I had my ovaries removed a bit over a year ago. Now I take Aromasin along with my weekly Herceptin. Remain NED : )
Also take fish oil, flax seed oil, and coq10 vit e bcomplex calcium and vit c.
It is really interesting and exciting to see we seem to be on the same path even if we are from all over the world.
Hugs
Marily
Stage IV her2, er pr +++ mets to lymph, liver. lung , bone
r mast, 13 lymph AC/Tax Hercep
tamox-aromasin
ps seem to be getting back to Herceptin ok after my allergic response to it. Remain on weekly dose double diluted and given over 2 1/2 hours with benedry.. no adverse side effects and gradually decreasing benedryl by 1/2 than next week will have only 1/4. or 12.5mgm. Some cramping so restarted the quinine.

[kat in the delta]

I go to my Onc. tomorrow to see the results of my hormone levels---which I am sure I will be post menop. I had my uterus removed 6 yrs ago, but kept my ovaries. He mentioned either Arimidex or Femara, which my sister took and it make her jts/ ache/ Her Onc changed her to Aromasin and she says it is better altho she liked tamoxifen the best---but was on it for 5 yrs. She was not her2. like me. kat
Is there anything I need to know or ask him about before my visit ???? I just finished my only year on herceptin, but see another study of 2 yrs. What is the difference between the Bayer Serum test and the serum blood test/?, elissa(sp?) blood test etc,,,,,,kat

[R.B.]

This article gives an idea how complex the whole oestrogen issue is.

It further underlines it is not just a question of oestrogen produced in the ovaries,

BUT as important of even more important the oestrogen produced with the cancer cells and their supporting surrounds.

I have only skimmed bits of it. It will take a while to get to even begin to get to grips with but immediately rasied questions as to the balance of impacts of treatment protocols and whether it would be sufficent to halt local production whilst leaving wider body production alone (Implications for ovarian removal etc. for those to who longer term fertility is important etc) In this case I simply raise the questions as I have not looked sufficiently at the subject subject to do more than have questions.


RB



Sex steroid-producing enzymes in human breast cancer

http://erc.endocrinology-journals.or.../full/12/4/701

ABSTRACT

Biologically active hormones are produced and secreted from the endocrine organs, transported through the circulation, and act on their target tissues where their specific receptors are expressed (Fig. 1AGo). This system is known as the endocrine system, and biological features of hormone-dependent target tissues are generally considered to be influenced by the plasma concentration of the biologically active hormones. In addition, hormones can also act in the same cell (autocrine) (Fig. 1BGo) or neighboring cells (paracrine) (Fig. 1CGo) without release into the circulation. A large proportion of androgens in men (approximately 50%) and estrogens in women (approximately 75% before the menopause, and close to 100% after the menopause) are synthesized in peripheral hormone-target tissues from abundantly present circulating precursor steroids (Labrie et al. 2003), where the enzymes involved in the formation of androgens and estrogens are expressed (Fig. 1DGo). These locally produced bioactive androgens and/or estrogens exert their action in the cells where synthesis occurs without release into the extracellular space. This phenomenon is different from the autocrine, paracrine and classical endocrine action, and is called ‘intracrine’. In classical endocrine systems, only a small amount of hormone is generally utilized in the target tissues, and thereafter the great majority is metabolized or converted to inactive forms. On the other hand, an intracrine system requires minimal amounts of biologically active hormones to exert their maximum effects. Therefore, intracrine is an efficient mode of hormone action and plays important roles especially in the development of hormone-dependent neoplasms. It is also important to note that, in an intracrine system, serum concentrations of hormones do not necessarily reflect the local hormonal activity in the target tissues.



View larger version (42K):
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Figure 1 Summary of endocrine (A), autocrine (B), paracrine (C), and intracrine (D) actions. {701fig1}, inactive hormone; {701fig2}, bioactive hormone; {701fig3}, receptor; {701fig4}, promoter region of the target gene.


Sex steroids, such as estrogens and androgens, play important roles in various target tissues including reproductive organs. A majority of breast carcinoma tissues express estrogen (ER) and androgen (AR) receptors, and estrogens greatly contribute to the growth of breast cancers. Breast carcinoma tissues have been demonstrated to process intracrine activity. Locally produced biologically active estrogens act in breast carcinoma tissues. This mechanism has been considered to play a pivotal role in the proliferation of breast carcinoma cells. The blockade of this pathway potentially reduces cell proliferation of breast tumors, and it is very important to obtain a better understanding of sex steroid-related enzymes in breast carcinoma as potential therapeutic targets of endocrine therapy. Therefore, in this review we summarize the results of recent studies on the expression and regulation of the enzymes related to intratumoral production of sex steroids in human breast carcinoma tissues, and discuss the potential biological and/or clinical significance of intratumoral production of sex steroids in these carcinomas.

[heblaj01]

Robin has posted a very interesting article at http://www.her2support.org/vbulletin/showthread.php?t=24319

In it the researchers describe,among other things, two of the modes of action of Herceptin.
The attaching of Herceptin to the HER protein on the surface of cancer cells & the destruction of this protein is a relatively slow process while the activation of the PTEN (which control cell division) starts within 10 minutes. PTEN also appears necessary for Herceptin to be effective in any case.
So if a patient starts with a high level of PTEN it no only predicts that she likely will respond to Herceptin but also that she may respond very quickly.
This adds an other possible factor which may explain the fast response of some posters in this thread.

[Susan Rankin]

Hi,

I finished Herceptin this past Tuesday. I had been on it for one year, weekly infusions. I started Herceptin and Arimidex at the same time. I have recently changed to Femara hoping it will help my joint pain. I will post to report if I am feeling better after the Herceptin soon. It may be the Arimidex/Femara causing all the side effects. We will see.

Susan

[Bev]

Sadie,

In any case, you shouldn't be on antioxidants during rads. You would be aiding and abetting the enemy cancer cells. After rads, hit the old search key here. Search for Gina Popp's posts as her supplement advice seems reasonable. Good Luck, BB

[sadie]

Bev,
Thanks for THAT info. I had no idea!
I have 4 more rad days to go!

Thanks R.B. for your info too. I'll be checking it out so I can start as soon as I finish with my rad tx
Sadie

[fcrcm]

Well, sorry to be on the negative side. I have been on Herceptin, Zeloda and Arimadex since Nov. 2005 for bone, lymph and liver mets. My June scans showed a new bone mets in hip. I'm trying to figure out what to do next, or if this is to be expected.

Would love to hear from any others with experiences like mine.

fcrcm

[kat in the delta]

Sorry to hear of your new site. Zometa is given for bone cancer and also for osteoporosis to stop bone loss.
I am almost osteoporisis and my Onc gave my One 15min IV of Zometa while on Taxol and herceptin.
Now I will be on Arimidex, which causes more bone loss.so my Onc. is going to infuse me with Zometa again soon.
So sorry you have it in your hip--I know that is painful.
Be careful, too, don't fall....I might even get a walker if I were you.........keep me informed......my cousin has it in his vertebrae, hip, legs, lungs.......he is cont..rad and chemo. He first had surgery to put in a plate to support his leg to keep it from breaking on its own. He is a fighter.......was on a walker but finally has gotten a wheelchair, thank God--I worry about him-------he tries to do TOO MUCH--
You need to rest daily.......kat

[Annemarie]

I am stage 4. Diagnosed May 2000. Stage 3b. Her2+++. Single brain mets three times. Now on Herceptin and Femara and have been NED for 2 years.

[heblaj01]

Annemarie,
Thanks for replying;your post is very interesting on several points:
1. your onc is giving you Femara while you are HER-2 positive (but not ER+ ?)
2. you are young & anti estrogen medication such as Femara is usually
for postmenopausal ER+ cancer patients.
3. you are long term NED (congratulations & best wishes for 2007!) in spite of
a reccurent brain met.
How do you (or your onc) explain this nice success & the choice of regimen?
Did you get other treatments?

[AnnemarieF]

Hi,
I am her 2+++, ER+/PR+. I take Lupron for the Femara to work and then get 6 mg of Herceptin every three weeks. I also have been taking the Temodar for a year. My Dr. wants to put me on Tykerb once that gets approval and come off of the Herceptin. Really I pushed my Dr. to do all of these things and he was opposed but would do them if I got second opinions from respected oncologist. So that is what I did and he listened.

My Dr. wanted me to take Tamoxifen but I had read that Her 2+ patients don't respond that well and do better with aromatose inhibitors. That was a fight because he had to give it to me with Lupron and it is not protocol. Then I had met Christine and told my Dr. that I wanted Herceptin and he felt opposed because it does not cross the bbb. So I got a second opinion from a thought leader. I am doing well. I know I should go for a PET scan which gets me very anxious.
Annemarie

[Soccermom]

Thanks so much for this new info! I have been on Arimidex during Herceptin and now by itself for one year. I was 1 node +. This gives me a *sigh* of relief!

Marcia

[Carolyns]

Hi,

I am 50 years old. BC History - 1989 bc stage 2 in left breast CAF & mastectomy, 1999 bc stage 1 in right breast mastectomy and no further treatment, 2003 hysterectomy.

Feb. 06 diagnosed with mets to bone, skin, lymph nodes, chest wall ER+,
PR+ and Her+. Had spinal surgery to replace C6 due to spinal cord compression from cancer.

March 06, Started trial with Femara and Lapatinib (50% chance). Zometa monthly. Skin, chest wall, lymph nodes resolved within a few weeks.

3 month scans showed all except bones resolved but I had progression to liver - 7 tiny spots. Switched to Gemzar and Herceptin for 4 months liver spots down to 3 and described as the size of a few grains of sand. After 4 months we stopped chemo and did 15 treatments of radiation to spine C6 area. The radiation was originally planned for added protection after the surgery after some healing time. Resumed chemo for 1 more month 2 weeks after completion of radiation.

December scans showed only 3 specs on liver and bones show healing activity after initial flare effect. Third week in December switched to loading dose of Faslodex and continuing Herceptin weekly and Zometa monthly. I hope it works and will keep you posted.

Still don't know if I was getting Lapatinib during the trial or not.

Thanks, Carolyns

[kat in the delta]

Carolyns,
My cousin just had the same vertebrae replaced 1 week ago. She is not Her2+--at least I do not think she is--she is calling now. She just found out she had breast cancer 1 month ago......I wish you 2 could get together...Tell me how is that part of your spine or (neck) doing now ?? How long has it been since your surgery on it?? My cousin-55 is wearing a neck brace for now until it heals, i guess.....She is concerned because she is so tired....Let me know more about yourself....How do you feel?? kat in the delta I will send you her private e-mail address after telling her I found someone like her...... RSVP here/privately,-------------- kat in the delta