Anyone on HERCEPTIN+AROMATASE INHIBITORS?

[heblaj01]

One reply (from Taffy) to an other posting revealed a fast & exceptional response to Herceptin+ Arimidex (+ fish oil supplements) after failing on chemo for recurrent disease.

Are there others being treated with at least Herceptin plus one of the aromatase inhibitors such as :
Letrozole (=Femara),
Anastrozole(Arimidex),
Aromasin (Exemestane),
Fulvestrant(Faslodex), etc...?

Did you get unexpected good & fast results for mets &/or primary tumours?

More responders to the regimen than one single woman would increase the probability it may be usefull to a larger population of patients.

Note:
A small clinical trial of Herceptin+ Arimidex is underway in Europe.
For those who are interested in the scientific background you may look at the articles listed in the following post
http://www.her2support.org/vbulletin...ad.php?t=23945

[Becky]

I am on Herceptin, Arimidex and fish oil but I do not have advanced/metastatic disease. I am Stage 2. I have been on Herceptin since mid June, 2005 and Arimidex since Sept 05. I will be on the combination until the end of September, 2006. I have taken fish oil before bc but only one 1g capsule a day. When diagnosed, I upped it to 3 per day and now I am on 5 per day (plus one flaxseed oil capsule as well).


Therefore, I am hoping this combination will reduce my chance of recurrence. After September, I will continue with the Arimidex for 4 additional years. At my next visit, my onco is going to run my estradiol levels to see how well (or if) the Arimidex is working. I will post that on this board. More importantly, if it is not working, I will post what my doc will be doing next (he is the best) so that will be important info. I got my ovaries removed in order to use the Arimidex.

Kind regards

Becky

[suzan w]

I am on Herceptin-every 3 weeks, for a year, and Arimidex-for 5 years...began both in Oct. 05. Also early stage...Am taking fish oil supplements, COQ10, calcium/d, magnesuim, glucosamine-chondriotin as well

[sadie]

I have finished w/chemo; Will have Herceptin-only treatment thru Feb '06;
Just starting radiation; Will start taking Arimidex after radiation.
This is news to me about fish oil being taken to help deter a recurrence.
I am only taking calcium & a multivitamin right now.
Should I be taking fish oil? Anything else?
I heard virgin olive oil is good to take, so I was going to start that.
Would that be a replacement for fish oil?
What about flaxseed oil?
I am also taking coQ10 50mg/day.
Should I take more now that I'm done with chemo?
My dr doesn't recommend anything to me.
She will respond to any questions I have, tho.
But I don't know what questions to ask when it comes to diet or supplemental vitamins etc

[Susan]

I am on 1 year of Herceptin, and monthy injections of Faslodex. I was Stage 1, no lymph node involvement, I had 4 A/C DD, radiation too. Everything is going good. Had my one year mammogram, and blood work up and everthing checked out good. I'll finish Herceptin in Dec 06. Faslodex for 5 years/

[sassy]

I had left mast, DD A/C, Taxol, and have been on Herceptin since June 05 and Arimidex following rads in November 05. Have also added Multi oils, COq-10, B6, glucosomin, Calcium with D, and multi. Not metistatic, no recurrence as yet--so far so good.


DX 2/05
triple positive
5/14 nodes positive
Stage II, grade 2

Sassy
________
LITTLESWEETY

[Roz]

I guess that leaves me to report on metastases. I had skin and lymph node involvement as well as a pleural effusion. Went onto Arimidex and Herceptin and it worked straight away. Next scan was NED, and has been this last 18 months since then. Good luck, my dear. We all have our own unique history and our own story. What happens to one doesn't mean a great deal to another's profile. But what it does do is give us all HOPE,---that we will be one of the ones to beat the odds, and that is what we must do--HOPE.

[R.B.]

Interesting post


Sassy - If the omega three six issue is in your thoughts the keys are DHA/EPA intake and balancing the omega threes and sixes.

In most diet six is already high. Multi oils include six. If the multi is your only source it would depend on the composition of the multi oil. If you are also getting six from other sources fish oil is preferable. Fish oils has lots of different fats in it including omega 9 a little six MCTs etc.

You might like to check out omega three and six throught the search engine above.

DHA is important. Women have a higher need and conversion rate than men assuming you metabolism is working well. The safest option has to be to help the body out and take it in the form of fish or similar.

Please talk to your advisor about any dietary changes.

DHA Oestrogen -

DHA/fats and oestrogen are definately linked - eg high exercising low body fat women losing reproductive cycles. I am off to look at annorexia etc to see if there is any information on the mechanisms.

RB

[DeborahNC]

I'm on Herceptin only for Stage 1. My onc does not give AI until Herceptin is completed, but has plans to for me to start when I'm through.

[R.B.]

More on fats and brains.

This time from the perspective of a search on anorexia.

Key phrase " In patents with acute and chronic inflammatory conditions, low tissue concentrations of omega-3 fatty acids and high concentrations of proinflammatory cytokines are found".

BC is considered by some at least in part to connect to the COX2s inflamatory pathways etc.

RB





1: Curr Opin Clin Nutr Metab Care. 2005 Jul;8(4):403-7. Related Articles, Links
Click here to read
Omega-3 fatty acids and anorexia.

Goncalves CG, Ramos EJ, Suzuki S, Meguid MM.

Surgical Metabolism and Nutrition Laboratory, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York 13210, USA.

PURPOSE OF REVIEW: To review the mechanisms of action of omega-3 fatty acids and their role in the brain, as well as their therapeutic implications in anorexia. RECENT FINDINGS: Recent studies have demonstrated that omega-3 fatty acids modulate changes in the concentrations and actions of several orexigenic and anorexigenic neuropeptides in the brain, including neuropeptide Y, alpha-melanocyte stimulating hormone and the neurotransmitters serotonin and dopamine. In patients with acute and chronic inflammatory conditions, low tissue concentrations of omega-3 fatty acids and high concentrations of proinflammatory cytokines are found, in association with anorexia and decreased food intake. The data suggest that omega-3 fatty acid supplementation suppresses proinflammatory cytokine production and improves food intake by normalizing hypothalamic orexigenic peptides and neurotransmitters. SUMMARY: Based on current data, omega-3 fatty acid supplementation has a role in the treatment of anorexia by stimulating the production and release of orexigenic neurotransmitters in food intake regulatory nuclei in the hypothalamus.

Publication Types:

* Review


PMID: 15930965 [PubMed - indexed for MEDLINE]

[R.B.]

I am NOT suggesting that anybody who has referred to being lean and fit as annorexic.

The point I am trying to illustrate is that some very fit people are very fat intake quantity but not type concious, which could give rise to huge omega three six imbalances, and MAY help explain why it is not just absolute weight that is a factor in BC.

I have postulated the scenario before but this is rather more authoritative and too the point.

RB



1: Prostaglandins Leukot Essent Fatty Acids. 2004 Oct;71(4):205-9. Related Articles, Links
Click here to read
A pilot open case series of ethyl-EPA supplementation in the treatment of anorexia nervosa.

Ayton AK, Azaz A, Horrobin DF.

Hull and East Riding Hospitals Trust, UK.

Anorexia nervosa (AN) carries the highest risk of morbidity and mortality amongst psychiatric disorders. The efficacy of current treatment approaches is limited. Despite the fat-phobic nature of the disease, poly-unsaturated fatty acids (PUFAs) have not received much research attention. Patients who consume western diet, which is rich in n-6 PUFAs and trans-fatty acids, are likely to develop severe n-3 PUFA deficiency during self-induced starvation. Re-feeding programmes do not take into consideration n-3 EFA intake, possibly leading to further n-3 PUFA deficiency during weight restoration, and this might contribute to the maintenance of the disorder. To test this hypothesis, we carried out a systematic case series of E-EPA supplementation in the treatment of AN. Seven young patients received 1g/day E-EPA in addition to standard treatment, and were followed up for 3 months. Three of them recovered and four improved. Randomised controlled trials are warranted to examine the effectiveness of E-EPA in AN further.

Publication Types:

* Clinical Trial


PMID: 15301789 [PubMed - indexed for MEDLINE]

[R.B.]

"FAS-dependent endogenous fatty acid metabolism, once considered a minor anabolic-energy-storage pathway in normal cells, has become a jack-of-all-trades in cancer cells".


More evidence as to the importance of fat mechanisms and cancer.

For me DHA EPA are the most likely areas to look at as they are essential to reproduction, have to be made in the body if not eaten, and we are eating less of them and our modern diet may be blocking the pathways to make them. Both are found in fish oil. Hereceptin, and tamoxifen both interact in this pathway and synergies suggest some chemos may too.

I wish they would do some large scale trials looking at outcomes based on fats content in tissues.

RB

ABSTRACT



1: Arch Immunol Ther Exp (Warsz). 2004 Nov-Dec;52(6):414-26. Related Articles, Links

Fatty acid synthase-catalyzed de novo fatty acid biosynthesis: from anabolic-energy-storage pathway in normal tissues to jack-of-all-trades in cancer cells.

Menendez JA, Lupu R.

Department of Medicine, Evanston Northwestern Healthcare Research Institute, Evanston, IL 60201, USA.

In 1994, Kuhajda and colleagues unambiguously identified the oncogenic antigen-519, a prognostic molecule found in breast cancer patients with markedly worsened prognosis, as fatty acid synthase (FAS),the key enzyme for the de novo fatty acid biosynthesis. It now appears that human carcinomas and their pre-neoplastic lesions constitutively over express FAS and undergo significant endogenous fatty acid biosynthesis. Moreover, FAS blockade specifically induces apoptotic cancer cell death and prolongs survival of cancer xenograft hosts. Therefore, FAS signaling seems to play a central role in the maintenance of the malignant phenotype by enhancing cancer cell survival and proliferation. This review documents the rapidly changing perspectives on the function of FAS in cancer biology. First, we describe molecular mechanism by which aberrant transduction cascades driven by oncogenic changes subvert the down-regulatory effects of dietary fatty acids, resulting in tumor-associated FAS insensitivity to nutritional signals. Second, we speculate von the putative function that hypoxia can play as the epigenetic factor that triggers and maintains FAS overexpression in cancer cells by inducing changes in gene expression and in metabolism for survival. Third, we explore the role that FAS exhibits in cancer evolution by specifically regulating cancer-related proteins such as Her-2/neu oncogene and estrogen receptor. Finally, we reveal previously unrecognized functions of FAS on the response of cancer cells to chemo-,endocrine-,and immuno therapies. These findings, all together, should ultimately enhance our understanding of how FAS-dependent endogenous fatty acid metabolism, once considered a minor anabolic-energy-storage pathway in normal cells, has become a jack-of-all-trades in cancer cells.

Publication Types:

* Review


PMID: 15577743 [PubMed - indexed for MEDLINE]

[R.B.]

"FAS-dependent endogenous fatty acid metabolism, once considered a minor anabolic-energy-storage pathway in normal cells, has become a jack-of-all-trades in cancer cells".


More evidence as to the importance of fat mechanisms and cancer.

For me DHA EPA are the most likely areas to look at as they are essential to reproduction, have to be made in the body if not eaten, and we are eating less of them and our modern diet may be blocking the pathways to make them. Both are found in fish oil. Hereceptin, and tamoxifen both interact in this pathway and synergies suggest some chemos may too.

I wish they would do some large scale trials looking at outcomes based on fats content in tissues.

RB

ABSTRACT



1: Arch Immunol Ther Exp (Warsz). 2004 Nov-Dec;52(6):414-26. Related Articles, Links

Fatty acid synthase-catalyzed de novo fatty acid biosynthesis: from anabolic-energy-storage pathway in normal tissues to jack-of-all-trades in cancer cells.

Menendez JA, Lupu R.

Department of Medicine, Evanston Northwestern Healthcare Research Institute, Evanston, IL 60201, USA.

In 1994, Kuhajda and colleagues unambiguously identified the oncogenic antigen-519, a prognostic molecule found in breast cancer patients with markedly worsened prognosis, as fatty acid synthase (FAS),the key enzyme for the de novo fatty acid biosynthesis. It now appears that human carcinomas and their pre-neoplastic lesions constitutively over express FAS and undergo significant endogenous fatty acid biosynthesis. Moreover, FAS blockade specifically induces apoptotic cancer cell death and prolongs survival of cancer xenograft hosts. Therefore, FAS signaling seems to play a central role in the maintenance of the malignant phenotype by enhancing cancer cell survival and proliferation. This review documents the rapidly changing perspectives on the function of FAS in cancer biology. First, we describe molecular mechanism by which aberrant transduction cascades driven by oncogenic changes subvert the down-regulatory effects of dietary fatty acids, resulting in tumor-associated FAS insensitivity to nutritional signals. Second, we speculate von the putative function that hypoxia can play as the epigenetic factor that triggers and maintains FAS overexpression in cancer cells by inducing changes in gene expression and in metabolism for survival. Third, we explore the role that FAS exhibits in cancer evolution by specifically regulating cancer-related proteins such as Her-2/neu oncogene and estrogen receptor. Finally, we reveal previously unrecognized functions of FAS on the response of cancer cells to chemo-,endocrine-,and immuno therapies. These findings, all together, should ultimately enhance our understanding of how FAS-dependent endogenous fatty acid metabolism, once considered a minor anabolic-energy-storage pathway in normal cells, has become a jack-of-all-trades in cancer cells.

Publication Types:

* Review


PMID: 15577743 [PubMed - indexed for MEDLINE]

[panicked911]

I am a strong triple positive (er, pr her2) started herceptain November 05 - while on tomaxifen - off tomaxifen in Dec. 05 began lupron shots and arimidex - nasty joint aches espceially when I wake up in the morning - fingers elbows, knees, hips and soles of my feet - it sucks - but what is the alternative ? Hoping it will get better when doen with herceptain in November - was recently put down to 1 every three weeks - symptoms a little better but.... only supplments are citri cal, multi, cq10 and folic acid and E.
I was told to be very careful of the supplments such as flaxseed oil b/c stringly er positive

Susanne

[R.B.]

Re flax seed.

Please use the seach facility above and check out the posts on flax seed.

Here is one, and there are others. Try flax seed and one word flaxseed in the search engine above - click on search.


http://www.her2support.org/vbulletin...ight=flax+seed


And here is one on fats. The potentially eostrogenic components of flaxseed should not be confused with the compontents of oils DHA EPA etc. They are not the same.

Flaxseed is high in omega three, and I understand the oil contains no phyto - oestrogens.

There does seem to be confusion on the role of flax seed and flax oil.

You may wish to print out the trials and show them to your onc or discuss them with whoever talked to you about flaxseed.

If you can provide any definative answers please do come back.

RB

[Lisa1962]

My initial diagnosis was Stage IV - mets to spine and liver - I take Femara and get avery 3 week infusions of Herceptin (I also get Zometa to protect my bones)

I was NED after 2 treatments

[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.