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Old 05-11-2011, 03:49 AM   #1
fullofbeans
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more lung mets- what to do???

Hi all,

I have had a scan results today and all the lung mets have increased (I have 9 mets) on each sides with the biggest one being 9 mm (was 7) another increased from 4mm to 7.5mm and a new one appeared of 2 mm.

I have been on tykerb/herceptin and xeloda for 3 months now..

kind of running out of options.. i really was hoping that with this combo i would at least be stable.. I have been waiting and waiting to post good news but they have not come and every scans since my recurrence have been negative news.. I am getting rather tired and going back to this post helps me remind me that this board is a good place to find some fighting spirit. I am rolling with the punches today tho and can't stop crying..

Any idea, any of you who have had this combo working later and not at the beginning..?
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35 y/o
June 06: BC stage I
Grade 3; ER/PR neg
Her-2+++; lumpectomies

Aug 06: Stage IV
liver mets: 6 tumours
July 06 to Jan 07: 2*FEC+6*Taxotere; 3*TACE; LITT
March 07- Sept 07: Vaccination trial (phase 2, peptide based) at the UW (Seattle).
Herceptin since 2006
NED til Oct 09
Recurrence Oct 2009: to internal mammary gland since October 2009 missed on Oct and March 2010 scan.. palpable nodes in May 2010 when I realised..
Nov 2011:7 mets to lungs progressing fast failed hercp/tykerb/xeloda combo..

superior vena cava blocked: stent but face remains puffy

April 2012: Teresa Trial, randomised to TDM1
Nov 2012 progressing on TDM1
Dec 2012 blockage of my airways by tumours, obliteration of these blocking tumours breathing better but hoping for more- at mo too many tumours to count in the lungs and nodes.

Dec 2012 Starting new trial S-222611 phase 1b dual egfr her2+ inhibitor.



'Under no circumstances should you lose hope..' Dalai Lama

Last edited by fullofbeans; 05-11-2011 at 06:29 AM..
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Old 05-11-2011, 08:04 AM   #2
schoolteacher
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Re: more lung mets- what to do???

FB,

I have been wondering and thinking about you. I am so glad to hear from you today. Sorry about your scan results. Has anyone suggested Navelbine at the center you are receiving treatment from? Please let us know how you are doing.

Amelia
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Old 05-11-2011, 08:40 AM   #3
michka
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Re: more lung mets- what to do???

FB, I am so sorry you have to find another treatment. I don't like to know you are crying. We will help you to fight. I am sure more knowledgeable ladies will come in this discussion but I will share some thoughts.
I don't think the treatment you have now will start working better if you are progressing after 3 months. What did you have before the 3 month treatment with Tykerb/Herceptin and Xeloda? Did you have another Taxane since Taxotere? It seemed to have worked for you. Navelbine with Herceptin may be another option if you haven't tried it yet? I am sorry if I am asking questions but I do not remember what treatment you had in 2010. It would help to know in order to allow our sister "Brains" to think about treatment options. Hugs. Michka
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Old 05-11-2011, 09:53 AM   #4
ElaineM
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Wink Re: more lung mets- what to do???

I am sorry to hear about the lung mets. Several others have mentioned Navelbine. I think it was originally developed for lung cancer. Even though breast cancer is different than lung cancer my view is because it was developed for lung cancer it might work especially well for breast cancer that travels to the lung. I am not sure, but that seems to make sense to me. Herceptin and Navelbine is an accepted combo.
Take good care of yourself.
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Old 05-11-2011, 10:06 AM   #5
krisvell
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Re: more lung mets- what to do???

FOB,
I just want you to know that I am rooting, praying that you will get the right treatment to knock back your lung mets.
Hugs and Love,
Kris......
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Nottingham 6/9 - Grade 2 5.2cm, several nodes
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10/27/09 - Mastectomy RB
Path Report: RB No residual tumor pCR,
2 of 15 pos - .5mm largest micromets
12/18/09 - Radiation started (28)
02/05/10 - Finished Radiation
01/11/10 - Started Femara
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11/15/10 - Started Walter Reed BC Vaccine trial at
1/04/11 - Sibley Mem. Had to withdraw due to met
01/23/11 - Stage IV - Brain Met 1.6cm 1.7cm
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8/11 = Now think it's really necrosis
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12/11 - Necrosis gone AVASTIN worked.
12/11 - Bone &CT found


Oct '10 - Ran Hartford 1/2 Marathon to Thank Dr. Slamon for Herceptin!
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Old 05-11-2011, 10:40 AM   #6
radiant
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Re: more lung mets- what to do???

Well, I know it's disheartening, but at least your mets are small in size. Based on your profile, there is still tons of tx options available to you. abraxene, taxol, etc - navelbine, gemzar. I think you need to have had a taxene b4 you can get tdm-1 extended access, but I'm not sure. There's also a new mm-11 clinical trial that's having decent results (targeting the cancer w/herceptin).

HTH,
KIm
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Dx Stage 3C 2005, triple +, tons of lymph nodes as well. FEC, surgery, TCH, rads, herceptin 1 year. And, Aromasin.
2007 - recurrence to medistinal lymph node, Abraxene and Herceptin - took it down 50%
2008 - on Arimidex/Herceptin - stable lymph node.
2009 - stable on Arimidex/Herceptin
2010 - lymph node progression and liver mets.
2010 - went on Gemzar, Navelbine, Herceptin - Navelbine and Herceptin took liver mets down. lymph node slightly progressed.
2010 - did Xeloda & Tykerb - MAJOR progression in liver in only 6 weeks.
Dec 2010 - present - Ixempra/Avastin/Herceptin/Fasoldex - regressing
June 2012 - chemo break
Sept 19, 2012 - start t-dm1. Chose this over going back on Ixempra.
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Old 05-11-2011, 02:31 PM   #7
chrisy
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Re: more lung mets- what to do???

I was also going to suggest Navelbine as I know several have had good success combating lung mets with this - and of course you want to continue to target the her2 with herceptin or tykerb.

Agreed, you are dealing with "small" mets, but I am totally with you on how disheartening it is. There are many options.

I do wonder, are you certain these existing mets and the "new" one are really growing? They are all so small, possibly is it just they are picking up a slightly different "slice"?
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June 2002 extensive hi grade DCIS (pre-cancer-stage 0, clean sentinal node) Mastectomy/implant - no chemo, rads. "cured?"
9/2004 Diag: Stage IV extensive liver mets (!) ER/PR- Her2+++
10/04-3/05 Weekly Taxol/Carboplatin/Herceptin , complete response!
04/05 - 4/07 Herception every 3 wks, Continue NED
04/07 - recurrence to liver - 2 spots, starting tykerb/avastin trial
06/07 8/07 10/07 Scans show stable, continue on Tykerb/Avastin
01/08 Progression in liver
02/08 Begin (TDM1) trial
08/08 NED! It's Working! Continue on TDM1
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02/10 Continue NED. 5/10 9/10 Scans NED 10/10 Scans NED
12/10 Scans not clear....4/11 Scans suggest progression 6/11 progression confirmed in liver
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12/11 Begin MM302 Phase I trial - bust:(
03/12 3rd times the charm? AKT trial

5/12 Scan shows reduction! 7/12 More reduction!!!!
8/12 Whoops...progression...trying for Perjeta/Herceptin (plus some more nasty chemo!)
9/12 Start Perjeta/Herceptin, chemo on hold due to infection/wound in leg, added on cycle 2 &3
11/12 Poops! progression in liver, Stop Perjeta/Taxo/Herc
11/12 Navelbine/Herce[ptin - try for a 3 cycles, no go.
2/13 Gemzar/Carbo/Herceptin - no go.
3/13 TACE procedure
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Old 05-11-2011, 03:15 PM   #8
Pam P
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Re: more lung mets- what to do???

I don't have other suggestions in addition to what you've received from others. But want you to know I'm thinking of you and hoping to get a good working combo soon. So disappointing to know tykerb/xeloda failed for you in so short of time, but there are many other options so keep the faith and you'll find the one. Keep us posted. Pam
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Old 05-11-2011, 05:29 PM   #9
CourtneyL
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Re: more lung mets- what to do???

FOB - I am so sorry to hear about your progression. Do not lose heart, my dear. You've got plenty of options. Our stories are similar. I too progressed while on Xeloda and had a reoccurence in the lungs. Gemzar took care of them the first time and was an easy chemo for me to tolerate. The buggers came back in the lungs this February and I started on Gemzar again. So far my tumor markers have been plummeting so we think it is working on the lungs once again. I'll scan next week to confirm. If Gemzar is an option, I would highly recommend this drug to you. It can work. You'll find something. I KNOW it!
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4/17/08: Dx Stage IV at age 30 - extensive mets to liver, lungs, and bones. Er/Pr-, Her2+++
April 08-Aug 08:Taxotere, Cytoxan, Herceptin, Zometa - complete response!
Sept 08-Dec 08: Herceptin +Zometa for maintenance.

Jan 09-April 09: Brain mets. Add Tykerb. Watch and wait.
April 09: Gamma Knife 10 brain mets, add Xeloda.
Sept 09: Gamma Knife to 1 brain met.
Nov 09- April 10: Lung progression, add Gemzar to Herceptin, Zometa.
May 10- Sept 10: HER2 Vaccine Trial

Sept 10: Add Tykerb for more brain mets.
Oct 10: Gamma Knife to 7 brain mets.
Dec 10: Switch from Zometa to Denosumab.
Jan 11: Gamma Knife to 3 brain mets.
March 11: Gemzar/Herceptin for lung/bone progression.
April 11: More brain mets - Intrathecal Herceptin
June 11: Ixempra/Herceptin for lung, soft tissue progression.
Aug 11: Gamma Knife
Sep 11: Abraxane/Herceptin
Future: NED

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Old 05-11-2011, 08:49 PM   #10
Elizabethtx
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Re: more lung mets- what to do???

I have no further suggestions, but want you to know I am crying with you. This disease is an awful place to be. My hope is that you know you are not alone. We are praying and hoping that some new drug combination will be the answer! Hang in there, stay strong and fight to get the care you deserve.
Many hugs,
Elizabeth
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Nottingham score grade 2
Ki67 30%
3/2010 A/C 4 DD/2wks
5/2010 Herceptin/Taxotere 4D/3wks
8/2010 Herceptin until May 2011
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Pet scan Aug 2010 clear
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Old 05-11-2011, 11:24 PM   #11
Jackie07
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Re: more lung mets- what to do???

FB,

I did a web search using the following combination “DOC and Her2 breast cancer lung metastasis” and found this slide presentation:
Targeted Therapy for HER2 Overexpressing
www.primeoncology.org/Files/Doc/SLIDES/EPBreastBarcelona09/006Case5Aapro.pdf


Also, there's an impressive long-term survival case [found through PubMed database search] reported by a hospital in Japan. Notice that she's also Her2 positive and ER, PR negative:

Gan To Kagaku Ryoho. 2010 Nov;37(12):2760-2.
[A long-term survival case of local recurrence of breast cancer treated with combined modality therapy].

[Article in Japanese]
Katsuta E, Ohkubo T, Someno Y, Saguchi M, Aoyagi H, Takahata T, Hasegawa K, Hamada S, Kaneko J, Maejima S.
Source

Dept. of Surgery, Hasuda Hospital.

Abstract

The case was a 70-year-old woman. In 1997, the patient underwent pectoral muscle-preserving mastectomy and axillary/subclavicular lymph node dissection for the treatment of right breast cancer. Histological diagnosis was invasive ductal carcinoma (T2, N2, M0, Stage IIIA). She received a combination therapy with TAM and UFT for 5 years postoperatively. Because tumor recurrence occurred in right axillary lymph nodes in the 9th postoperative year, the patient underwent resection of these lymph nodes followed by 6 cycles of AC-based chemotherapy.

Multiple lung metastases occurred in the 10th postoperative year, and then, the patient received 8 cycles of DOC-based chemotherapy. In the 11th postoperative year, a mass appeared again in the right axilla, and 6 cycles of capecitabine-based chemotherapy was administered. In the 12th postoperative year, pulmonary metastasis was in progression and an increased right axillary mass were noted. Thus, the specimen extirpated in 2006 was examined again, revealing negative ER, negative PgR and positive HER2.

Six cycles of combined trastuzumab+PTX therapy were administered. Lung metastasis decreased in size, allowing a judgment of partial response. Because the right axillary mass had grown to 10 cm, and the patient's QOL was reduced, it was extirpated. The patient is scheduled to receive a postoperative radiotherapy, followed by resumption of chemotherapy.

Hang in there. We are fighting alongside you.
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Old 05-12-2011, 10:37 AM   #12
PinkGirl
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Thumbs up Re: more lung mets- what to do???

Sorry to hear this news FOB ... I don't have any chemo advice but
I'll keep all my fingers and toes crossed for you ...
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Old 05-12-2011, 02:32 PM   #13
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Re: more lung mets- what to do???

Is cyberknife an option for you? Seems to be the latest big buzzword in my area. Ceesun
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Old 05-12-2011, 04:12 PM   #14
JeanBeanie
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Re: more lung mets- what to do???

FOB
I was just recently Dx in March - I am stage Iv (lung, Liver and Bone) I had a partial hip replacement - after that my doctor started me on Hercpetin and Navelbine - she said with those two together showed 80% rate in treatment working. It is every week Herceptin and 3 weeks on and one week off for Navelbine.
Ask you doctor why not Navelbine -
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Old 05-12-2011, 08:35 PM   #15
Catherine
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Re: more lung mets- what to do???

FOB and JeanieBean...are you related??

So sorry to hear about the progression, FOB. Thank goodness there are ladies on our site that can offer some good advice. I am hoping and praying that the doctors can find the right meds for you. Take good care. Your US support team is here.

Hugs, Catherine
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Old 05-12-2011, 09:38 PM   #16
Adriana Mangus
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Re: more lung mets- what to do???

Hi FB,

When I was dx with a recurrence in 2003 I was placed on Navelbine+herceptin and it worked for two years!!
Have you asked your oncologist about this drug? From the posts I have read it works for most of us Her2+.

Much Love to you. Sending you a HUGE HUG!!!!!!!!

Adriana
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28 nodes neg
Er,Pr, Positive HER2 status unknown
2003- Recur to rt lung.July 16 ( B-Day!)
Her2+++ Er,Pr, Negative
2003 - Aug04--Navelbine + Herceptin
2004- 2007--
NED - Herceptin, only
2007 Feb-April Xeloda added to hereceptin
2007-May Back on Navelbine+Herceptin
2008-Feb-Mar 15 Ses Rad to Rt. Lung
2008- Oc 17 Add Tykerb to Herceptin
2009- June-- Discont Tykerb
2009 July 7--Current Taxol + Herceptin
2009 Dec--Discontinued treatment due to progression. Looking into cyberknife.
2010-Aug Accepted to TDM1, no SE, except liver count went up.
2010-2011 September got kicked out of the trial, due to a small spot found on lung.
2011- 2012 September thru early 2013 on Herceptin
2013- March Bone density shows small spot on 5th rib.
2013 - April 4th appt with onc. will post after discussing course of treatment.
2013-March-April Cyber knife to brain and radiation to rib. Chest --base line before chemo-CT-Scan stable for lung issue. CA2729 Normal.
2013 April Herceptin- TDMI
2013 Sept Herceptin + Perjeta . CA2729 within normal range. Brain and Pet scans October 31st. will post results.
2013 October Brain MRI- mixed response. Will see Onc/rad on Halloween.
2013 October/November Brain-MRI nothing new. Repeat MRI next year in May.

2013 December Continue Herceptin and Perjeta. Stable at the moment.
2014 February Brain MRI -clear!
2014 January Added Taxotere to Perjeta+Herceptin.
2014 March Stopped chemo-chest ct-scan next.

2014- March Scans shows tumor's larger, CA2729 higher. Discontinue Herceptin.
2014 April Perjeta+ Halaven
2014 April CA2729 went down 60 points after one cycle. Cough does not want to go away.
2014 June Continue on Perjeta + Halaven-- no more cough. Stable
2014 June Back on Herceptin + abraxane
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Old 05-13-2011, 03:02 AM   #17
fullofbeans
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Re: more lung mets- what to do???

Dear ladies thank you so much for all your advice,

yes I had thought about navelbine (which I can get) or indeed to some form of laser treatment (but money is an issue here) as I would be surprised that laser treatment would be on the NHS. Not only we have to fight we this awful desease but for many of us we have to fight to get the treatment that would be most appropriate, it is very tiring..

I know I should not care but do you lose your hair on Navelbine? and what are the most common side effects, at least xeloda is/was quite easy.

And yes Chrisy you are right they are small and are to tell about new one being a new one since it is quite small

Thank for your good thought I am slowly regaining faith in a potential victory, you ladies are fighters


Much love XOXOx

PS and no I am not related to jeanybeans
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35 y/o
June 06: BC stage I
Grade 3; ER/PR neg
Her-2+++; lumpectomies

Aug 06: Stage IV
liver mets: 6 tumours
July 06 to Jan 07: 2*FEC+6*Taxotere; 3*TACE; LITT
March 07- Sept 07: Vaccination trial (phase 2, peptide based) at the UW (Seattle).
Herceptin since 2006
NED til Oct 09
Recurrence Oct 2009: to internal mammary gland since October 2009 missed on Oct and March 2010 scan.. palpable nodes in May 2010 when I realised..
Nov 2011:7 mets to lungs progressing fast failed hercp/tykerb/xeloda combo..

superior vena cava blocked: stent but face remains puffy

April 2012: Teresa Trial, randomised to TDM1
Nov 2012 progressing on TDM1
Dec 2012 blockage of my airways by tumours, obliteration of these blocking tumours breathing better but hoping for more- at mo too many tumours to count in the lungs and nodes.

Dec 2012 Starting new trial S-222611 phase 1b dual egfr her2+ inhibitor.



'Under no circumstances should you lose hope..' Dalai Lama

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Old 05-13-2011, 04:43 AM   #18
JeanBeanie
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Re: more lung mets- what to do???

Morning FOB's
You do not lose your hair - it might thin out if you are on the medicine for a long period of time, what I did is cut my hair short. It does cause constipation. Hope this helped - best of luck and my prayers are with you.
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Old 05-13-2011, 09:16 AM   #19
greenacres
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Re: more lung mets- what to do???

I'm so sorry to hear about the progression. My thoughts and prayers are with you. Do you mind if I ask you a question? I see you started at Stage 1 - did you have any symptoms when you progressed? I am having some things going on and I don' tknowi f I should call my onc before my 6/7 appt. I'm just curious if you felt really, REALLY tired, had body aches, bone aches, and where, etc. Again, from reading all the other posts, it looks as though you have quite a few treament options still available to you. I am also Stage 1, Grade 3, Her 2+++ and er/pr neg. GOod luck to you. Sandra
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Call Back Mammo: 11/17/09
Biopsy: 11/25/09
Diagnosis Call: 12/2/09
Partial MX: 12/16/09. 3 LN clean.
6 Cycles Chemo (TCH) Jan-April/10; Herceptin all of 2010; 33 Rads complete 7/10. Herceptin done 12/10.
FOLLOW UPS:
Bil mammo, and Breast MRI 12/10 - CLEAN! (after a second lump was biopsied and BENIGN - showed giant cell reaction?).
Bil mammo 6/11 - CLEAN!
Left mammo 12/11 - CLEAN!
PET/CT scan 4/6/12 - CLEAN!
Bil mammo 8/12 - CLEAN!
November 2012 - Gallbladder Removed.
Bil MRI 2/13 - CLEAN!

http://www.caringbridge.org/visit/sandragreen
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Old 05-13-2011, 10:56 AM   #20
DeenaH
Senior Member
 
Join Date: Apr 2010
Posts: 129
Re: more lung mets- what to do???

First, I am so sorry. I am waiting for yesterday's PET/CT results, and am hoping for continuing stability in my lungs, but know the time will come when Tykerb/Herceptin won't be enough. I haven't read all of the other suggestions, but I noticed you had done the peptide vaccine in Seattle. There is a newer trial with the Tcell infusions especially for people who have already had the vaccine. Might be worth looking into. Also, what about TDM-1?

There are so many new things coming down the pipeline for HER2. Hang in there...you'll get through this too! You know you aren't alone.
__________________
March 2010: Diagnosed with Stage IIIC IDC with axillary, mammary and suplaclavicular node involvement. ER/PR -, HER2+++. 7cm tumor in right breast.
April 2010: Started neoadjuvent chemo. 4 DD A/C every 2 weeks, 4 DD Taxotere every 3 weeks with Herceptin weekly.
August 2010: Finished chemo!
August 20, 2010: PET/CT showed no cancer in any nodes, and only a little uptake to the breast.
September 9, 2010: Bilateral mastectomy with immediate reconstruction with implants and Alloderm.
September 16, 2010: Pathology report showed 18/51 positive axillary nodes, 3.2cm tumor. Granual sized cancer found in the fatty tissue between levels 1 and 2.
October 19, 2010: CT showed several spots on lungs and 1 spot on liver. Liver spot is 2mm, lung spots range from 2mm to 4mm. We don't know if they are cancer or not.
12/15/10: Brain MRI clear
1/7/11: PET/CT
1/13/11: Recurrence in lungs. Start Tykerb
5/13/11: Progression in lungs
6/3/11: Lung surgery to get tumors for chemosensitivity testing.
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