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Old 03-09-2016, 11:50 AM   #1
Lani
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Thumbs up "significantly imroved" 2 yr disease ree survival if 1 yr of neratinib given after

completion of 1 yr of herceptin after chemo for Stages I-III her2+ bc


I previously posted about neratinib during SABCS


The Lancet Oncology


Volume 17, No. 3, p367–377, March 2016

Neratinib after trastuzumab-based adjuvant therapy in patients with HER2-positive breast cancer (ExteNET): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial

Prof Arlene Chan, MDcorrespondenceemail
, Suzette Delaloge, MD
, Frankie A Holmes, MD
, Beverly Moy, MD
, Hiroji Iwata, MD
, Vernon J Harvey, MD
, Nicholas J Robert, MD
, Tajana Silovski, MD
, Erhan Gokmen, MD
, Prof Gunter von Minckwitz, MD
, Bent Ejlertsen, MD
, Stephen K L Chia, MD
, Janine Mansi, MD
, Prof Carlos H Barrios, MD
, Prof Michael Gnant, MD
, Marc Buyse, ScD
, Ira Gore, MD
, John Smith II, MD
, Graydon Harker, MD
, Norikazu Masuda, MD
, Katarina Petrakova, MD
, Angel Guerrero Zotano, MD
, Nicholas Iannotti, MD
, Gladys Rodriguez, MD
, Prof Pierfrancesco Tassone, MD
, Alvin Wong, PharmD
, Richard Bryce, MBChB
, Yining Ye, PhD
, Bin Yao, MS
, Prof Miguel Martin, MD
for the ExteNET Study Group

Published Online: 10 February 2016
Article has an altmetric score of 17
DOI: http://dx.doi.org/10.1016/S1470-2045(15)00551-3 |
showArticle Info
This article can be found in the following collections: Breast cancer

Summary

Background

Neratinib, an irreversible tyrosine-kinase inhibitor of HER1, HER2, and HER4, has clinical activity in patients with HER2-positive metastatic breast cancer. We aimed to investigate the efficacy and safety of 12 months of neratinib after trastuzumab-based adjuvant therapy in patients with early-stage HER2-positive breast cancer.
Methods

We did this multicentre, randomised, double-blind, placebo-controlled, phase 3 trial at 495 centres in Europe, Asia, Australia, New Zealand, and North and South America. Eligible women (aged ≥18 years, or ≥20 years in Japan) had stage 1–3 HER2-positive breast cancer and had completed neoadjuvant and adjuvant trastuzumab therapy up to 2 years before randomisation. Inclusion criteria were amended on Feb 25, 2010, to include patients with stage 2–3 HER2-positive breast cancer who had completed trastuzumab therapy up to 1 year previously. Patients were randomly assigned (1:1) to receive oral neratinib 240 mg per day or matching placebo. The randomisation sequence was generated with permuted blocks stratified by hormone receptor status (hormone receptor-positive [oestrogen or progesterone receptor-positive or both] vs hormone receptor-negative [oestrogen and progesterone receptor-negative]), nodal status (0, 1–3, or ≥4), and trastuzumab adjuvant regimen (sequentially vs concurrently with chemotherapy), then implemented centrally via an interactive voice and web-response system. Patients, investigators, and trial sponsors were masked to treatment allocation. The primary outcome was invasive disease-free survival, as defined in the original protocol, at 2 years after randomisation. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00878709.
Findings

Between July 9, 2009, and Oct 24, 2011, we randomly assigned 2840 women to receive neratinib (n=1420) or placebo (n=1420). Median follow-up time was 24 months (IQR 20–25) in the neratinib group and 24 months (22–25) in the placebo group. At 2 year follow-up, 70 invasive disease-free survival events had occurred in patients in the neratinib group versus 109 events in those in the placebo group (stratified hazard ratio 0·67, 95% CI 0·50–0·91; p=0·0091). The 2-year invasive disease-free survival rate was 93·9% (95% CI 92·4–95·2) in the neratinib group and 91·6% (90·0–93·0) in the placebo group. The most common grade 3–4 adverse events in patients in the neratinib group were diarrhoea (grade 3, n=561 [40%] and grade 4, n=1 [<1%] vs grade 3, n=23 [2%] in the placebo group), vomiting (grade 3, n=47 [3%] vs n=5 [<1%]), and nausea (grade 3, n=26 [2%] vs n=2 [<1%]). QT prolongation occurred in 49 (3%) patients given neratinib and 93 (7%) patients given placebo, and decreases in left ventricular ejection fraction (≥grade 2) in 19 (1%) and 15 (1%) patients, respectively. We recorded serious adverse events in 103 (7%) patients in the neratinib group and 85 (6%) patients in the placebo group. Seven (<1%) deaths (four patients in the neratinib group and three patients in the placebo group) unrelated to disease progression occurred after study drug discontinuation. The causes of death in the neratinib group were unknown (n=2), a second primary brain tumour (n=1), and acute myeloid leukaemia (n=1), and in the placebo group were a brain haemorrhage (n=1), myocardial infarction (n=1), and gastric cancer (n=1). None of the deaths were attributed to study treatment in either group.
Interpretation

Neratinib for 12 months significantly improved 2-year invasive disease-free survival when given after chemotherapy and trastuzumab-based adjuvant therapy to women with HER2-positive breast cancer. Longer follow-up is needed to ensure that the improvement in breast cancer outcome is maintained.
Funding

Wyeth, Pfizer, Puma Biotechnology.
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Old 03-10-2016, 08:29 AM   #2
Debbie L.
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Re: "significantly imroved" 2 yr disease ree survival if 1 yr of neratinib given afte

Thanks for posting this, Lani.

So, what do we think of the information? I've heard that neratinib is a tough one, mostly d/t the diarrhea. Do you think that trying to manage the side effects for a whole year is worth the "significant" difference (2.3%, by my math) in disease-free survival? Maybe for high risk stage III but not for stage I (because the higher the risk, the higher the absolute benefit)?

Debbie Laxague
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Old 03-11-2016, 12:49 PM   #3
Lani
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Re: "significantly imroved" 2 yr disease ree survival if 1 yr of neratinib given afte

as professors of economics say: "it all comes down to a cost/benefit analysis"

Every patient must, in an imperfect world, gather the best info they can, evaluate whether that info is more likely or not to reflect the truth & be trusted ( how it was gathered, methodology, statistics, short- vs long-term results, whether data is representative, who paid for the study etc), and decide how the treatment fits their goals, tolerance of risk, tolerance of side-effects, likelihood of being able to complete the treatment, how they perceive their own risk &how much weight they give to each of these variables in the "big picture" and add in their own "intuition" about how each factor will play out.

Everyone places different weights on the likelihood they themselves will get for example diarrhea, how they tolerate it, how they can manage it with their job/lifestyle, how long they could alter their job.lifestyle if they had to, how long they could tolerate it & if it is worth it for a few absolute percentage points of avoiding recurrence which are actually a large percentage of relative percentage(eg if your likelihood it would not recur went from 98% to 99% that seems like a small difference...but your risk of recurrence went down by 50%--from 2% to 1%!)

These are totally personal individual things and I could never think of advising another person on this...only providing them info so they know what things to take into consideration and how to go about weighting the importance of each of them in looking at the overall picture (the same way you would in choosing a new cellphone)

Just so you know, at least 2 longterm trial publications have come out showing no difference in adding neoadjuvant lapatinib to herceptin when chemo was given as well & these papers looked much further out in the timeline of survival--so, perhaps the "education of the puppy dog" effect of chemo made the combination work less well, perhaps resistnce develops later, perhaps it is the nondividing dormant cells in the bone marrow that are the source of the recurrence surviving the treatment while the "sleep" sitting there like mold sits in your shower stall after you bleach it, adopting a spore form, waiting for moist conditions to come to life and plagure your bathroom again... and perhaps some other explanation.

More studies & more time will add to the picture, as will subdividng out the different subsubtypes of her2+ bc.



When making a treatment decisions there are no hard & fast right answers (disconcerting!), but that means personal preferences & input from intuition can play a part (a consolation!)

Debbie:
Also the overriding variable may be that when the additional costs are added in, I doubt insurance cos. & govts will pay for every her2+ patient 2 expensive medications instead of one, for just a few absolute percentage pts of increased survival. They will require biomarkers or genomic analysis etc tied to thpse who will fail without the addition of a 2nd expensive drig I would predict.



Hope this helps!
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Old 03-11-2016, 05:11 PM   #4
agness
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Re: "significantly imroved" 2 yr disease ree survival if 1 yr of neratinib given afte

I wonder how this worked for patients like me who had CNS invasion prior to systemic therapy with brain mets revealing itself later along.

Thx for sharing.
__________________
  • Dx 2/14 3b HER2+/HR- left breast, left axilla, internal mammary node (behind breast bone). Neoadjuvant TCHP 3/14-7/2. PCR 8/14 LX and SND. 10/21-12/9 Proton therapy to chest wall.
  • Dx 7/20/15 cerebellar met 3.5x5cm HER2+/HR-/GATA3+ 7/23/15 Craniotomy.
  • 7/29/15 bone scan clear. 8/3/15 PET clean scan. LINAC SRS (5 fractions) Sept 2015. 9/17/15 CSF NED, 9/24/15 CSF NED, 11/2/15 CSF NED.
  • 10/27/15 atypical uptake in right cerebellum - inflammation?
  • 12/1/15 Leptomeningeal dx. Starting IT Herceptin.
  • 1/16 - 16 fractions of tomotherapy to cerebellum, break of IT Herceptin during rads, resume at 100 mg weekly
  • 3/2016 - stable scan
  • 5/2016 stable scan
  • 7/2016 pseudoprogression?
  • 9/2016 more LM, start new chemo protocol and IV therapy treatment with HBOT
  • 11/2016 Cyberknife to temporal lobe, HBOT just prior
  • 12/2016 - lesions starting to show shrinkage
  • 8/2017 - Stable since Dec 2016. Temporal lobe lesion gone.
  • Using TCM, naturopathic oncology, physical therapy, chiro, massage, medical qigong, and energetic healing modalities in tandem. Stops at nothing.
  • Mother of 2 boys - ages 7 and 10 (8/2017) and a lovely partner with lots to live for.
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Old 03-12-2016, 05:20 PM   #5
donocco
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Re: "significantly imroved" 2 yr disease ree survival if 1 yr of neratinib given afte

Interesting question. Neratinib is an improved Lapatanib and Lapatanib (Tykerb) crosses the blood brain barrier. Ill bet Neratinib does but Im not sure. Ill check it ougt.

Paul
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Old 03-14-2016, 12:04 AM   #6
broccoli
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Re: "significantly imroved" 2 yr disease ree survival if 1 yr of neratinib given afte

Seems like it may. See this report: http://www.ascopost.com/News/36358
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2012-Feb-29 D-Day: IDC ER-/PR- HER2+++ Grade 3, Stage 3 - several biopsy proven positive nodes
2012-Mar - July: Neoadjuvant FEC-D + Herceptin (6 rounds)
2012-Apr: DVT in arm that received chemo - put on LMW Heparin
2012-Apr: Port installed
2012-Sep-7: Lumpectomy + ALND - pCR with residual DCIS
2012-Oct: Switched from LMW Heparin to Warfarin
2012-Oct-Nov: 30 days of rads
2013-Jan: Entered Adjuvant Metformin trial (Metformin or placebo for 5 years)
2013-Jan: Switched from Warfarin to Xarelto
2013-Mar: First signs of lymphedema
2013-May-16: Last Herceptin (17 doses in total)
2013-Jun: Port removed and anticoagulants stopped
2014-Mar: Lymphedema worsened and became unresponsive to treatment
2015-Apr: Started PENTOCLO protocol to attempt to improve radiation fibrosis
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Old 03-15-2016, 10:39 PM   #7
Lani
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Re: "significantly imroved" 2 yr disease ree survival if 1 yr of neratinib given afte

Journal of Clinical Oncology

© 2016 by American Society of Clinical Oncology
Translational Breast Cancer Research Consortium (TBCRC) 022: A Phase II Trial of Neratinib for Patients With Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer and Brain Metastases
Rachel A. Freedman⇑, Rebecca S. Gelman, Jeffrey S. Wefel, Michelle E. Melisko, Kenneth R. Hess, Roisin M. Connolly, Catherine H. Van Poznak, Polly A. Niravath, Shannon L. Puhalla, Nuhad Ibrahim, Kimberly L. Blackwell, Beverly Moy, Christina Herold, Minetta C. Liu, Alarice Lowe, Nathalie Y.R. Agar, Nicole Ryabin, Sarah Farooq, Elizabeth Lawler, Mothaffar F. Rimawi, Ian E. Krop, Antonio C. Wolff, Eric P. Winer and Nancy U. Lin
+ Author Affiliations

Rachel A. Freedman, Rebecca S. Gelman, Christina Herold, Nicole Ryabin, Sarah Farooq, Elizabeth Lawler, Ian E. Krop, Eric P. Winer, and Nancy U. Lin, Dana-Farber Cancer Institute; Beverly Moy, Massachusetts General Hospital; Alarice Lowe and Nathalie Y.R. Agar, Brigham and Women’s Hospital, Boston, MA; Jeffrey S. Wefel, Kenneth R. Hess, and Nuhad Ibrahim, The University of Texas MD Anderson Cancer Center; Polly A. Niravath and Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; Michelle E. Melisko, University of California, San Francisco, San Francisco, CA; Roisin M. Connolly and Antonio C. Wolff, Johns Hopkins University, Baltimore, MD; Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI; Shannon L. Puhalla, University of Pittsburgh Cancer Institute and Magee-Women's Hospital, Pittsburgh, PA; Kimberly L. Blackwell, Duke University Medical Center, Durham, NC; and Minetta C. Liu, Mayo Clinic, Rochester, MN.
Corresponding author: Rachel A. Freedman, MD, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215; e-mail: rafreedman@partners.org.
Abstract

Purpose Evidence-based treatments for metastatic, human epidermal growth factor receptor 2 (HER2)–positive breast cancer in the CNS are limited. Neratinib is an irreversible inhibitor of erbB1, HER2, and erbB4, with promising activity in HER2-positive breast cancer; however, its activity in the CNS is unknown. We evaluated the efficacy of treatment with neratinib in patients with HER2-positive breast cancer brain metastases in a multicenter, phase II open-label trial.

Patients and Methods Eligible patients were those with HER2-positive brain metastases (≥ 1 cm in longest dimension) who experienced progression in the CNS after one or more line of CNS-directed therapy, such as whole-brain radiotherapy, stereotactic radiosurgery, and/or surgical resection. Patients received neratinib 240 mg orally once per day, and tumors were assessed every two cycles. The primary endpoint was composite CNS objective response rate (ORR), requiring all of the following: ≥50% reduction in volumetric sum of target CNS lesions and no progression of non-target lesions, new lesions, escalating corticosteroids, progressive neurologic signs/symptoms, or non-CNS progression—the threshold for success was five of 40 responders.

Results Forty patients were enrolled between February 2012 and June 2013; 78% of patients had previous whole-brain radiotherapy. Three women achieved a partial response (CNS objective response rate, 8%; 95% CI, 2% to 22%). The median number of cycles received was two (range, one to seven cycles), with a median progression-free survival of 1.9 months. Five women received six or more cycles. The most common grade ≥ 3 event was diarrhea (occurring in 21% of patients taking prespecified loperamide prophylaxis and 28% of those without prophylaxis). Patients in the study experienced a decreased quality of life over time.

Conclusion Although neratinib had low activity and did not meet our threshold for success, 12.5% of patients received six or more cycles. Studies combining neratinib with chemotherapy in patients with CNS disease are ongoing.
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Old 02-18-2017, 10:41 PM   #8
waterdreamer
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Re: "significantly imroved" 2 yr disease ree survival if 1 yr of neratinib given afte

Neratanib has been a miracle drug for me. I am on it alone and it has changed my life. My doctor was going to put me on hospice prior to taking this drug. I was on O2 24/7 and my CEA was 967. Today I no longer need oxygen and at my last blood draw, my CEA was 150.
__________________
Breastfeeding when diagnosed with Her2+ May 2008
Oct 2008 Double mastectomy 22/28 lymph nodes positive
Decline chemotherapy (decision I regret)
Nov 2009 Mets to lungs and bones.
Dec 2009 Start Taxotere and Herceptin, T1, T3 heal completely and lungs are clear, T2 and first rib have lytic lesions. First rib becomes sclerotic. Considered stable.
May 2011, Onc calls progression and I cross over from comparison arm of clinical trial to TDM-1
Brain scan in Sept 2011 showed small tumor in right cerebellum, did Novalis radiation.


Feb 2013 < 1cm tumor in left frontal lobe. Did Novalis in March and latest scan shows no sign of brain metastasis.
Aug 2013 did 36th round of TDM-1 Due to TDM-1 side effects, shortness of breath, and difficulty getting my balance when getting out of bed, agreed with my oncologist to stop TDM-1.
Took a six week break, bone scan showed small uptake on left first rib. CT showed hypodensities in liver (too small to biopsy) and small nodule in lungs (mediastinal).
Started Navelbine weekly. Did one round with Herceptin.
Skipped next 2 rounds, due to neutropenia. Next chemo 7th Nov - have had 3 Neupogen shots, so WBC should look better... Did not tolerate Navelbine well.
December 2013 scans show no sign of active cancer.
March 2014 - currently only on Herceptin - brain MRI clear, PET/CT two nodules in right lung show uptake
May 2014 - stop Herceptin.
Sept 22, 2014 Brain MRI clear :) PET/CT Progression in lungs.
Sept 2014, Xeloda, Tykerb and Herceptin.
Nov 2014 - Decide to take a break from all treatment.
May 2015 - Brain met radiated with Novalis
July 2015 - Have progression in right lung.
Sept 2015 - Perjeta and Herceptin alone after a 9 month break from all treatment.
Nov 2015 - Thoracentesis 1500ml removed from right lung.
Dec 2015 - Two tiny 1mm brain mets radiated in right cerebellum.
Feb 2016 - Thoracentesis 2200ml drained from right lung
Feb 2016 - Stopped Perjeta and Herceptin and started back on Kadcyla as I had no previous progression on it. After 1 cycle of Kadcyla markers begin to drop. On second cycle add Keytruda.
March 2016 - Thoracentesis 1650ml drained from right lung.
April 2016 – Thoracentesis 1500 ml drained from right lung.
June 2016 – CT scan shows progression in right lung, as well as moderate pleural effusion requiring Thoracentesis.
June 2016 – Decide to stop Keytruda, and will do chemosensitivity test through Rational Therapeutics. Plan to continue on Kadcyla for next two cycles.
July 2016 - Start weekly Abraxane with Herceptin. WBRT with hippocampal sparing, Taking Namenda. 15 sessions over 3 weeks.
Aug - Dec 2016 - 2 infusions of Navelbine, very hard on my body and still dealing with anasarca (generalized edema) 1 infusion of Havalen
My doctor wants to put me on hospice.
Dec 23rd 2016 - I am granted compassionate use of Neratanib.
May 31st 2017 - still on Neratinib, feeling good.
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Old 02-23-2017, 06:55 AM   #9
Joannacco
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Re: "significantly imroved" 2 yr disease ree survival if 1 yr of neratinib given afte

I was reading your moving post. I also have a 5 1/2 year old son and a 9 year old daughter. Just finished my TCHP and I have surgery ahead of me in April. I really feel for you lady! You are trying everything and you will kick cancer's butt! Hang in there and continue to be strong. Question. I had an 8 cm patchwork line of IDC and it had one focal sample of LVI. It was grade 2. I also think I will get PCR from midway MRI. Did they do a Pet/CT scan on your whole body when you were first diagnosed and it was clear? It is so disheartening to think that you got a PCR from TCHP and were originally truly clear except for lymph nodes and then it all of the sudden metasticized. Ugh. My ca27 score was a 32 before my 5th chemo and it has inched up a bit from the original baseline. I just hope this doesn't happen to me.
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Old 02-24-2017, 05:48 AM   #10
TiffanyS
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Re: "significantly imroved" 2 yr disease ree survival if 1 yr of neratinib given afte

Thanks for posting Lani. I had heard of Neratinib before, but I didn’t know much about it. I am glad that it’s been a miracle drug for you waterdreamer, and I hope it continues to work for you for years to come.


¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬ ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬
12/15 – First mammogram
01/16 – Second mammogram and ultrasound.
01/16 – Meet surgeon and go for third mammogram, second ultrasound and biopsy. Surgeon confirms cancer in left breast and lymph nodes and sets surgery date.
01/16 – Chest scan and bone scan done– all looks good.
02/16 – Surgery - left breast mastectomy and 16 lymph nodes removed (8 had cancer).
02/16 – CT scan done – small nodules on lung but Doctor advises it’s post surgical. They will continue to monitor just in case.
03/16 – Meet radiation oncologist and find out results of Pathology Report. I’m told that I have locally advanced breast cancer, based on the size of my tumour (7 cm!) and the fact that they found cancer cells in eight lymph nodes. I’m also told that I’m HER 2 positive, with high levels of estrogen and progesterone and that my cancer is stage 3, grade 2.
03/16 – Meet oncologist and am told that my cancer is actually grade 3, and that I should have done chemo before surgery. Too late now!
03/16 – Start first of six doses of chemo (Carboplatin and Docetaxal) and Herceptin (for 18 months).
04/16 – Have port put in.
04/16 – Get second dose of chemo, but Docetaxal is left out due to liver enzymes being high. I was unable to get a full dose of Docetaxal after my first treatment.
06/16 – Finished chemo! One month off and then I start radiation.
06/16 – Start Tamoxifen.
07/16 – First radiation treatment – 24 more to go!
08/16 – Went for Genetic Testing to see if I have the BRCA gene. Tested negative for BRCA I and II
08/16 – Radiation oncologist biopsies “scar tissue” on my chest wall. I am told that I have a local recurrence and need to have rush surgery.
09/16 – Meet surgeon who advises that I need to meet with a plastic surgeon, as they will need to do a skin graft to close me up after surgery. Meet plastic surgeon and all looks good. A surgery date is set for October 4.
09/16 – Go for rush ultrasound, bone scan, breast MRI and CT scan.
09/16 – Meet oncologist who advises that the ultrasound and bone scan results look good, and that MRI shows three small masses at surgery site, but lymph nodes are clear. Still awaiting the results of the CT scan, but we are positive it will look good.
09/16 – Get a call from my oncologist, who advises that CT scan shows small spots on my lungs, and a large lymph node in the middle of my chest. This means the cancer has spread! She looks into getting me funded for TDM-1 and cancels my surgery.
10/16 – Meet oncologist, who advises that I have to take Perjeta before I can take TDM1. I start Perjeta/Herceptin every three weeks for an indefinite amount of time, and Taxol, which I will take two weeks in a row with one week off and then two weeks in a row for 8-16 treatments. Stop Tamoxifen.
10/16 – Meet surgeon, who reviews my CT scan and advises that the spots on my lungs may not be cancer, and that he doesn’t see a lymph node in my chest. He thinks it’s a spot on my lung. I’m feeling very confused! He advises that my oncologist doesn’t want me to have surgery to remove the three small masses on my scar line, as she wants to use them as a way to determine if the treatment is working. He advises that if they have not shrunk in 6 months, he will revisit surgery.
10/16 – CEA blood test to determine Tumour markers. Results were normal (2.7). My doctor advises that this could mean two things: (1) that the treatment is working, and the tumours are shrinking, or (2), that I'm one of those people who never get elevated CEA levels. Given that some people never get an elevated CEA level, this test doesn’t seem very accurate to me! Asked for PET scan, but am told I don’t qualify.
10/16 – Brain MRI – NED!
11/16 - CA-15-30 blood test – Tumour markers are normal at 19.
11/16 – Second CEA blood test – Tumours markers are still normal at 1.6
11/16 – Second CA-15-30 bloot test – Tumour markers are still normal at 19
11/16 – Develop lymphedema and have to wear a sleeve
12/16 – CT Scan shows that the tumors on my lungs and the lymph node in the middle of my chest are shrinking, and that some have resolved. Also, the small masses along my scar line are no longer visible. This means the medication is working!
12/16 – Small “pimple” shows up where old tumour on chest wall was located. Doctor is going to monitor it for now.
01/17 – A second “pimple” shows up on chest wall, as well as a small lump under the skin. My doctor thinks it’s scar tissue and will monitor it for now.
03/17 – CT Chest scan scheduled to see if there’s improvement to chest and lungs. If results the are good, I get to stop taking Taxol!
03/17 – Second brain MRI scheduled
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