~Rich66~Update on Mom If You have A Moment

Believe51 · 09-15-2008, 12:53 PM

Hey Rich, thinking about Mom and wondering how she is making out. I have been very busy lately but I have been following her journey the best I can. Keep doing what you are doing, you are a wonderful son and caregiver. Keeping Mom on my mind and sending her a cyber hug and positive thoughts her way!! If you get a moment please update us all>>Believe51

Rich66 · 09-15-2008, 01:30 PM

Thank you! Awaiting path er and her2 status of biopsy and meeting with local onc Thursday (18th) to hear options, meeting with Dr. Cobleigh in Chicago on the 25th. Meanwhile trying to understand current options for liver mets status as well as promising pipeline developments. Any thoughts always welcome. Thanks again!
PS: Does yellowish bm mean anything?

DonnaD · 09-15-2008, 03:42 PM

Rich,
Please check your private message and e-mail.
Donna

Rich66 · 09-15-2008, 07:18 PM

Having labs drawn tomorrow. Seems like possible jaundice. Anyone have this with liver mets?

StephN · 09-15-2008, 09:52 PM

Hi -
Jaundice is not a good sign. I did not get to that point with my liver mets, but Esther and a couple of other members here did have jaundice.

If it is jaundice, your Mom needs immediate treatment. She should not wait until the 25th to see Dr. Cobleigh. If it is jaundice, call this onc and get your Mom in ASAP.

StephN · 09-16-2008, 10:59 AM

Hi -
Please post on the lab results and the possible jaundice when you have them.

Rich66 · 09-16-2008, 05:04 PM

Onc left message while mom was out saying, pathology was in (no details) bilirubin was up "slightly", she would call tomorrow..and that Thursday consult would be start date for treatment(no details). A bit concerned..just a few hours to decide? No second opinion? !!!!!

Rich66 · 09-16-2008, 07:41 PM

Is this normal?

Rich66 · 09-17-2008, 08:06 AM

Her 2 came at "low end of high" 1.8 FISH at state lab. Re-doing part of test. Local onc not considerng it her2 pos. Offering Xeloda. Suggesting start tomorow

Believe51 · 09-17-2008, 08:25 AM

Thanks for the wonderful updates of 'pieced' information as you get it. I will be thinking of her as she embarks on this new chemo regime. This is a great drug and has proven effective in so many others, I am praying the same for Mom.

And you Rich, have grown so very much since you have found us here. Your love, support and devotion for Mom shines so bright. You have researched and gathered ammo here and on other reputable sites to guide your Mother into her recovery.

So here is to you both: May you find the missing piece of her puzzle and may Mom have a fair fight to beat up those nasties.>>Believe51

PS.....'fair fight' seems so inappropriate being used in cancer-talk....none of this is fair to anyone who has this damn illness.

Rich66 · 09-17-2008, 09:39 AM

This feels very bad right now. The local onc actually said that if this doesn't work, there may be no treatment to pursue. This thought seems to be driven by a rise in bilirubin. 1.9 on some scale with normal limit of 1 that is different from what the onc usually sees. But the same lab had some sort of problem with another part of the blood test..I think the whole blood test should be redone elsewhere. And the borderline FISH makes me think that should be redone in another lab for comparison. Have e-mailed the onc about this. This is happening so fast.

Lani · 09-17-2008, 09:47 AM

1: J Clin Oncol. 2008 Sep 15. [Epub ahead of print]
PMID: 18794539 [PubMed - as supplied by publisheMetronomic Cyclophosphamide and Capecitabine Combined With
Bevacizumab in Advanced Breast Cancer.
Dellapasqua S, Bertolini F, Bagnardi V, Campagnoli E, Scarano
E, Torrisi R, Shaked Y, Mancuso P, Goldhirsch A, Rocca A, Pietri
E, Colleoni M.
Medical Senology Research Unit and Division of Medical Oncology, Department of
Medicine; Division of Hematology-Oncology, Department of Medicine; and Division
of Epidemiology and Biostatistics, European Institute of Oncology; Department of
Statistics, University of Milan-Bicocca, Milan, Italy; Molecular and Cellular Biology
Research, Sunnybrook Health Sciences Centre; Department of Medical Biophysics,
University of Toronto, Toronto, Ontario, Canada; and Oncology Institute of
Southern Switzerland, Bellinzona and Lugano, Switzerland.
PURPOSE: Metronomic chemotherapy has shown efficacy in patients
with metastatic breast cancer. When used in association with targeted
antiangiogenic drugs, it was more active than metronomic therapy
alone in preclinical and clinical studies. PATIENTS AND METHODS:
Patients with advanced breast cancer were candidates to receive
metronomic oral capecitabine (500 mg thrice daily) and
cyclophosphamide (50 mg daily) plus bevacizumab (10 mg/kg every 2
weeks). RESULTS: In 46 assessable patients, we observed one
complete response (CR; 2%), 21 partial responses (PR; 46%), 19
patients (41%) with stable disease (SD), and five patients (11%) with
progressive disease, for an overall response rate of 48% (95% CI,
33% to 63%). Additional long-term disease stabilization (SD >/= 24
weeks) occurred in eight patients, for an overall clinical benefit (CR +
PR + SD >/= 24 weeks) of 68% (95% CI, 51% to 81%). Median
time to progression was 42 weeks (95% CI, 26 to 72 weeks).
Toxicity was generally mild. Grade 3 or 4 nonhematologic adverse
effects included hypertension (n = 8), transaminitis (n = 2), and
nausea/vomiting (n = 2). Higher baseline circulating endothelial cells
(CECs) were correlated with overall response (P = .02), clinical benefit
(P = .01), and improved progression-free survival (P = .04).
CONCLUSION: Treatment with metronomic capecitabine and
cyclophosphamide in combination with bevacizumab was effective in
advanced breast cancer and was minimally toxic. The number of
baseline CECs significantly correlated with response and outcome,
therefore supporting further studies on this surrogate marker for the
selection of patients to be candidates for antiangiogenic treatments.

This was for her2- bc (for her2+ they combined metronomic w herceptin)

Virtually all trials want normal liver functions as they do not want to cause liver failure/unacceptable toxicity caused by their "experimental combination"

Let's hope you mom's LFT problems were due to a virus or other transient, correctible cause. This happened to my dad about three weeks ago. His LFTs were 100 times normal and it was assumed it was due to one of his two cancers (one of which is already known to have metastasized to his liver). But two weeks later his LFTs were normal --his doctor ordered antibody titers for cytomegalovirus before going on vacation. It is unclear to me if they were ever done, or how they came out, but as my fathers LFTs went back to normal, it became a moot point.

Rich66 · 09-17-2008, 10:43 AM

Lani,
Does this study have implications for non-study treatment? The bilirubin will be retested tomorrow. I have asked that the FISH be redone since it is borderline "low side of high". What I have read labels that as "equivocal" results.
Any thoughts on Xeloda as monotherapy vs with Taxane?

StephN · 09-17-2008, 02:47 PM

Rich -
Look up TriciaK on this site. She has heart trouble and DID take Herceptin for her mets. She has been NED for a few years now.

They say that mets grow more slowly in the elderly, so these people do not often get the immediate attention the younger patients get. The recheck is the best idea, but for the FISH test it takes longer than the usual labs.

I have a friend in her 70's who is back on Xeloda for the 2nd time and doing fine with it. The only Taxane this friend took was Abraxane and it was definitely tougher for her. Although the Abraxane shut down her mets when the Xeloda was no longer effective.

Rich66 · 09-18-2008, 06:00 PM

Bilirubin recheck still at 1.8..slightly elevated.
Her2 is being rechecked here by IHC..the known to be inferior test. Didn't like it when I pointed this out. I had sent her these links previously:
http://www.medscape.com/viewarticle/562042
http://www.medscape.com/viewarticle/570997_4
"For these tumors, counting additional cells did not change the HER2 status because all showed equivocal amplification. On repeated FISH, the average number of cells counted was 40 (range, 30-60 cells). It seems from our study that repeated FISH on a larger tumor section is more helpful than counting additional cells on an equivocally amplified sample."

Neither article discusses using IHC to recheck.
Asked to have it sent to Mayo for independent FISH. In other words still in "equivocal" territory regarding 1.8 FISH and the Her2 issue altogether.

Visit emphasis was on Xeloda...maybe combined with AI. I brought up Taxol and she said not good with Xeloda...single agent approach better because lower toxicity. I mentioned Avastin and suddenly she said could do Avastin and Taxol. Maybe because of FDA fast track? I asked if it was more effective than xeloda and she said no one knows..never compared.
But...1!&$!
Chest x-ray shows 2cm mass in lung... Chest CT and bone scan will be done early October.
Trying to determine if she should take "something" before 2nd opinion next Thursday. Only drawback would be trial exclusion..maybe trials would take to long to enter/get approval anyway...right?
Doc here thinks it's probably ok..but it all makes me nervous and a bit crazy. I put a call into Cobleigh's nurse and hopefully the Dr. will call us tomorrow for guidance and/or earlier appointment for 2nd opinion.
Hard to know what's prudent..........

Rich66 · 09-22-2008, 07:00 PM

Getting kicked out of library.
After putting 2 oncs together...
Wednesday 9am Mom starts Taxol/carbo/Hercep(in case FISH becomes positive)
Please give thoughts, advise regarding side effects etc. Wondering about drugs to support immune and Iron.

jones7676 · 09-23-2008, 06:22 AM

I sure don't know enough about this to offer advice..but wanted to wish you the best and let you know I'm thinking of you and your mom.

Rich66 · 09-23-2008, 06:57 PM

Any comments on typicalside effects..especially day of first cycle?We are supposed to travel afterwards to Chicago (2.5 hr drive)

Rich66 · 09-24-2008, 12:36 PM

Thought plan was Taxol, carbo, hercep. IHC came back negative and the local doc felt the prudent thing was to just use Taxol, meet with Cobleigh tomorrow and add extra ingredients upon further discussion. I don't know about this but stepping into this slowly seemed to have some psych benefit to mom since she is unfamiliar with chemo. Seemed to think Carbo was not worth doing if her2 was negative. Mentioned gemcitazine or something as possible combo. Sure wish this her2 test would be resolved soon. Supposed to go to Mayo next for further FISH test. Strange. They gave me mom lorazepam for nausea and it made her speak gibberish. Gave her benadryl and it made her legs restless. Loopy and restless. Hard to see her this way. It's 2:30pm and we're supposed to drive 2.5 hrs to Chicago by tonight.As always..thoughts?

Rich66 · 09-25-2008, 11:28 AM

Strange. Last minute negative IHC retest made local onc want to skip herceptin, and therefore skip carbo. The agreed 1st step was to do Taxol solely first round, meet with Dr. Cobleigh in Chicago after and go from there with any combinations. Still going to get 2nd FISH read somewhere. I wish I knew what lab Slamon relied upon. Anyone got 2nd opinion on equivocal her2 path?
Mom was up all the night before and the though of chemo made her a bit queasy. Doc said she'd give her an anti nausea pill. Turned out it was 1 miligram lorazepam. That made her absolutely loopy all day and part into the night. Benadryl made her legs extremele restless. I had to walk backwards in front of her to keep her from falling. Ended up canceling trip to Chicago based on Dr. Cobleigh's recommendation, trying to reschedule. Mom is fine today..maybe it would have been ok to go to Chicago.
That said, the Taxol part hasn't seemed to phase here too much. is harder to control bowel movements a potential SE? Overall she seems more comfortable with the idea of chemo. I just hope we can keep things moving and have aggressive enough treatment to get things more controlled. A couple interventional radiologists have expressed interest in her case after seeing scans. One told me they sometimes do IR (spheres etc) simultaneously with chemo when situation is dire.