a large pooled analysis of benefit of herceptin beyond progression in Stage IVs

[Lani]

Keep this on file in case of government health care policies or insurance companies that want to stop herceptin, saying "it is obviously not working"

It just needs to be supplemented with something else

If the progression is to the brain, they often want to start lapatinib+ capecitabine as it is approved for that indication, but studies also show the benefit of staying on herceptin there as well. They hypothesize that although it normally does not cross the blood brain barrier, when mets cause a disruption it might (among other theories)

Clin Breast Cancer. 2012 Dec 28. pii: S1526-8209(12)00273-X. doi: 10.1016/j.clbc.2012.11.008. [Epub ahead of print]
A Pooled Analysis of 2618 Patients Treated with Trastuzumab Beyond Progression for Advanced Breast Cancer.
Petrelli F, Barni S.
Source
Azienda Ospedaliera di Treviglio, UO Oncologia medica, Treviglio, Italia. Electronic address: faupe@libero.it.
Abstract
BACKGROUND:
In HER2+ MBC, continuing trastuzumab (T) after the progression during a first-line T-based regimen, represents 1 of the possible strategies, even if few data from randomized trials exist in this setting.
MATERIALS AND METHODS:
The authors have performed a systematic review through PubMed, including all prospective and retrospective publications exploring the efficacy of a T-based second-line therapy in HER2+ MBC patients treated beyond progression with a first-line T-containing treatment. Pooled estimates of the RR, TTP, and OS were calculated.
RESULTS:
A total of 29 studies (4 randomized controlled phase III trials, 2 observational studies, 8 prospective nonrandomized trials, and 15 retrospective case series) were retrieved for a total of 2618 patients. All were treated with a second-line, T-based treatment beyond progression with a first-line T-based chemotherapy. Overall, the median RR, TTP, and OS obtained from the selected articles were 28.7%,7, and 24 months.
CONCLUSIONS:
This pooled analysis confirms that continuing T beyond the first progression continues to be 1 of the effective and preferred choices in HER2+ MBC, failing a (T-based) first-line regimen.
Copyright © 2013 Elsevier Inc. All rights reserved.
PMID: 23276465

[Rolepaul]

The problem is that CSF has a high turnover and that the concentration seen in my Xeloda/Tykerb treated patient CSF was still less than 10% of the blood concentration. High concentrations were found to be needed in the CSF to be effective. This was also true with three other patients that are seeing some success with IT Herceptin.