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Old 05-14-2016, 06:32 PM   #1
ladiired
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Join Date: May 2016
Posts: 5
Unhappy New person to site

I am a newcomer to this site but not a newcomer to BC. I was first diagnosed in Sep 2012 I have ER/PR+ and HER2+ BC. Stage 2b. went into remission Oct 2013. Rediagnosed Nov 2015 at Stage 4 after coughing for 3 months. Started Taxotere/Herceptin/Perjetta Dec. 4 2015. Done with Taxotere and now on Herceptin/Perjetta treatment. I am 47 years young, 3 kids, (24,17, & 7), graduating this June with my Bachelor's degree in Social Work and starting the Masters program in July.

I am frustrated these days with the limitations this has placed on me, especially with the breathing issues. I had a 3.5" x 2.5" tumor in my lung that is now 1" but I find that I still have issues with my breathing when I am gardening, especially bending over ad when I exert myself. I occasionally cough that dry cough but it still freaks me out when I do it. Has anyone here had the same tumor placement as me and do you still occasionally cough? I have been slightly panicking since I have been coughing more on days that I am active. Does it get better or am I stuck with this?

9/20/2012 First diagnosis -ER/PR+, HER2+, left breast
10/08/2012 First chemo
01/07/2013 last chemo
02/25/2013 Lumpectomy
03/25/2013 Lymphedectomy
05/01/2013 Radiation begins
07/03/2013 Radiation ends
09/25/2013 Last Herceptin
10/11/2013 Port OUT!!!
08/2015 Begin coughing
11/12/2015 Confirmation that mass in Lung is Cancer
12/21/2015 Gamma knife for Brain mets
12/22/2015 2nd Port in
12/23/2015 Chemo begins
03/18/2016 6th round of chemo - last for now
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Old 05-15-2016, 12:55 AM   #2
Pamelamary
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Re: New person to site

Welcome to the site, though of course I am sorry you have had to join us. I don't have lung mets, but there are others here who should be able to chime in with some support. Have you spoken to your doctors about the coughing? I hope you get some improvement.
Best wishes..... Pam
__________________
Diagnosed 2004: Lumpectomy - 2 tumours, both grade 1 infiltrating duct carcinoma, about 12mm. ER+,
C-erbB-2 status 3+.
Clear margins, no nodal involvement.
Radiotherapy, i year Tamoxifen, 4 years Arimidex.
Rediagnosed 2012: Multiple bone metastases.
3/12: began on Marianne trial - T-DM1 + Pertuzamab/Placebo.
5/12:Unexpected development of numerous bilateral liver mets. Came off trial.
Started Docetaxol/ Herceptin + Zometa.
8/12:Bones stable +major regression in liver (!)
9/12:Can't take any more Docetaxol! Start on Herceptin and Tamoxifen. Cross fingers!
Changed to Denosumab.
11/12: Scan shows stable - yay!
11/13: Still stable :-) !!!
1/16: All stable, but lowered calcium, so switched to Zometa 3 monthly.
2/19: Happily still stable on Herceptin, Letrozole and 3 monthly Zometa.
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Old 05-15-2016, 02:10 AM   #3
ladiired
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Re: New person to site

I have an appointment with my doctor on Wednesday &will be asking him about the coughing then
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Old 05-15-2016, 09:46 AM   #4
SoCalGal
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Re: New person to site

Coughing is also a side effect of Herceptin, I'm not sure if Perjeta has the same effect. I cough a lot, always have, even before cancer, my lungs are not great, probably have some form of COPD. Herceptin has me coughing more, my pulmonary guy has me on Tudorza (inhaler, you can google) and sometimes when it's worse, Singulair. I also have a spattering of lung mets, but can't correlate cough with mets. Cough with Herceptin = yes. Hope you find something to help with cough, and then get into a good headspace with acceptance of treatment related stuff as a way of life, something to be managed and always adjusted depending on how you're feeling/doing. It's a lot, but do-able.
Socalgal
__________________
1996 cancer WTF?! 1.3 cm lumpectomy Er/Pr neg. Her2+ (20nodes NEGATIVE) did CMF + rads. NED.
2002 recurrence. Bilateral mastectomy w/TFL autologous recon. Then ACx2. Skin lymphatic rash. Taxotere w/Herceptin x4. Herceptin/Xeloda. Finally stops spreading.
2003 - Back to surgery, remove skin mets, and will have surgery one week later when pathology can confirm margins.
‘03 latisimus dorsi flap to remove skin mets. CLEAN MARGINS. Continue single agent Herceptin thru 4/04. NED.
‘04 '05 & 06 tiny recurrences - scar line. surgery to cut out. NED each time.
1/2006 Rads again, to scar line. NED.

3/07 Heartbreaking news - mets! lungs.sternum. Try Tykerb/Xeloda. Tykerb/Carbo/Gemzar. Switch Oncs.
12/07 Herceptin.Tykerb. Markers go stable.
2/8/08 gamma knife 13mm stupid brain met.
3/08 Herceptin/tykerb/avastin/zometa.
3/09 brain NED. Lungs STABLE.
4/09 attack sternum (10 daysPHOTONS.5 days ELECTRONS)
9/09 MARKERS normal!
3/10 PET/CT=manubrium intensely metabolically active but stable. NEDhead.
Wash out 5/10 for tdm1 but 6/10 CT STABLE, PET improving. Markers normal. Brain NED. Resume just Herceptin plus ZOMETA
Dec 2010 Brain NED, lungs/sternum stable. markers normal.
MAR 2011 stop Herceptin/allergy! Go back on Tykerb and switch to Xgeva.
May-Aug 2011 Tykerb Herceptin Xgeva.
Sept 2011 Tykerb, Herceptin, Zometa, Avastin.
April 2012 sketchy drug trial in NYC. 6 weeks later I’m NED!
OCT 2012 PET/CT shows a bunch of freakin’ progression. Back to LA and Herceptin.avastin.zometa.
12/20/12 add in PERJETA!
March 2013 – 5 YEARS POST continue HAPZ
APRIL 2013 - 6 yrs stage 4. "FAILED" PETscan on 4/2/13
May 2013: rePetted - improvement in lungs, left adrenal stable, right 6th rib inactive, (must be PERJETA avastin) sternum and L1 fruckin'worsen. Drop zometa. ADD Xgeva. Doc says get rads consultant for L1 and possible biopsy of L1. I say, no thanks, doc. Lets see what xgeva brings to the table first. It's summer.
June-August 2013HAPX Herceptin Avastin Perjeta xgeva.
Sept - now - on chemo hold for calming tummy we hope. Markers stable for 2 months.
Nov 2013 - Herceptin-Perjeta-Avastin-Xgeva (collageneous colitis, which explains tummy probs, added Entocort)
December '13 BRAIN MRI ned in da head.
Jan 2014: CONTINUING on HAPX…
FEB 2014 PetCT clinical “impression”: 1. newbie nodule - SUV 1.5 right apical nodule, mildly hypermetabolic “suggestive” of worsening neoplastic lesion. 2. moderate worsening of the sternum – SUV 5.6 from 3.8
3. increasing sclerosis & decreasing activity of L1 met “suggests” mild healing. (SUV 9.4 v 12.1 in May ‘13)
4. scattered lung nodules, up to 5mm in size = stable, no increased activity
5. other small scattered sclerotic lesions, one in right iliac and one in thoracic vertebral body similar in appearance to L1 without PET activity and not clearly pathologic
APRIL 2014 - 6 YRS POST GAMMA ZAP, 7 YRS MBC & 18 YEARS FROM ORIGINAL DX!
October 2014: hold avastin, continue HPX
Feb 2015 Cancer you lost. NEDHEAD 7 years post gamma zap miracle, 8 years ST4, +19 yrs original diagnosis.
Continue HPX. Adding back Avastin
Nov 2015 pet/ct is mixed result. L1 SUV is worse. Continue Herceptin/avastin/xgeva. Might revisit Perjeta for L1. Meantime going for rads consult for L1
December 2015 - brain stable. Continue Herceptin, Perjeta, Avastin and xgeva.
Jan 2016: 5 days, 20 grays, Rads to L1 and continue on HAPX. I’m trying to "save" TDM1 for next line. Hope the rads work to quiet L1. Sciatic pain extraordinaire :((
Markers drop post rads.
2/24/16 HAP plus X - markers are down
SCIATIC PAIN DEAL BREAKER.
3/23/16 Laminectomy w/coflex implant L4/5. NO MORE SCIATIC PAIN!!! Healing.
APRIL 2016 - 9 YRS MBC
July 2016 - continue HAP plus Xgeva.
DEC 2016 - PETCT: mets to sternum, lungs, L1 still about the same in size and PET activity. Markers not bad. Not making changes if I don't need to. Herceptin/Perjeta/Avastin/Xgeva
APRIL 2017 10 YEARS MBC
December 2017 - Progression - gonna switch it up
FEB 2018 - Kadcyla 3 cycles ---->progression :(
MAY30th - bronchoscopy, w/foundation1 - her2 enriched
Aug 27, 2018 - start clinical trial ZW25
JAN 2019 - ZW25 seems to be keeping me stable
APRIL 2019 - ONE DOZEN YEARS LIVING METASTATIC
MAY 2019 - progression back on herceptin add xeloda
JUNE 2019 - "6 mos average survival" LMD & CNS new single brain met - one zap during 5 days true beam SBRT to cord met
10/30/19 - stable brain and cord. progression lungs and bones. washing out. applying for ds8201a w nivolumab. hope they take me.
12/27/19 - begin ds8401a w nivolumab. after 2nd cycle nodes melt away. after 3rd cycle chest scan shows Improvement, brain MRI shows improvement, resolved areas & nothing new. switch to plain ENHERTU. after 4th cycle, PETscan shows mostly resolved or improved results. Markers near normal. I'm stunned but grateful.
10/26/20 - June 2021 Tucatinib/xeloda/herceptin - stable ish.
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Old 05-15-2016, 10:35 AM   #5
ladiired
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Re: New person to site

Thank you SOCALGAL. The reason I worry about the cough is because my previous experience with Herceptin I basically didn't have any noticeable side effect. However, I didn't think about Perjetta. I will be asking my doc about this on Wednesday. I did realize some time ago that consistent, continual treatment was now a part of my life not something I would be done with. That being said, I may have accepted this reality in my logical head space but I am working on the emotional space. It is taking me time to adjust to the new reality especially since it has been only 7 months since the official diagnosis. I will get there just going to take time. yes, I CAN DO THIS!!!!!! I have TONS of support but no matter how much support I have there are just days where it is too much to take. I love my support network but reaching out to those who are LIVING this will help me gain perspective and support from those in the trenches of this D@#N disease. Also, it helps me to know that I CAN do this for a very long time.
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Old 05-15-2016, 11:38 AM   #6
SoCalGal
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Location: LA LA Land
Posts: 1,606
Re: New person to site

Herceptin didn't always make me cough, but I know from years of use that it creates a drip and for me, gives me a stupid dry choaky cough.

As far as being a thriver, with stage 4, it takes time, and even after 9 years, there are MANY days when I am overwhelmed and sick of sucking it up, pushing thru and having to endure. It's like anything else, with all the chaos and ups and downs. Being present and STAYING present is really the best way to be. I have little notes all over my house (like on my bathroom mirror, my refrigerator, in my makeup drawer, that have reminders on them. "Breathe" "Stay present" "Be Here Now" "Be Brave" "Smile" "Be Tall" "Cuck Fancer". I move these around so I don't become accustomed to seeing them and ignore them. For me, these notes are quite effective. And cancer or not, every night when I wash my face, and look in the mirror, I say my mother's words, BE KIND TO YOURSELF.
Yup, everynight...
__________________
1996 cancer WTF?! 1.3 cm lumpectomy Er/Pr neg. Her2+ (20nodes NEGATIVE) did CMF + rads. NED.
2002 recurrence. Bilateral mastectomy w/TFL autologous recon. Then ACx2. Skin lymphatic rash. Taxotere w/Herceptin x4. Herceptin/Xeloda. Finally stops spreading.
2003 - Back to surgery, remove skin mets, and will have surgery one week later when pathology can confirm margins.
‘03 latisimus dorsi flap to remove skin mets. CLEAN MARGINS. Continue single agent Herceptin thru 4/04. NED.
‘04 '05 & 06 tiny recurrences - scar line. surgery to cut out. NED each time.
1/2006 Rads again, to scar line. NED.

3/07 Heartbreaking news - mets! lungs.sternum. Try Tykerb/Xeloda. Tykerb/Carbo/Gemzar. Switch Oncs.
12/07 Herceptin.Tykerb. Markers go stable.
2/8/08 gamma knife 13mm stupid brain met.
3/08 Herceptin/tykerb/avastin/zometa.
3/09 brain NED. Lungs STABLE.
4/09 attack sternum (10 daysPHOTONS.5 days ELECTRONS)
9/09 MARKERS normal!
3/10 PET/CT=manubrium intensely metabolically active but stable. NEDhead.
Wash out 5/10 for tdm1 but 6/10 CT STABLE, PET improving. Markers normal. Brain NED. Resume just Herceptin plus ZOMETA
Dec 2010 Brain NED, lungs/sternum stable. markers normal.
MAR 2011 stop Herceptin/allergy! Go back on Tykerb and switch to Xgeva.
May-Aug 2011 Tykerb Herceptin Xgeva.
Sept 2011 Tykerb, Herceptin, Zometa, Avastin.
April 2012 sketchy drug trial in NYC. 6 weeks later I’m NED!
OCT 2012 PET/CT shows a bunch of freakin’ progression. Back to LA and Herceptin.avastin.zometa.
12/20/12 add in PERJETA!
March 2013 – 5 YEARS POST continue HAPZ
APRIL 2013 - 6 yrs stage 4. "FAILED" PETscan on 4/2/13
May 2013: rePetted - improvement in lungs, left adrenal stable, right 6th rib inactive, (must be PERJETA avastin) sternum and L1 fruckin'worsen. Drop zometa. ADD Xgeva. Doc says get rads consultant for L1 and possible biopsy of L1. I say, no thanks, doc. Lets see what xgeva brings to the table first. It's summer.
June-August 2013HAPX Herceptin Avastin Perjeta xgeva.
Sept - now - on chemo hold for calming tummy we hope. Markers stable for 2 months.
Nov 2013 - Herceptin-Perjeta-Avastin-Xgeva (collageneous colitis, which explains tummy probs, added Entocort)
December '13 BRAIN MRI ned in da head.
Jan 2014: CONTINUING on HAPX…
FEB 2014 PetCT clinical “impression”: 1. newbie nodule - SUV 1.5 right apical nodule, mildly hypermetabolic “suggestive” of worsening neoplastic lesion. 2. moderate worsening of the sternum – SUV 5.6 from 3.8
3. increasing sclerosis & decreasing activity of L1 met “suggests” mild healing. (SUV 9.4 v 12.1 in May ‘13)
4. scattered lung nodules, up to 5mm in size = stable, no increased activity
5. other small scattered sclerotic lesions, one in right iliac and one in thoracic vertebral body similar in appearance to L1 without PET activity and not clearly pathologic
APRIL 2014 - 6 YRS POST GAMMA ZAP, 7 YRS MBC & 18 YEARS FROM ORIGINAL DX!
October 2014: hold avastin, continue HPX
Feb 2015 Cancer you lost. NEDHEAD 7 years post gamma zap miracle, 8 years ST4, +19 yrs original diagnosis.
Continue HPX. Adding back Avastin
Nov 2015 pet/ct is mixed result. L1 SUV is worse. Continue Herceptin/avastin/xgeva. Might revisit Perjeta for L1. Meantime going for rads consult for L1
December 2015 - brain stable. Continue Herceptin, Perjeta, Avastin and xgeva.
Jan 2016: 5 days, 20 grays, Rads to L1 and continue on HAPX. I’m trying to "save" TDM1 for next line. Hope the rads work to quiet L1. Sciatic pain extraordinaire :((
Markers drop post rads.
2/24/16 HAP plus X - markers are down
SCIATIC PAIN DEAL BREAKER.
3/23/16 Laminectomy w/coflex implant L4/5. NO MORE SCIATIC PAIN!!! Healing.
APRIL 2016 - 9 YRS MBC
July 2016 - continue HAP plus Xgeva.
DEC 2016 - PETCT: mets to sternum, lungs, L1 still about the same in size and PET activity. Markers not bad. Not making changes if I don't need to. Herceptin/Perjeta/Avastin/Xgeva
APRIL 2017 10 YEARS MBC
December 2017 - Progression - gonna switch it up
FEB 2018 - Kadcyla 3 cycles ---->progression :(
MAY30th - bronchoscopy, w/foundation1 - her2 enriched
Aug 27, 2018 - start clinical trial ZW25
JAN 2019 - ZW25 seems to be keeping me stable
APRIL 2019 - ONE DOZEN YEARS LIVING METASTATIC
MAY 2019 - progression back on herceptin add xeloda
JUNE 2019 - "6 mos average survival" LMD & CNS new single brain met - one zap during 5 days true beam SBRT to cord met
10/30/19 - stable brain and cord. progression lungs and bones. washing out. applying for ds8201a w nivolumab. hope they take me.
12/27/19 - begin ds8401a w nivolumab. after 2nd cycle nodes melt away. after 3rd cycle chest scan shows Improvement, brain MRI shows improvement, resolved areas & nothing new. switch to plain ENHERTU. after 4th cycle, PETscan shows mostly resolved or improved results. Markers near normal. I'm stunned but grateful.
10/26/20 - June 2021 Tucatinib/xeloda/herceptin - stable ish.
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Old 05-15-2016, 11:54 AM   #7
ladiired
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Posts: 5
Smile Re: New person to site

Yes. Be kind to myself...in my school we are taught about SELF-CARE and it is reinforced at every turn. I think one of the hardest things is not only how this thing affects me but also affect my family. We are all having to adjust to a new "normal". I like the idea of the notes. Thank you for normalizing the feelings of being overwhelmed, and tired of being "strong".

I realize now that the dry, hacky, choky cough cases panic in me since this was the thing that started the medical search to find the cause resulting in my current situation. Love PTSD. ;-)

Thank you for answering my post. It helps to "talk" with someone else in a similiar/same situation. My family and friends are there for me but it really helps to talk to someone who knows intimately the MindF%^k this has on a person. I like your CUCK FANCER may I appropriate it for myself?
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Old 05-15-2016, 01:17 PM   #8
Lani
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Re: New person to site

please check out the following thread:

http://her2support.org/vbulletin/sho...h+goblet+cells

ie, I put in "Lani herceptin & goblet cells" into the search function on the burgundy bar above and went several pages to find a thread called cough


Old 02-02-2008, 07:42 PM #1
Angela
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Join Date: Apr 2006
Location: North Carolina
Posts: 45
Question cough
I have been on herceptin by itself for almost a year now. I had a CT scan of my chest on Dec 10th and it showed only a 2mm spot left in my lung. But I got a cold at the beginning of January and I am still coughing. I finally went to my primary Dr. yesterday and they just gave me an antibiotic and some cough medicine with hydrocodone in it. Good Stuff! Has anyone else developed a cough on herceptin? Has it been long enough since my last CT scan to ask for an x-ray or another CT scan?

Any suggestion are greatly appreciated. I am sick of coughing and my co-works have started coming into my office asking question like: How are you really doing? What did the Dr. say on your last visit? One person even asked when my last CT scan was done and what were the results. I get tired of people always looking at me and thinking cancer.
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Old 02-02-2008, 08:37 PM #2
Sherryg683
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Posts: 1,014
Yes, I have coughing spells and times when my chest feels so tight that I get worried that somethings going on..there are times when I find it hard to breath (although I think some of it's anxiety). If you had radiation that could cause it and I don't know about Herceptin, but it messes with my sinuses so I figure it's probably messing with other things such as breathing too. In fact, I do find I usually get real tight in the chest after Herceptin. If you had a CT in December, I wouldn't think you would need on right now. Is the spot in your lungs cancerous? I had 2 lung spots too but they went away with chemo. I had PET/CTs every 3 to 4 months for the first 2 years. Now, I will do them every 6 months. As far as the coughing, it's that time of the year, I wouldn't worry about it at all with a scan as recent as yours. And to think of it, before I was diagnosed I had no coughing or breathing problems at all, no symptoms. I wish that I felt as good as I did before the cancer was discovered. Most of my symptoms now are due to the chemo and medicine...sherryg
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Old 02-04-2008, 03:15 PM #3
John21
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Join Date: May 2006
Posts: 85
Cough
It seems to me I have ask this question too. My wife has a little cough now and then and I atrribute it to the Herceptin. I have read others on the site claiming the same symptom. I believe you are experience the side effect of Herceptin. But to be safe, check it out if you are concerned. It is hard for me to believe a 2mm spot will cause a cough, but in the beginning I was worried about every little change. Drove my wife crazy!
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Old 02-04-2008, 05:56 PM #4
Jean
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Location: New Jersey
Posts: 3,123
Hi Andrea,
It is common to have a dry hacking cough while on herceptin. In fact
I am off herceptin since May 07 and I still have a slight dry cough now
and then but it is eased up about 90% since I completed my one year
of herceptin. Since you just had a CT in Dec. I would think you would
not check this again for at least 6 months. I had a small (MM nodule)
which my lung specialist was tracking. It stayed the same during one
checkup and then 6 months later was smaller, we continued to check
it for 2 yrs. which it has remained the same. The lung dr. is convinced
it is not cancer. Now I have a check in once per yr. Hope yours
is the same and remains the same or gets smaller. From what I have
been told these small nodules are rather common.

All Good Wishes,
Jean
Last edited by Jean; 02-04-2008 at 05:58 PM..
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Old 02-04-2008, 06:54 PM #5
CLTann
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Cough is a very complicated event and its cause can be traced to many, many factors. It is a body's own mechanism trying to correct some problems in the upper respiratory organs, from throat down to wind pipe to the lungs. Eating or drinking too fast, resulting in having some foreign substance going to the wrong pipe will cause cough, until the situation is corrected. A small abnormality in the breathing system can cause cough. Accumulation of water can induce cough. Of course, the presence of any growth, whether benign or not, will trigger cough. Some cough is associated with bad mucous sound and some are dry cough. It is a symptom that we should not take too lightly. Drug side effects can include cough, which is probably caused by irritation to the throat or windpipe. If the cough does not go away in three weeks, it is advisable to check in for an x ray first. I always hesitate to recommend CT scan due to its high level of radiation. Of course, radiation is another cause of cough too.
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Old 02-04-2008, 08:08 PM #6
Lani
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Join Date: Mar 2006
Posts: 4,675
two of my previous posts on herceptin/coughing
from a previous post of mine ( I added others too)
#1
LOPSIDED
Senior Member

Join Date: Apr 2006
Posts: 91
Sick & Tired Ofcoughing Everyday
I Was Really Starting To Worry About Mets To The Lungs. I Can't Quit Coughing. When I'm Talking, I Don't Sound Like I Have A Cold But Everyday I Am Having Coughing Spells. My Cough Sounds Terrible. I Went For A Chest X-ray And It Came Back Normal. Now My Doc Is Sending Me For A Ct Scan To Be On Safe Side. I Know Its That Time Of Year For Flu's & Cold But This Coughing Is Exausting. Any Cough Remedies.......anyone?

12-05-2007, 05:39 PM #2
Grace

Posts: n/a

Sheila,

I had a similar cough last year (twice) where I simply couldn't stop coughing. It lasted for many weeks, but it did finally get better. I was on herceptin at the time. I know that others have had something similar, and I understand it's a particular type of flu that's going around. I used Tylenol for coughs and it helped some but not a whole lot. Have you tried honey before going to bed? I didn't but I read an article yesterday that honey is now being recommended for children in lieu of cough medicine. Hope you're better soon.

12-05-2007, 06:28 PM #3
Lolly
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Join Date: Aug 2001
Location: Oregon
Posts: 1,552

Sheila, my husband had pneumonia this spring and to get some relief from the terrible coughing at night so he could sleep, his doctor prescribed codeine cough syrup, but only to take at night. It really worked, but it's strong stuff.
I don't think raw honey is recommended for chemo patients, if you're still on chemo, so talk that over with your doctor if you want to try it, or make sure you get pasturized honey.

<3 Lolly

12-05-2007, 06:44 PM #4
Lani
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Join Date: Mar 2006
Posts: 1,946
from an old post of mine
For those complaining of nasal/sinus symptoms/coughing which they relate to Herceptin, I submit the following two articles. The nose, like the more distant airways/bronchiols have ciliated epithelial cells (lining cells with tiny hairs which help trap bacteria, molds and other particulates) . These articles raise questions which may help explain symptoms while on Herceptin--showing that her2 is necessary not just in embryogenesis, but also in adulthood for repair of these kinds of cells. They may help explain your nasal complaints, the reports of rare pulmonary problems in patients on Herceptin and perhaps the dry-eye problem I posted on before. The more they look into what her2 does, the more they find!:


Am J Physiol Lung Cell Mol Physiol. 2006 Feb 17; [Epub ahead of print]
Related Articles, Links
*
Differentiation of Human Airway Epithelia Is Dependent on ErbB2.

Vermeer PD, Panko L, Karp P, Lee JH, Zabner J.

Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA.

A clinical case documented a reversible change in airway epithelial differentiation that coincided with the initiation and discontinuation of trastuzumab, an anti-erbB2 antibody. This prompted the investigation into whether blocking the erbB2 receptor alters differentiation of the airway epithelium. If so, blocking or exogenously stimulating the receptor would lead to consequences on differentiation. To test this hypothesis, an in vitro model of well-differentiated human airway epithelia was treated with trastuzumab or heregulin-alpha, an erbB ligand. In addition, co-culturing with human lung fibroblasts tested whether in vivo subepithelial fibroblasts function as an endogenous source of ligands able to activate erbB receptors expressed by the overlying epithelial cells. Epithelia were stained with hematoxylin and eosin and used for morphometric analysis. Trastuzumab treatment decreased the ciliated cell number by 49% and increased the metaplastic, flat cell number by 640%. Heregulin-alpha treatment increased epithelial height, decreased the number of metaplastic and non-ciliated columnar cells while it increased the goblet cell number. We found that normal human lung fibroblasts express transforming growth factor-alpha, heparin binding-epidermal-like growth factor, epiregulin, heregulin-alpha, and amphiregulin, all of which are erbB ligands. Co-cultures of airway epithelia with primary fibroblasts increased epithelial height comparable to that achieved following heregulin-alpha treatment. These data show that erbB2 stimulation is required for maintaining epithelial differentiation. Furthermore, the mesenchyme underlying the airway epithelium secretes a variety of erbB ligands that might direct various pathways of epithelial differentiation.

PMID: 16489114 [PubMed - as supplied by publisher]


1: FASEB J. 2005 Aug;19(10):1374-6. Epub 2005 May 27.
Related Articles, Links
*
ErbB2 activity is required for airway epithelial repair following neutrophil elastase exposure.

Fischer BM, Cuellar JG, Byrd AS, Rice AB, Bonner JC, Martin LD, Voynow JA.

Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710, USA.

In cystic fibrosis and chronic bronchitis, airways are chronically injured by exposure to neutrophil elastase (NE). We sought to identify factors required for epithelial repair following NE exposure. Normal human bronchial epithelial cells were treated with NE (50 nM, 22 h) or control vehicle. Following NE treatment, we found a marked and sustained decrease in epithelial proliferation as detected by Ki67 immunostaining. 3H-thymidine incorporation was also initially depressed but increased over 72 h in NE-treated cells, which suggests that DNA synthesis constitutes an early repair process following NE exposure. We hypothesized that ErbB2 receptor tyrosine kinase, a regulator of cancer cell proliferation, was required for epithelial DNA synthesis following NE exposure. Immediately following NE treatment, by flow cytometry analysis, we found a decrease in ErbB2 surface expression. Protein levels of the full-length 185 kD ErbB2 receptor significantly decreased following NE treatment and smaller ErbB2-positive bands, ranging in size from 23 to 40 kD, appeared, which suggests that NE caused ErbB2 degradation. By real-time RT-PCR analysis, we found no change in ErbB2 mRNA expression following NE treatment, which suggests that changes in ErbB2 protein levels were regulated at the post-translational level. Following NE treatment, full-length 185 kD ErbB2 levels increased to pretreatment levels, correlating with the increase in thymidine incorporation during the same time period. Importantly, inhibition of ErbB2 activity with AG825 (5 microM) or Herceptin (3.1 microM), an ErbB2-neutralizing antibody, blocked thymidine incorporation only in NE-treated cells. These results suggest ErbB2 is a critical factor for epithelial recovery following NE exposure.

PMID: 15923396 [PubMed - in process]



I started the post with my summary:
"For those complaining of nasal/sinus symptoms which they relate to Herceptin, the following two articles may hold clues as to what may be going on. The nose/airways have ciliated epithelial cells (lining cells with tiny hairs which help trap bacteria, molds and other particulates) and other specialized cells (including further down the "airways" in the bronchi and bronchioles). These articles raise questions which may help explain symptoms while on Herceptin--showing that her2 is necessary not just in embryogenesis, but also in adulthood for repair of these kinds of cells. They may help explain your nasal complaints, the reports of rare pulmonary problems in patients on Herceptin and perhaps the dry-eye problem I posted on before. The more they look into what her2 does, the more they find!:"

A “translation” of the “Greek” of the two articles:

Because of a case of a patient whose airways changed when Herceptin treatment was started and when Herceptin was stopped in terms of which types of specialized cells were present/absent they tried in a petri dish to see what happens to airway cells and found:

Trastuzumab treatment decreased the ciliated cell number by 49% and increased the metaplastic, flat cell number by 640%.

Thus the cells necessary to fight infection were more than halved and the cells with little specialized function, which do not secrete or trap bacteria, mold or particles went up by more than 6 fold.

In the other article, after bronchitis or other diseases where a white blood cell enzyme injures airway (bronchial) lining tissue her2 is necessary to repair the damage caused by this enzyme in an adult. The "Greek" is just describing how they proved the mechanism of how this occurs, at what step it occurs and whether the changes were on a gene or protein level.

Both articles emphasize that her2 fulfills physiologic functions in an adult and Herceptin can potentially adversely affect those functions. Epithelial cells are numberous throught the body--thhey line organs facing the "outside world"(which is sometimes inside as in the stomach and intestines) they function to keep infectious and dangerous particles out, secrete substances to lubricate and or digest, etc. Her2 seems to be necessary to keep these cells specializiing to serve different necessary functions and to repair/replace damaged cells.

Thus it seems it is not just the heart that Herceptin affects.

01-01-2008, 10:43 AM #3
Lani
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Join Date: Mar 2006
Posts: 2,068
another thread I posted to on the same subject
#1
Caroline UK
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Join Date: Nov 2006
Location: London, England
Posts: 93
Herceptin cough
I've had a little, wheezy cough for the last 8 weeks or so, nothing too troublesome but always just there. Had a chest x-ray last week and it's fine, thank goodness. My oncologist said about 20% of people on Herceptin experience this cough. Not exactly allergic, sort of hyper-sensitive to it. Has anyone else experienced this? Have you noticed if anything helps or makes it worse?

05-10-2007, 11:26 PM #2
Roz
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Join Date: Oct 2005
Location: Sydney Australia
Posts: 91

Hi, Yes I have had the same cough! Feel as if I am asthmatic with the little wheeze. It is a shame for me as I also have tended to get my "cancer return" in my right upper lobe, so I tend to panic if I get too much wheezing. All part of the rich tapestry etc.. I suppose.

05-11-2007, 09:11 AM #3
tousled1
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Join Date: Feb 2006
Location: Acworth, GA
Posts: 1,895

Caroline,

I had the cough almost the entire year I was on Herceptin. Had my last Herceptin April 20th and my cough is almost gone.

05-11-2007, 09:50 AM #4
Jeanette
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Join Date: Oct 2005
Posts: 127
cough
I also had the cough all the time i was on Herceptin. Sucked on a lot of hard candy to control it. It is gone now, thankfully, very annoying.

05-12-2007, 08:02 AM #5
Caroline UK
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Join Date: Nov 2006
Location: London, England
Posts: 93

Ok, thanks everyone, always seems to help when I hear from others who've had the same thing, even if it wasn't anything too serious. Sometimes I just feel a bit alone with all these little niggly things, and I feel reluctant to wear friends down by 'moaning' about them.

05-12-2007, 09:00 PM #6
Adriana Mangus
Senior Member

Join Date: May 2006
Location: California
Posts: 272
Me too
Hi Caroline:

I have been coughing for at least 8 months, I have scratchy throat wheezing,a lot of phlegm, also. I feel like am producing excesive saliva. Do you have phlegm, too?

I went to see my personal physician, she said the lungs are clear, -thanks to God-, since my mets are in the upper lobe rt lung- so based on that the diagnosis is chronic rhinitis, but I really doubt it very much. I did not know that herceptin may be the cause. I feel good about knowing this information, but it's annoying to deal with this cough. The doc recommended Benadryl which it seems to help, I also take cough medicine like Robitusin. I have had many sleepless nights due to this, no FUN!..

How is it for you ladies? I can rest on my back, walk; but sometimes when I talk or want to eat, sip on water; then I feel like urgency to cough, like I said it's annoying!!!!!

Thanks all for sharing!!!!! I FEEL MUCH BETTER!!!!

05-13-2007, 03:38 PM #7
Lani
Senior Member

Join Date: Mar 2006
Posts: 1,947
I posted this before---role of her2 in maintenance of upper airways explains cough
as well as nasal symptoms

For those complaining of nasal/sinus symptoms which they relate to Herceptin, I submit the following two articles. The nose, like the more distant airways/bronchioles have ciliated epithelial cells (lining cells with tiny hairs which help trap bacteria, molds and other particulates) . These articles raise questions which may help explain symptoms while on Herceptin--showing that her2 is necessary not just in embryogenesis, but also in adulthood for repair of these kinds of cells. They may help explain your nasal complaints, the cough and the reports of rare pulmonary problems in patients on Herceptin and perhaps the dry-eye problem I posted on before. The more they look into what her2 does, the more they find!:


Am J Physiol Lung Cell Mol Physiol. 2006 Feb 17; [Epub ahead of print]
Related Articles, Links
*
Differentiation of Human Airway Epithelia Is Dependent on ErbB2.

Vermeer PD, Panko L, Karp P, Lee JH, Zabner J.

Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA.

A clinical case documented a reversible change in airway epithelial differentiation that coincided with the initiation and discontinuation of trastuzumab, an anti-erbB2 antibody. This prompted the investigation into whether blocking the erbB2 receptor alters differentiation of the airway epithelium. If so, blocking or exogenously stimulating the receptor would lead to consequences on differentiation. To test this hypothesis, an in vitro model of well-differentiated human airway epithelia was treated with trastuzumab or heregulin-alpha, an erbB ligand. In addition, co-culturing with human lung fibroblasts tested whether in vivo subepithelial fibroblasts function as an endogenous source of ligands able to activate erbB receptors expressed by the overlying epithelial cells. Epithelia were stained with hematoxylin and eosin and used for morphometric analysis. Trastuzumab treatment decreased the ciliated cell number by 49% and increased the metaplastic, flat cell number by 640%. Heregulin-alpha treatment increased epithelial height, decreased the number of metaplastic and non-ciliated columnar cells while it increased the goblet cell number. We found that normal human lung fibroblasts express transforming growth factor-alpha, heparin binding-epidermal-like growth factor, epiregulin, heregulin-alpha, and amphiregulin, all of which are erbB ligands. Co-cultures of airway epithelia with primary fibroblasts increased epithelial height comparable to that achieved following heregulin-alpha treatment. These data show that erbB2 stimulation is required for maintaining epithelial differentiation. Furthermore, the mesenchyme underlying the airway epithelium secretes a variety of erbB ligands that might direct various pathways of epithelial differentiation.

PMID: 16489114 [PubMed - as supplied by publisher]


1: FASEB J. 2005 Aug;19(10):1374-6. Epub 2005 May 27.
Related Articles, Links
*
ErbB2 activity is required for airway epithelial repair following neutrophil elastase exposure.

Fischer BM, Cuellar JG, Byrd AS, Rice AB, Bonner JC, Martin LD, Voynow JA.

Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710, USA.

In cystic fibrosis and chronic bronchitis, airways are chronically injured by exposure to neutrophil elastase (NE). We sought to identify factors required for epithelial repair following NE exposure. Normal human bronchial epithelial cells were treated with NE (50 nM, 22 h) or control vehicle. Following NE treatment, we found a marked and sustained decrease in epithelial proliferation as detected by Ki67 immunostaining. 3H-thymidine incorporation was also initially depressed but increased over 72 h in NE-treated cells, which suggests that DNA synthesis constitutes an early repair process following NE exposure. We hypothesized that ErbB2 receptor tyrosine kinase, a regulator of cancer cell proliferation, was required for epithelial DNA synthesis following NE exposure. Immediately following NE treatment, by flow cytometry analysis, we found a decrease in ErbB2 surface expression. Protein levels of the full-length 185 kD ErbB2 receptor significantly decreased following NE treatment and smaller ErbB2-positive bands, ranging in size from 23 to 40 kD, appeared, which suggests that NE caused ErbB2 degradation. By real-time RT-PCR analysis, we found no change in ErbB2 mRNA expression following NE treatment, which suggests that changes in ErbB2 protein levels were regulated at the post-translational level. Following NE treatment, full-length 185 kD ErbB2 levels increased to pretreatment levels, correlating with the increase in thymidine incorporation during the same time period. Importantly, inhibition of ErbB2 activity with AG825 (5 microM) or Herceptin (3.1 microM), an ErbB2-neutralizing antibody, blocked thymidine incorporation only in NE-treated cells. These results suggest ErbB2 is a critical factor for epithelial recovery following NE exposure.

PMID: 15923396 [PubMed - in process]



A “translation” of the “Greek” of the two articles:

Because of a case of a patient who developed a chronic cought on herceptin (which disappeared when herceptin was stopped) whose airways changed when Herceptin treatment was started and when Herceptin was stopped in terms of which types of specialized cells were present/absent, they tried in a petri dish to see what happens to airway cells and found:

Trastuzumab treatment decreased the ciliated cell number by 49% and increased the metaplastic, flat cell number by 640%.

Thus the cells necessary to fight infection were more than halved and the cells with little specialized function, which do not secrete or trap bacteria, mold or particles went up by more than 6 fold.

In the other article, after bronchitis or other diseases where a white blood cell enzyme injures airway (bronchial) lining tissue her2 is necessary to repair the damage caused by this enzyme in an adult. The "Greek" is just describing how they proved the mechanism of how this occurs, at what step it occurs and whether the changes were on a gene or protein level.

Both articles emphasize that her2 fulfills physiologic functions in an adult and Herceptin can potentially adversely affect those functions. Epithelial cells are numerous throught the body--they line organs facing the "outside world"(which is sometimes inside as in the stomach and intestines) they function to keep infectious and dangerous particles out, secrete substances to lubricate and or digest, etc. Her2 seems to be necessary to keep these cells specializiing to serve different necessary functions and to repair/replace damaged cells.

Thus it seems it is not just the heart that Herceptin affects.
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Old 05-16-2016, 08:47 AM   #9
Mtngrl
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Re: New person to site

I did not know that Herceptin can cause coughing.

I have a dry cough that I believe is an atypical symptom of GERD (gastroesophageal reflux "disease.") I recently figured out it gets worse when I wear tight waistbands, especially when I bend over.

I also have lung mets. I've also been on Herceptin for five years, and Perjeta for around two. But GERD causes coughing, and coughing exacerbates GERD. Vicious cycle, with possibly multiple contributors.
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Amy
_____________________________
4/19/11 Diagnosed invasive ductal carcinoma in left breast; 2.3 cm tumor, 1 axillary lymph node, weakly ER+, HER2+++
4/29/11 CT scan shows suspicious lesions on liver and lungs
5/17/11 liver biopsy
5/24/11 liver met confirmed--Stage IV at diagnosis
5/27/11 Begin weekly Taxol & Herceptin for 3 months (standard of care at the time of my DX)
7/18/11 Switch to weekly Abraxane & Herceptin due to Taxol allergy
8/29/11 CT scan shows no new lesions & old lesions shrinking
9/27/11 Finish Abraxane. Start Herceptin every 3 weeks. Begin taking Arimidex
10/17/11--Brain MRI--No Brain mets
12/5/11 PET scan--Almost NED
5/15/12 PET scan shows progression-breast/chest/spine (one vertebra)
5/22/12 Stop taking Arimidex; stay on Herceptin
6/11/12 Started Tykerb and Herceptin on clinical trial (w/no chemo)
9/24/12 CT scan--No new mets. Everything stable.
3/11/13 CT Scan--two small new possible mets and odd looking area in left lung getting larger.
4/2/13--Biopsy of suspicious area in lower left lung. Mets to lung confirmed.
4/30/13 Begin Kadcyla/TDM-1
8/16/13 PET scan "mixed," with some areas of increased uptake, but also some definite improvement, so I'll stay on TDM-1/Kadcyla.
11/11/13 Finally get hormone receptor results from lung biopsy of 4/2/13. My cancer is no longer ER positive.
11/13/13 PET scan mixed results again. We're calling it "stable." Problems breathing on exertion.
2/18/14 PET scan shows a new lesion and newly active lymph node in chest, other progression. Bye bye TDM-1.
2/28/14 Begin Herceptin/Perjeta every 3 weeks.
6/8/14 PET "mixed," with no new lesions, and everything but lower lungs improving. My breathing is better.
8/18/14 PET "mixed" again. Upper lungs & one spine met stable, lower lungs less FDG avid, original tumor more avid, one lymph node in mediastinum more avid.
9/1/14 Begin taking Xeloda one week on, one week off. Will also stay on Herceptin and Perjeta every three weeks.
12/11/14 PET Scan--no new lesions, and everything looks better than it did.
3/20/15 PET Scan--no new lesions, but lower lung lesions larger and a bit more avid.
4/13/15 Increasing Xeloda dose to 10 days on, one week off.
7/1/15 Scan "mixed" again, but suggests continuing progression. Stop Xeloda. Substitute Abraxane every 3 weeks starting 7/13.
10/28/15 PET scan shows dramatic improvement everywhere. All lesions except lower lungs have resolved; lower lungs noticeably improved.
12/18/15 Last Abraxane. Continue on Herceptin and Perjeta alone beginning 1/8/16.
1/27/16 PET scan shows cancer is stable.
5/11/16 PET scan shows uptake in some areas that were resolved on the last two scans.
6/3/16 Begin Kadcyla and Tykerb combination
6/5 - 6/23 Horrible diarrhea from K&T together. Got pneumonia.
7/15/16 Begin Kadcyla only every 3 weeks.
9/6/16 Begin radiation therapy on right lung lesion that caused the pneumonia.
10/3/16 Last of 12 radiation treatments to right lung.
11/4/16 Huffing and puffing, low O2, high heart rate, on tiniest bit of exertion. Diagnosed as radiation pneumonitis. Treated with Prednisone.
11/11/16 PET scan shows significant improvement to radiated part of right lung BUT a bunch of new lung lesions, and the bone met is getting worse.
11/22/16 Begin Eribulin and Herceptin. H every 3 weeks. E two weeks on, one week off.
3/6/17 Scan shows progression in lungs. Bone met a little better.
3/23/17 Lung biopsy. Tumor sampled is ER-, PR+ (5%), HER2+++. Getting Herceptin and Perjeta as a maintenance treatment.
5/31/17 Port placement
6/1/17 Start Navelbine & Tykerb
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Old 05-28-2016, 01:49 PM   #10
norkdo
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Re: New person to site

Ladiired, I'm so sorry. And so in awe of the content of the responses you have here too. Please continue to use this site to express the emotional side of what you are being told and experiencing. Please do. It helps others in your predicament to read that they are not alone in the feelings you are going through/symptoms etc. My toes and fingers are crossed for you and I hope you update us here about how it is going. You are not alone.
__________________
fall 2008: mammo of rt breast worrisome so am asked to redo mammo and have ultrasound of rt breast.I delay it til january 2009 and the results are "no cancer in rt breast. phew."
found plum sized lump in right breast the day before my dad died: April 17th 2011. saw it in mirror, while i was wearing a top, examining my figure after losing 10 lbs on dr. bernstein diet.
diagnosed may 10 2011

mast/lymphectomy: june 7 2011, 5/20 cancerous nodes. stage 3a before radiation oncologist during our first mtg on july 15th says he found cancer on the lymph node of my breast bone. Now stage 3b.
her2+++, EN-, PN-. Rt brst tumors:3 at onset, 4.5 cm was the big one
chemos: 3fec's followed by 3 taxotere, total of 18 wks chemo. sept: halfway thru chemo the mastectomy scar decides to open and ooze pus. (not healed before chemo) eventually with canasten powder sent by friend in ny (illegal in canada) it heals.
radiations:although scheduled to begin 25 january 2012, I am so terrified by it (rads cause other cancers) I don't start til february, miss a bunch, reschedule them all and finally finish 35 rads mid april. reason for 7 extra atop the 28 scheduled is that when i first met my rads oncologist he said he saw a tumor on the lymph node of my breastbone. extra 7 are special kind of beam used for that lymphnode. rads onc tells me nobody ever took so long to do rads so he cannot speak for effectiveness. trials had been done only on consecutive days so......we'll see.....
10 mos of herceptin started 6 wks into chemo. canadian onc says 10 mos is just as effective as the full yr recommended by dr. slamon......so we'll see..completed july 2012.
Sept 18 2012: reconstruction and 3 drains. fails. i wear antibiotic pouch on my job for two months and have 60 consecutive days visiting a nursing centre where they apply burn victims' silver paper and clean the oozing infection daily. silicone leaks out daily. plastic surgeon in caribbean. emergency dept wont remove "his" work. He finally appears and orders me in into an emergency removal of implant. I make him promise no drains and I get my way. No infection as a result. Chest looks like a map of Brazil. Had a perfectly good left breast on Sept 17th but surgeon wanted to "save another woman an operation" ? so he had crashed two operations together on my left breast, foregoing the intermediary operation where you install an expander. the first surgeon a year earlier had flat out refused to waste five hours on his feet taking both boobs. flat out refusal. between the canadian health system saving money and both these asses, I got screwed. who knows when i can next get enough time off work (i work for myself and have no substitute when my husband is on contract) to get boobs again. arrrgh.


I have a blog where I document this trip and vent.
www.nora'scancerblog.blogspot.com . I stopped the blog before radiation. I think the steroids made me more angry and depressed and i just hated reading it anymore
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