Herceptin and the Heart ... Need help

Hi. I was initially dx 08/02 ... invasive ductal carcinoma with dcis ... lumpectmy and radiation. In 04/05 I was dx with lymph node cancer ... same side reoccurrence, 2 out of 16 nodes positive. anxillary dissection, 3 months A/C every 3 weeks, 3 months Taxol/Herceptin weekly. HER2NEU 3+, Elston grade 3, hormone negative, comedo necrosis. I begain triple dose Herceptin 12/19/05 every 3 weeks for 9 more months. I had a reaction the very first dose of Herceptin/Taxol in August. I was there 9 hours that day and they had to give me injections to counter-act the reaction and then continued with the treatment. The reaction was chills, body aches. On 12/20/05, The day after the triple dose of Herceptin alone, I was really ill ... chills, body aches ... flue like symptoms.

My muga scan before Taxol/Herceptin was LVEF 75% .... after 3 months of Taxol/Herceptin it was 50.5%. After the first triple dose Herceptin I began to notice breathing issues .... getting out of breath on exertion and I have been very tired. On 12/25/05 I noticed little pockets of water retention/swelling in my feet and my feet feel more numb then they did after the Taxol. I called the docs office yesterday and they put me on a dieuretic for water retention via a phoned in prescription.

Has anyone else had issues like this while on Herceptin and is it cause to be worried?

Thank you,
Diana

"little pockets of water" and swelling in feet is edema. associated with CHF
sometimes.(Congestive heart failure) Maybe your doc sould address the underlying problem not just the symptoms. I would have another muga scan and decide what to do from there. Probably see a cardiologist.

[Rupali]

I went thru similar experience where the LVEF fell from 61% to 45%. I saw a cardiologist and he put me on Coreg and Lisinopiril. I also started taking 400 mg COQ10 daily and walk and yoga. That helped. Ia m back at 58%.
U will see recovery in 4 weeks.
Also eat 2 servings of wild salmon every week .

[BonnieT]

Hi
I would strongly suggest seeing a cardiologist!! My MUGA dropped from 53 to 35 after herceptin ( every 3 week cycle) I saw a cardiologist had an ECHO done ( they can visualize the heart) and was put on Coreg. and Lisinopril, I also take 100 mg Coq12.
After 2 months off of hercpetin my MUGA went back into the 50's.
Also I am now taking Herceptin once a week instead of every 3 weeks that way you take a lower dose each week that equalls what you would take every 3 weeks and that has helped me.
Best of luck and keep us posted
BonnieT

If you see a cardiologist this might be of interest. (see link below) To the best of my knowledge ErbB - 2 is the same as HER2 c-neu (these things seem to have lots of different names which is confusing).

Changing you three six balance and including some GLA (borage is preferable as lower in omega six) has been reported as possibly boosting the impact of Herceptin. You need to look through the posts on the subject.

There are certainly strong links between cardovascular health and balancing omega three and sixes (cutting doen on sources of omega six, sunflower, corn, grapeseed, soya oils - looking a labels of prepacked foods - watching out for hydrogenated fats ---- and increasing threes fish, fish oil (not codliver which tastes prety unpleasant) flax oil, green veg etc). There are lots of posts on this site. See articles of interest "the importance of omega three and six to breast cancer".

Wider dietary change is worthwhile considering.

A post on this site makes the point that the same effect can be acheived with varing doses depending on individual circumstances, and the impact monitored - I think it was Gina - it seemed to me to make perfect sense at a common sense level.

These are complex subjects. As usual you need to read it all for yourself so you are comfortable with your decisions after discussion with your advisers. I am only an interested amateur. There is lots of information posted on this site.

RB





Links ErbB -2 to heart - implications re herceptin etc. Beyond me but would proabably be of interest to someone with necessary expertise, and does demonstrate the need for cross specialism.

RB




http://www.ncbi.nlm.nih.gov/entrez/...l=pubmed_docsum

1: J Biol Chem. 1998 Apr 24;273(17):10261-9. Related Articles, Links
Click here to read
Neuregulins promote survival and growth of cardiac myocytes. Persistence of ErbB2 and ErbB4 expression in neonatal and adult ventricular myocytes.

Zhao YY, Sawyer DR, Baliga RR, Opel DJ, Han X, Marchionni MA, Kelly RA.

Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.

Neuregulins (i.e. neuregulin-1 (NRG1), also called neu differentiation factor, heregulin, glial growth factor, and acetylcholine receptor-inducing activity) are known to induce growth and differentiation of epithelial, glial, neuronal, and skeletal muscle cells. Unexpectedly, mice with loss of function mutations of NRG1 or of either of two of their cognate receptors, ErbB2 and ErbB4, die during midembryogenesis due to the aborted development of myocardial trabeculae in ventricular muscle. To examine the role of NRG and their receptors in developing and postnatal myocardium, we studied the ability of a soluble NRG1 (recombinant human glial growth factor 2) to promote proliferation, survival, and growth of isolated neonatal and adult rat cardiac myocytes. Both ErbB2 and ErbB4 receptors were found to be expressed by neonatal and adult ventricular myocytes and activated by rhGGF2. rhGGF2 (30 ng/ml) provoked an approximate 2-fold increase in embryonic cardiac myocyte proliferation. rhGGF2 also promoted survival and inhibited apoptosis of subconfluent, serum-deprived myocyte primary cultures and also induced hypertrophic growth in both neonatal and adult ventricular myocytes, which was accompanied by enhanced expression of prepro-atrial natriuretic factor and skeletal alpha-actin. Moreover, NRG1 mRNA could be detected in coronary microvascular endothelial cell primary cultures prepared from adult rat ventricular muscle. NRG1 expression in these cells was increased by endothelin-1, another locally acting cardiotropic peptide within the heart. The persistent expression of both a neuregulin and its cognate receptors in the postnatal and adult heart suggests a continuing role for neuregulins in the myocardial adaption to physiologic stress or injury.

PMID: 9553078 [PubMed - indexed for MEDLINE]