Over 80 & Herceptin:special precautions?

[heblaj01]

I wonder if information is available from kins of patients over 80 years old taking Herceptin as to special precautions to avoid or minimize short term & long term side effects in particular for the initial loading dose which is normally twice larger than subsequent doses.

Concerning the potential cardiac side effects is it true or not that the longer the infusion time (within reason) the lesser the risk?
If so, how long should the infusion time be?

[Cathya]

I am not sure how available that information is but Tom's mother is over 80 has been totally controlling her disease using herceptin. I would do a search of Tom's posts and perhaps email him directly. He would be a marvelous resource in this matter.

Cathy

[Tom]

Hello Heblaj.

My Mom is 82 now, and has been receiving Herceptin since last July. The only immediate side effect at the start, was a fever several hours after she received her loading dose, which is 4MG/KG of body weight, infused over 90 minutes. They continue with the 90 minute infusion time for a few visits, just to make sure you tolerate it well. Of course, the patient is pretreated at every session with Benedryl, to lessen any unwante response to the drug. After a few treatments without complictions, they will stop the Benedryl, give only Tylenol, and shorten the infusion time to 30 minutes.

As for cardiac toxicity, it usually occurs most frequently when Herceptin is given with other conventional chemotherapeutic agents. My Mom is receiving Herceptin alone, and has shown only mild cardiac response to the drug. Her baseline MUGA score for left ventricular ejection fraction, was 80, which is unusually high by anyone's standards. After a period of three months, it dropped to 70, then reovered to 75. The last MUGA showed it has once again dropped to 70.

I give Mom 100MG of CoQ-10, three (3) times a day, to try to help minimize it's effects on her cardiac function. I also give Mom a long list of supplements and dietary ingredients. If you do a search of my past posts, or the words cardiac or MUGA, you will probably find out plenty about staving off the effects of chemo drugs on the heart. I would remind you though, that CoQ-10 is a powerful antioxidant and you should consult your oncologist about taking it DURING any conventional chemo drug regimen. Most here I believe, WITHOLD CoQ-10 during their chemo cycle, an resume it during breaks in their treatment to try to help their heart recover somewhat before their next cycle.

I hope this helps you somewhat. If you have any further questions, just post again. Tke care and good luck with the treatment.

Tom

[heblaj01]

Thanks a lot to both Cathy & Tom for the quick reply which I received just before the elderly lady in my family took her first 6mg/kg loading infusion of Herceptin today.
Also received just on time the MUGA test result: 69%. Since the lady is 90 years old this month, her onc complained her MUGA was better than his!
Both these events helped me in discussions with the onc about the dosing which remained unchanged

Your reassuring reply & the MUGA relieved a bit my anxiety even though the hospital nurses told me they can't remember a Herceptin patient in this age category among their 3000 yearly cancer patients of every stripe.

She was pretreated with Decadron (& at my request with 2 tylenol taken before & after the infusion whose duration was extended to over 2 hours instead of 11/2 hour).
So far in the 7 hours after the infusion the only observed side effect has been a 15 minutes moderate nose bleeding which occured less than 3 hours after the end of the I.V.

I am not entirely happy about the use of the cortisone Decadron because of its potential side effects including on open angle glaucoma.
I noted that several posters have indicated that they were taking Benadryl & Tylenol.
Does anyone know the pros & cons of the two pretreatment modes?

[Tom]

I must admit that I am a little shocked to hear the choice of Decadron for preteatment, but I don't know any of the details of your relative's disease. That stuff packs a wallop, and is often used to drastically reduce swelling around the brain in the event of head trauma or brain tumors. Personally, I wouldn't want to be given anything that would suppress my immune system in any way. Ask her doctor about our concerns.
Take a look at Genentech's website to read all of the important information regarding Herceptin's use and administration, including side effects.


www.gene.com


Also look at www.herceptin.com , which is a site for Herceptin itself. It is very informative.