Herceptin and Adriamycin?

[Brenda_D]

I posted this in a different forum and got no response. Maybe the girls here are more in tune with this?

I just watched a video from Healthology that says they aren't supposed to give Herceptin concurrent with Adriamycin, due to the high risk of heart damage.

I am currently getting Herceptin, Adriamycin, and Cytoxin in my chemo sessions!


I managed to get a transcript of the video to print out and take to my Onco. I'll let you all know what his response is.

[tousled1]

Brenda,

When I had my chemo I had the Adriamycin, and Cytoxin together for 4 rounds followed by 4 rounds Taxatere. I am now receving Herceptin alone. I too read that you should not have the Adriamycin with Herceptin since both are heard on the heart. I would definitely talk to your oncologist about it.

[CPA]

Yes, bring this up. The two should not be used concurrently.

[KellyA]

I had 4 DD of A/C followed by 12 weekly Taxol and my onc. would not even give me the Herceptin until my 6th dose of Taxol because of heart issues. He wanted to make sure that the A/C was out of my system. He may have been over-cautious, I don't know. I remember that it was driving me crazy because I wanted all 12 Taxols to be with the Herceptin and only 7 were. Maybe the guidelines have changed, or it might just be that the risk is still very low and your onc. felt the benefits outweighed the risks.

Love, Kelly

Dear Brenda,

I wish I could find the actual study (I have hundreds of breast cancer bookmarks, which means, of course, that I can never find what I'm looking for) that shows herceptin and adriamycin are contraindicated because of potential heart problems. It may even be on the herceptin drug insert. But you are correct, they are not supposed to be used together. My memory, after chemo, is not great but I recall that about 24% of women who took them concurrently had some heart issues. You really should talk to your doctor about your treatment. I know my oncologist is dead set against using the two together; my treatment was herceptin, with taxol and carboplatin, concurrent. I've been on herceptin for six months and my MUGA yesterday showed that LVEF is 61%. It's fallen a bit but still well within safe range. If I find the study I speak of I will post it later today.

Brenda,

Here is the warning carried within the herceptin prescribing information:

WARNINGS Cardiomyopathy Herceptin can cause left ventricular cardiac dysfunction. Cardiac dysfunction in patients receiving Herceptin therapy can be serious with disabling cardiac failure, death, and mural thrombosis leading to stroke (see BOXED WARNINGS: Cardiomyopathy).

Among women receiving adjuvant therapy for breast cancer in Study 1, 16% (136/844) of patients discontinued Herceptin therapy due to clinical evidence of myocardial dysfunction or significant decline in LVEF (see DOSAGE AND ADMINISTRATION: Dose Modifications). There was one death due to cardiomyopathy among patients receiving Herceptin. If Herceptin therapy is discontinued for left ventricular cardiac dysfunction, patients should be closely monitored for evidence of clinical deterioration and further decline in left ventricular function.

Among 32 patients receiving adjuvant chemotherapy (Studies 1 and 2) with clinical cardiac events as determined by ACREC, one patient died of cardiomyopathy and all other patients were receiving cardiac medication at last follow‑up. Approximately half of the surviving patients had recovery to a normal LVEF (defined as ≥ 50%) on continuing medical management at the time of last follow‑up. The safety of continuation or resumption of Herceptin in patients with Herceptin‑induced left ventricular cardiac dysfunction has not been studied.

In the adjuvant setting, among patients who completed AC chemotherapy and received at least one dose of paclitaxel, 2% [32/1677] of patients in the Herceptin arm and 0.4% [7/1600] of patients in the control arm experienced clinically symptomatic, laboratory‑confirmed cardiomyopathy as determined by an external review committee (ACREC).

Among patients with metastatic breast cancer, the incidence of CHF was 11% versus 1% in patients receiving paclitaxel with or without Herceptin and 28% versus 7% in patients receiving AC chemotherapy with or without Herceptin, respectively. The incidence of CHF in patients with metastatic breast cancer receiving Herceptin monotherapy was 7%.

An exploratory analysis for risk factors for symptomatic cardiomyopathy was conducted in patients receiving adjuvant treatment for breast cancer. The analysis is limited by the number and type of variables collected and how they were defined. Declining LVEF to below the lower limit of normal after completion of AC chemotherapy or during Herceptin treatment, a reported history of prior or concurrent use of anti‑hypertensive medications, and increasing age were associated with an increased risk of Herceptin‑induced symptomatic cardiomyopathy. Similar limited analyses in patients receiving chemotherapy for metastatic breast cancer identified prior cardiotoxic therapy (e.g., anthracycline or radiation therapy to the chest) and increasing age as potentially associated with an increased risk of Herceptin‑induced CHF.

Candidates for treatment with Herceptin should undergo a thorough baseline cardiac assessment, including history, physical examination, and an assessment of LVEF by echocardiogram or MUGA scan. Patients receiving Herceptin should undergo frequent monitoring for deteriorating left ventricular function. The following recommended schedule is consistent with that used in Studies 1 and 2: at baseline prior to AC chemotherapy, immediately prior to initiation of Herceptin, 3 months after initiation of Herceptin with paclitaxel, 3 months after initiation of Herceptin monotherapy, and 3 months after completion of Herceptin monotherapy. More frequent monitoring should be employed in patients with preexisting cardiac dysfunction. Monitoring will not identify all patients who will develop cardiac dysfunction.

[Sherryg683]

My Oncologist gave me Taxotere, Xeloda and Herceptin. I asked about Adrimiacin and he said no way would he give it as a coctail with Herceptin because of the high risk for heart attacks...sherryg683

[Mary Jo]

I had 4 rounds dose dense of adriamycin and cytoxin. Then 4 rounds of taxol with heceptin. The taxol was given every 2 weeks the herceptin every 3. Also did rads while on herceptin. My heart handled it all well. Thankfully.


Mary Jo

[Brenda_D]

Thanks everyone.
I plan to call my Onc's office on Monday and ask about getting Herceptin and Adriamycin in the same chemo setting, and express my concerns, because he only asked how my heart health was, and never ran any tests.

I may have to ask to have the Herceptin course be given after the AC course (4 treatments every 3 weeks) is finished.

I have learned that each person needs to be vigilant and look out after their own health care, and that it's ok to question your treatment and what the doctor is giving you.

[Lala]

Brenda
I am in the process of looking at Anthracyclines for my treatment.
I have been researching Adriamycin vs Doxil. I chose Doxil as the studies have shown less cardio toxicity.

I recently read an article posted here by Lani on Jan 17, 2007
"Anthracyclines on their way out of bc treatment?" see the link
http://her2support.org/vbulletin/showthread.php?t=26744

I found this article very interesting and informative.
If you are in question of your health; have your oncologist order an echocardiogram or muga to look at your LVF rate.
Best wishes to you.

[rinaina]

BrendaD you are so right about each patient looking out for themselves and bringing questions to the docs or anyone involved in the treatment...and the docs should respect you and your questions without a problem. I too read that A/C and Herceptin are a no no together.

[atdec05]

Hi Brenda,

You should have had an echocardiogram or MUGA test before you started chemo. Then at the end of chemo and every 3 months on Herceptin. I thought that was pretty much the standard.

- Anna

[Brenda_D]

I called the Onc's office and spoke with whoever answered the phone, and told her my concerns, and she replied "I don't know where you got your infomation, but we do that all the time" (give Hercpetin with Adriamycin).
I said, it came from Sloan Kettering (editorial approval) and that I had talked with several others getting chemo and that combo is a no-no.
She said she'd have the doc call me back.
His nurse called and said yes, there was that possibility and if I wanted that they could just give the A/C then after I finished those rounds, I could have the Herceptin.
I said, that's all I wanted, was to have those 2 treatments separated, as they should be.
So, now I guess all is well.

I have one more question. How long did most of you receive Herceptin?

[Mary Jo]

Hi Brenda,


I received A/C (4 dose dense cycles) - the started taxol along with herceptin. I received the taxol every 2 weeks but the herceptin every 3 weeks. I received herceptin every 3 weeks for 1 full year.

Mary Jo

[Sandy H]

I am glad you got this taken care of. My oncologist said, "no way" doing the two together. He goes with what Dana Farbar in Boston recommends. You are so right you have to really be pro active and stay on top of this disease. We have ourself to look after the docs have many of us and some have other types of cancers to keep track of. Wishing you well and thanks for keeping us updated. hugs, Sandy

[Brenda_D]

Heh, I just ran across this on the Genentech website.
The Herceptin fact sheet.
http://www.gene.com/gene/products/in.../factsheet.jsp

At the bottom, where it says Administration-

Do not administer concurrently with doxorubicin and cyclophosphamide.

Those are the generic names for Adriamycin and Cytoxan, both of which I received along with Herceptin, at my first chemo treatment.
I printed that out and highlighted it, and will give it to the Onc at the next treatment.

[Barbara2]

Many of your onc's breast cancer patients will benefit from your diligence! How nice that you will present the information to him, rather than dropping the subject...

[Hope M.]

Brenda,
I would be concerned about the competency of your oncologist. This is a well-known risk and the two drugs should never be given at the same time.

You may want to request a MUGA or echo to study your left ventricle function.

Good luck,
Hope M.

DX: May 2003; Stage 3, 4 pos nodes, tumor 8 X 9 cms
TX: 6 cycles TAC
25 rads
1 year weekly Herceptin