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Goddess Forever
Posts: 316
Reply with quote  #1 
Well my latest ct scan says node behind breastbone is about the same (in may it looked slightly better). Two spots in lung are less dense looking and one is more dense. Nothing new. 
Plan is to stay with kadcyla today and maybe one more cycle. Or I can change now or after the next cycle to:
What do u think?

Cancer is a word, not a sentence

Chief of Research
Posts: 1,129
Reply with quote  #2 
It is clear that although there is no strict objective  response from the T-DM1  (complete (CR) or partial response (PR)), you are still obtaining a clinical benefit, that of relatively stable disease (SD).  My therapeutic posture is to accept that as an interim benefit only, and push to achieve true objective response. 
At this stage, the best options I would consider to be:
  1. First: Add the newly-approved and highly effective anti-HER2 agent, pertuzumab (Perjeta) (to current T-DM1, or as fallback,  to Herceptin)
  2. Second: based on two or more successive monthly marker readings, if two markers readings past baseline don’t not show significantly successively decreasing levels (at least 25%, preferably 50% reduction), then I would consider either: 
    • adding exemestane (Aromasin) + everolimus (Afinitor) to either T-DM1 or Herceptin;
    • adding a chemotherapy agent to this regimen:
      • either gemcitabine (Gemzar) 
      • the new-generation anthracycline, namely pegylated liposomal doxorubicin (PLD, commercially: Doxil).
  3. Third: Obtain a current baseline tumor marker reading, then administer the Herceptin + lapatinib (Tykerb) dual anti-HER2 regimen if not already tried.
  4. Track markers closely (monthly), and if no objective benefit on above regimens:
    • add eribulin (Halaven)  to any regimen achieving at least stable disease
    • consider a clinical trial (especially, but not restricted to, those using pertuzumab with chemotherapy, or eribulin (or both)).
That is a highly proactive and aggressive treatment plan to achieve some true tumor load reduction and disease regression.

As to clinical trials, although I haven’t had the opportunity to review all potentially attractive clinical trials, evaluating their level of promise, and then ranking them by evidentiary support ((the entire process a large undertaking of at least an intensive week of review, or more), I did perform an accelerated examination for you which suggests these two when restricting attention to combination pertuzumab (Perjeta)-based treatment, without as far as I can see any exclusion criteria that  would apply to you, so these are explorable (hyperlinking to the full descriptions):
  1. Phase II Study of Eribulin Mesylate, Trastuzumab, and Pertuzumab in Women With Metastatic, Unresectable Locally Advanced, or Locally Recurrent HER2-Positive Breast Cancer. [Locations: Dana-Farber only, in Mass.] 
  2. Paclitaxel, Trastuzumab, and Pertuzumab in the Treatment of Metastatic HER2-Positive Breast Cancer. [locations: NY, NJ, at Memorial Sloan Kettering sites]
I give  them in the order of preference, but they should be discussed with your oncologist, depending on confirmation of eligibility and on geographical viability, but are worth exploring (the first, with eribulin (Halaven) + pertuzumab (Perjeta) + trastuzumab (Herceptin) looks especially promising, and we have some preliminary data of efficacy of eribulin in HER2+ disease.

Constantine Kaniklidis
Breast Cancer Watch

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