Herceptin Question

jen93652

Just a quick question to be sure I understand correctly -

Herceptin does not "cure or kill" cancer, it just prolongs your survival? Is it accurate to say that though the recurrance is postponed, it is an inevitable eventuality? (The chance of recurrance is not eliminated just postponed)

My hubbie feels that I am silly to be worried. It is easier for him to think that all is clear and everything is over but is that a true assumption? Not sure why this is foremost in my mind lately, so I thought I'd see how others feel about it.  Thanks very much

cbm

Hmm--I think it depends.  Herceptin is given for both adjuvant and metastatic treatment so the answer may be slightly different, depending on what it's given for.  There are women here who are WAY more technically competent than I am and will explain it better, but I think Herceptin tells your body's own defensive cells to attack (and kill) the cancer cell the Herceptin attaches itself to, and also they believe the Herceptin may tell the cancer cell itself to stop duplicating. 

I prefer to think of it like your hubby does, for whatever it's worth.  It's value does tend to be expressed as "cuts the recurrence rate in half" for the adjuvant use, I suppose because that is what the trial can show.  However, I think there are women here who will tell you it shrunk (shrank?) their tumor dramatically.  To me, that means killed cancer cells that won't be back!

I hope this helps; I have four more Herceptin treatments left, and on my worried days I try to figure out how  to get a few more after that. 

cbm 

bluedasher

Herceptin is an antibody that attaches to the HER2+ receptors on your cells. It works two ways - by stimulating your immune system to destroy the cancer cells - similar to what an antibody does for a virus cell - and by blocking the receptor so that the cell doesn't get signals to reproduce. 

Therefore, it or it plus chemo may have killed off all the cancer cells BUT we can't be certain it did so. Some cells may have been hidden away from the blood flow and didn't get enough of a dose to kill them. Occasionally there are HER2+ cells that Herceptin doesn't work against. And it is always possible that not all the cancer cells were HER2+. So, it may be all clear but we have no way of knowing for sure.

I'm a little confused by your signature which says stage IIb but also says mets which would be stage IV. If you are stage II, the BCIRG 006 clinical trial included women with cancer similar to you and the disease free survival at  4 years (the latest released data - I hope they release the 10 year data sometime) was 82% and survival was 92%. That was for TCH treatment. For AC-TH, the numbers are about a percent higher but the difference isn't statistically significant (i.e. it might have been caused by random variation rather than by a difference in how effective the two are). 

So, your odds are pretty good but not perfect and you wouldn't be silly to have some worries that it may come back. I'm node negative so my odds are somewhat better but recurrence risk isn't zero even then. If you are stage IV, the odds are somewhat worse I guess but I haven't looked at the stage IV study results.

I've decided that worrying won't keep it from coming back and if it does, I'll be better off from having enjoyed the years between now and then. So I might as well get on with living my life and not worry. But I know that doesn't work for everybody. Some people have a harder time turning worry off. 

Here is the Herceptin website explanation of how it works:
http://www.herceptin.com/metastatic/what-is/how-does-it-work.jsp

carcharm

In a nutshell Herceptin is immune therapy against HER2+ cancer. The standard of care is 1 year of Herceptin post Chemo. Unfortunately, there are not many if any studies out there to say why 1 year of Herceptin is better than say 5 years or even 6 months. Through the CoC surveillance on our treatment modalities and studies that may be done in the future the standard of care may change. We are kind of the guinea pigs for this treatment. What we do know is that in previous studies it has proven to reduce/rid/prolong reoccurance in HER2+ breast cancer patients. I do see others in these threads who have mets who use it for that purpose also.

TheShopMama

My surgeon told me that when they first began using Herceptin in clinical trials, SURVIVORSHIP went up over 50%.

bluedasher

The 1 year that carcharm mentions is for adjuvant treatment. I think that they use it long term in some cases where there are mets.

We don't know if longer than 1 year helps for adjuvant, but the HERA study has one arm of Herceptin for a year and another arm with Herceptin for 2 years. That study has been going for quite a while and has released results for 1 year Herceptin but they haven't released results comparing the 1 and 2 year arms. I assume that if they had gotten results that said that there was a significant advantage to the longer treatment time, then they would have released them. My interpretation of them having not released anything is that there is no news there and the extra year of Herceptin isn't showing an advantage. 

There are good results in some small studies like FinHer using Herceptin for shorter terms like 9 or 18 weeks, but I don't think there have been any head to head studies of shorter term vs a year or at least nothing that has released conclusive results yet.