Herceptin

Hindsfeet

Since I'm seriously considering herceptin, I feel like I need to understand exactly what it is. Why does it sometimes effect the heart & or lungs? How does it work? How effective is it? Is chemo really necessary to take with it? What are the studies with or without chemo? Long term effects? How does it increase the immune system to fight the cancer?

If I take it I want to know that I'm doing the right thing not because a few people say so. I need to see the black & white facts as to the whole of it. So...I'm doing a little online research and welcome any information that gives me and everyone else considering it better insight to this drug and the herceptin stopping the over expressing her2+ gene.

sweetbean

I'm taking it because it rules.  Hope that helps. 

Hindsfeet

I've been reading that herceptin boost the immune system. That intrigues me. I found the below article interesting.

 http://discoverysedge.mayo.edu/immunity-vaccine/

 the researchers find Herceptin works by bumping up the production of antibodies -

From the same article it seems to advocate that a strong immune system is important in the fight against cancer that an immpaired immune system could make people more susceptible to the disease.

My question here is THEN why take anything that suppresses the immune system. Logically it seems that chemo or any drug that suppresses the immune system might make us more vulnerable to cancer recurrence or another cancer??? If chemo suppresses the immune system are we then making herceptin uneffective. From what I understand so far it seems that once the herceptin locks onto the her2+ gene that it no longer is a fast moving cell. Chemo kills fast moving cells so it seems logical to me it would not be a companion drug for herceptin. Once the herceptin antibody is locked onto the mutated cancer gene our then killer cells attacks it. Isn't this enough?

Just as a boosted immune system could be more effective in fighting cancer, an impaired immune response could make people more susceptible to the disease. Researchers have shown that ovarian cancer "escapes" the body's defenses by actively suppressing the immune system, but no one has ever linked that laboratory finding with patients' actual responses to treatment. And once women are diagnosed with ovarian cancer, there is wide variation in how people are affected, though it is not clear why.

From this same article it states that heart failure could be caused by people, who are either have or predisposed to RA.

Dr. Knutson teamed up with Dr. Gabriel, an epidemiologist, who for the past six years has been studying entire populations of individuals with rheumatoid arthritis. In some people, this illness is mild whereas in others it is aggressive, not only attacking their bones and joints but also other internal organs. Through her epidemiological studies, Dr. Gabriel found that people with rheumatoid arthritis experience an unusually high risk of heart disease, heart attack and heart failure.

Because sudden cardiac death is often the first cardiovascular event that someone with rheumatoid arthritis has, people don't realize they are at risk until it is too late, explains Dr. Gabriel. So, if researchers could develop predictive markers to identify those patients, they may be able to intervene and prevent devastating cardiac events.

Hindsfeet

http://www.beasurvivor.com/ch066.htm

immunotherapy (also called biological response modifier therapy, or biotherapy) is a relatively new approach to cancer treatment that targets cancer cells specifically.

The action of immunotherapy centers around the body's own built-in defense system-the immune system. This system includes various white blood cells (B cells, T cells, Natural Killer cells and monocytes), that circulate through the blood, each with its own specific way of attacking foreign particles, defective cells, and cancer cells. Think of the immune system as an army that relies on tanks, planes and foot soldiers, each group with its own responsibilities.

Immunotherapy works in a variety of ways:

• It can boost the immune system's natural cancer-fighting ability.
• It can coat the surface of cancer cells, cutting off the oxygen and nutrients they need to grow.
• It can make cancer cells more recognizable, and therefore more susceptible to destruction.
• It can boost the killing power of your immune system cells, such as T cells, NK cells, and macrophages.

The first immunotherapy compound to gain acceptance in breast cancer treatment is called Herceptin. Herceptin is a monoclonal antibody. An antibody is a protein naturally produced by the body to fight off all foreign particles. A monoclonal antibody is a protein bioengineered in a laboratory and designed to target certain cancer cells.

Herceptin finds and attaches itself to the HER-2/neu protein on the surface of these cells, slowing their growth. There is little if any effect on normal cells, which do not have an excess of HER-2/neu. Herceptin also works by attracting the body's own immune cells to help them find and destroy the cancer cells.

NOTICE: HERCEPTIN SLOWS THE GROWTH OF CANCER CELLS. NOTE, CHEMO KILLS FAST GROWING CANCER CELLS. THEN THERE IS NO NEED FOR CHEMO IF HERCEPTIN CAUSES OUR CANCER CELLS TO BE SLOWED DOWN. RATHER THE CANCER CELLS WOULD KILL OUR FAST MOVING KILLER IMMUNE CELLS THAT'S NEEDED TO DESTROY THE CELLS THAT HAS HERCEPTIN LOCKED ONTO IT.

Hindsfeet

In a recent clinical trial on tumor vaccination, it was observed that women who had completed therapy with trastuzumab had a significant superior E75-specific CD8⁺ T cell response to the first vaccination with E75 peptide.¹⁶ This demonstrates that the immunological effect of trastuzumab persists even after the antibody has been cleared and most importantly, that trastuzumab is able to induce a long lasting immunological effect, thereby indicating the generation of a memory immune response

http://jco.ascopubs.org/content/28/21/e369.full

Hindsfeet

Side effects:
Important things to remember about the side effects of trastuzumab:

• The side effects of trastuzumab and their severity depend on whether the drug is given in combination with other medications.  In other words, trastuzumab given in combination with other chemotherapy drugs may produce more severe side effects

http://www.chemocare.com/bio/herceptin.asp

Hindsfeet

The following side effects are common (occurring in greater than 30%) for patients taking trastuzumab.  The frequency of side effects reported is based on single agent trastuzumab:

• During the first infusion of this trastuzumab, you may develop chills or a fever. Your health care provider might prescribe medicine to prevent or treat these symptoms.
• Body pain
• Weakness
• Nausea

These side effects are less common side effects (occurring in about 10-29%) of patients receiving trastuzumab.  The frequency of side effects reported is based on single agent trastuzumab:

• Headache
• Diarrhea
• Abdominal pain
• Back pain
• Infection
• Flu-like symptoms
• Vomiting
• Cough
• Shortness of breath
• Rhinitis or pharyngitis (see cold symptoms)
• Insomnia (see sleep problems)
• Rash (see skin reactions)
• Dizziness
• Swelling (usually of the feet, ankles or hands)

Infrequently, serious hypersensitivity reactions (anaphylaxis) (see allergic reactions), have been associated with trastuzumab. Most of these events occur within 24 hours of infusion. However, delayed reactions have occurred. Trastuzumab should be used with caution in people with lung problems.  If a person experiences severe hypersensitivity reaction, trastuzumab may be discontinued.

A serious but uncommon side effect of trastuzumab can be interference with the pumping action of the heart. The incidence of heart problems (heart failure) increase in people with heart disease or other risk factors such as radiation to the chest, advancing age, and use of other heart-toxic drugs (such as doxorubicin and cyclophosphamide).  Your doctor may check your heart function before you may take any trastuzumab and will monitor your heart closely during your treatment.  Trastuzumab may be discontinued if symptoms of heart failure appear.

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here.  However, you should always inform your health care provider if you experience any unusual symptoms

http://www.chemocare.com/bio/herceptin.asp

Hindsfeet

Patients with tumors that are 3+ on the IHC test are most likely to benefit from Herceptin therapy; those with tumors that are 0 or 1+ are unlikely to benefit from this treatment. Patients with tumors that are 2+ often have an additional test, called fluorescence in situ hybridization (FISH), to determine whether the tumor is HER-2 positive. FISH measures the number of copies of a gene. Tumors with too many copies of the HER-2 gene as determined by the FISH test are considered positive. 

http://www.cancer.gov/cancertopics/factsheet/Therapy/herceptin/print

Hindsfeet

How do monoclonal antibody drugs work?

When a monoclonal antibody attaches to a cancer cell, it can:

• Make the cancer cell more visible to the immune system. The immune system attacks foreign invaders in your body, but it doesn't always recognize cancer cells as enemies. A monoclonal antibody can be directed to attach to certain parts of a cancer cell. In this way, the antibody marks the cancer cell and makes it easier for the immune system to find.

  The monoclonal antibody drug rituximab (Rituxan) attaches to a specific protein (CD20) found only on B cells, one type of white blood cell. Certain types of lymphomas arise from these same B cells. When rituximab attaches to this protein on the B cells, it makes the cells more visible to the immune system, which can then attack. Rituximab lowers the number of B cells, including your healthy B cells, but your body produces new healthy B cells to replace these. The cancerous B cells are less likely to recur.

• Block growth signals. Chemicals called growth factors attach to receptors on the surface of normal cells and cancer cells, signaling the cells to grow. Certain cancer cells make extra copies of the growth factor receptor. This makes them grow faster than the normal cells. Monoclonal antibodies can block these receptors and prevent the growth signal from getting through.

  Cetuximab (Erbitux), a monoclonal antibody approved to treat colon cancer and head and neck cancers, attaches to receptors on cancer cells that accept a certain growth signal (epidermal growth factor). Cancer cells and some healthy cells rely on this signal to tell them to divide and multiply. Blocking this signal from reaching its target on the cancer cells may slow or stop the cancer from growing.

• Stop new blood vessels from forming. Cancer cells rely on blood vessels to bring them the oxygen and nutrients they need to grow. To attract blood vessels, cancer cells send out growth signals. Monoclonal antibodies that block these growth signals may help prevent a tumor from developing a blood supply, so that it remains small. Or in the case of a tumor with an already-established network of blood vessels, blocking the growth signals could cause the blood vessels to die and the tumor to shrink.

• http://www.mayoclinic.com/health/monoclonal-antibody/CA00082

marjie

After my surgery & snb in August 2010, pathology showed that my surgeon had got lovely clear margins and that my lymph nodes were clear.

In very layman's terms, my onc explained that a good way to look at treatment was that surgery removed the cancer successfully, chemo was like a golden insurance policy, but herceptin was actually saving my life.  I will be finished in January.

AlaskaAngel

There are SO many issues involved in treatment that are hard to get across to newbies, who are so easily influenced by those "helpers" who think of chemo as a magic solution to the problem in the belief that it will certainly work for them.

One that sticks out by mile for me is the calculated way in which early stage breast cancer patients were sacrificed in behalf of more those at higher risk. What newbies don't know, and what the "helpers" don't grasp, is the history of the trials for trastuzumab.

In the world of cancer where chemotherapy is the golden standard, not because it works very well but because it is so toxic that it "must be effective in some way", any new drug would have to have impressive results to be considered against the use of chemotherapy. The biggest group of bc patients is the early stage bc patients, due to more early screening, etc. If that group had been included in the trials, the results would have been far less impressive because their recurrence rate is so much lower, even if all they have is surgery. So the trials were set up to only include the higher-risk patients. Investors do not like to fund drugs that do not have highly impressive results. So in terms of the use of chemotherapy with trastuzumab for ALL stages, the basic trastuzumab trial results are skewed. I can see why those who designed the trial did so to get the trials off the ground, and don't blame them for it. It at least got the drug approved, in a world where chemotherapy was so highly favored. But by doing what they did, they sacrificed early stage bc patients in the process. What IS so unfortunate is that so many "chemo helpers" in effect actually promote that unfortunate bias against early stage bc patients.

There is one thing that chemo does that trastuzumab alone does not do, and that I think probably makes a big difference in avoiding recurrence, and that is ovarian ablation. I suspect that for trastuzumab to be as effective as chemo and trastuzumab, some form of ovarian ablation must be accomplished. And because trastuzumab doesn't damage the immune system, I think ovarian ablation plus trastuzumab would have a far lower recurrence rate.

A.A.

Ang7

I have to say that I had some side effects during chemo but at the end of treatment, when I was on Herceptin alone, I had no side effects.

Hindsfeet

Marjie, I would ask your oncologist, in regard to chemo, what is the golden insurance policy? What kind of insurance does the chemo part give me?

Alaska Angel says that trastuzumab with chemo ovarian ablation makes for less recurrence...where is the study that shows that to be true? What confidence do we have that chemo plus trastuzumab is a guaranteed. I heard a study where possible 50% of those who took it were benefited. What happens to the other 50%? 

TheLadyGrey

I have never seen an explanation that I find personally satisfying as to why the protocol calls for Herceptin to be administered with chemo and not as a stand alone treatment.  I understand that some oncologists are willing to prescribe Herceptin by itself, but I gather that is not an FDA/NCI blessed therapy.  On that ground, insurance could choose not to cover Herceptin alone.  

I tend to follow the $$$ when I don't understand something, and there are certainly $$$ here to follow to some unsavory conclusions, but I also know that I am in WAY over my head -- I have only the dimmest understanding of how any of these treatments work. I'll never understand the science of it well enough to support an opinion.  

However, I'll bet that at some point in the not too distant future, Herceptin alone will be a recognized treatment for cancers like mine.  

When I start circling my cynical toilet, I remember that all I have to do is show up..... 

AlaskaAngel

Evebarry,

The idea that one would need to have ovarian ablation by other means than chemotherapy if one were to do trastuzumab alone is only my best guess. I mention it because no one knows yet if trastuzumab alone would be as effective as chemotherapy plus trastuzumab for early stage bc, and because a major effect of chemotherapy IS the menopausal effect that chemotherapy has on the ovaries.

Sales pitches are most effective when they are kept very, very simple. People with cancer easily grab the concept that "chemotherapy kills cancer cells", and buy into it. I'm not saying that it doesn't. But what I am saying is that the repeated wiping out of abnormal cells that are in the process of dividing at the time, while an appealing and very simple idea to visualize, may not even be the major effect of chemotherapy in prevention of recurrence. The hormonal suppression effect of chemotherapy on the ovaries may actually be what is most effective about chemotherapy, especially considering that there is scientific doubt that chemotherapy is effective on stem cells. It is known that younger patients do worse in general despite chemotherapy and often fail to achieve or maintain chemopause. So to me it adds up to a need to include ovarian ablation if one is doing trastuzumab alone, since trastuzumab does not have any identified hormonal effect on the ovaries. (Those who are completely menopausal at diagnosis presumably would then only need trastuzumab.)

What is most mysterious to me is, if someone like me can put 2 + 2 together and come up with 4, why aren't the researchers able to?

A.A.

Hindsfeet

AA ... In regard to ovarian obliation... I'm may be speaking from ignorance here, but isn't there good estrogen and bad estrogen? I've read that all our cells need good estrogen to function at its best. Once we've hit menapause then why do we need to rid our body of what little hormones we have? I know that cancer cells have hormone receptors. Doesn't all our cells have these same receptors?

I understand what you mean by logical reasoning in comparison to what the researchers are throwing at us. Logically, no one has answered my questions in regard to why chemo and herceptin together? Don't get it! Again, if herceptin stops the cancer cells from moving aggressively then chemo is going to ignore those cells. This is when we need a strong immune system to support the killer cells in their effort to kill the cancer cells with the hercepin locked onto it. Things have to make sense to me.

Also, AA ... have you read about a targeted chemo that only kills cancer cells? It does not have the side effects of regular chemo. I think it is given in lower dosages.

kim40

I took Herceptin for a year.  Once I was told how aggressive my cancer was by being Her2+, I had no qualms in taking and other than having a runny nose, that was it when it came to side effects.   I truly believe that Herceptin saved my life. 

Leslie1962

I did Herceptin because the advantages outweighed the risk. My ejection fraction did suffer a bit but not to the point of having to stop treatment. Had echo done every three months during treatment to monitor.