Choice of breast cancer or heart disease?

SunCrystal

Hello ladies,

I'm worried about heart damage caused by ACTH.  

I finished dose-dense AC in Nov. and then started on Herceptin and Taxol in Dec.  When I finished the 12 weeks of that regimen, I had a followup echocardiogram which showed normal heart function (Ejection Fraction = 60, same as pre-chemo baseline).  Since then I've had herceptin every 3 weeks.  I thought everything was going great (so side effects, no fatigue, I feel good) but my most recent echo showed that my left ventricular function had worsened. My oncologist was originally going to stop herceptin until I had another echo since the decline was > 10% but then decided to go ahead with that treatment since 50% is in the low normal range. The nurse administering the herceptin said that if my EF had been less than 48%, they definitely would not have done the herceptin. When I talked to the cardiologist, he said my EF was actually 45-50%.   I don't want to stop the herceptin because I sure don't want the cancer to return but am I setting myself up for future heart problems?  I will have another echo in 2.5 weeks before my next herceptin treatment. 

What has been other's experience with herceptin and lowered EF? At what point should herceptin be stopped? How much of a decline is too much?   

Thanks. 

Hindsfeet

SunCrystal...I declined chemo, and tamoxifen. I am only doing Herceptin (also mx) to prevent a recurrence. So...I know my recent heart problems isn't due to anything but Herceptin. After two rounds of Herceptin my EF dropped 15 pts. My oncologist, especially since Herceptin is all I'm doing, would like for me to continue Herceptin. I am now seeing a cardio specialist. I've had 4 echocardiograms, which is a echo after every 2 to 4 Herceptin treatments. I'm having another one tomorrow morning. If my EF drops below 50 then I will either be put on heart meds or taken off Herceptin for awhile. With other Herceptin side effects my choice would be to quit if my EF drops.

So far I've had 3 or 4 every three weeks infusions at higher dose. I've had 5 or 6 weekly infusions at low dose...those would equal about 2 regular infusions so I've had about 6 of 18 infusions. There are studies out there (I heard) giving 6 month Herceptin. I hope it proves that we don't really need a year infusion and 6 months is enough. For me that would mean I'm almost there.

SunCrystal

Thanks for your response, evebarry.  What happened wityou your last ehco?  Are you able to stay on herceptin?  I have another echo on Tuesday and then the oncologist will decide whether I can stay on it or need to take a break and let my heart recover.

Hindsfeet

Suncrystal, my EF dropped to 45. I'm not sure if it was 45 - 50 or 40-45 ... My oncologist cancelled my Herceptin appointments at least until mid-August. I feel as if I got enough to kill off any possible stray Her2+ cells. I would had like to had one more infusion as it would of completely covered my co pays so that the rest of my medical insurance for the year would be 100% covered...which would had helped covered my last breast reconstruction surgery at the end of the month. I'm fortunate to have a Herceptin grant to cover my copays. I have enough copays for specialist, scans and etc so that helps.

I am surprised your oncologist hasn't sent you to an cardio specialist. Have you had other Herceptin side effects? If I were you, I would take a six week break to see if your heart returns to normal. Or, ask for a smaller dose every week, or every other week.

(((hugs)))

DebbieB

I had the AC chemo 11 years ago when I was 45 years old.  5 years ago in about a 6 week period I started having shortness of breath that got progressively worse.  I ended up in the hospital with congestive heart failure.  After stress tests, echos, heart cath I found out the left ventricle of my heart was damaged and the damage was consistent with damage from Adriamycin.  My EF was down to 18% with normal being around 65%.  They put me on every class of heart drugs and slowly but surely after about 2 years my EF got back up to 60%.  I will remain on those drugs for the rest of my life but I am thankful they work because my other option was heart transplant.  When I was dxd with agressive bc that was highly HER+++ it was about as scarey as you can get as you know.  The heart problems scared me even worse.  I am still mad that my oncologist never did any muga scans.  I asked but he said they were not necessary! 

I would highly recommend to anyone who sees a steady decrease in EF or a large drop to talk to your onc and see a cardiologist about taking at least a short break to give your EF time to go back up.

dearjilly

Hello,

 I just got back from the cardiologist and he is putting me on ACE inhibitors and I am concerned about this.  Has anyone heard of this before?  He said my LV output was mildly low, but I didn't get a % this time around.  I almost just want to have another muga for piece of mind.