Kadcyla trial or push for more Perjeta?

Anonymous

Dx'ed with Stage III highly Her2+ cancer, my treatment plan was ACx4 followed by Taxol and Herceptin with six cycles of Perjeta. When the six Perjeta cycles were nearing their end, I asked my local oncologist (who is very highly thought of) and the oncologist I see at Moffitt about continuing Perjeta after surgery, as I kept reading about people who are getting it for a full year. They both said no, since it is not yet approved by the FDA for adjuvant usage yet and were concerned about side effects. I reluctantly agreed to drop the matter for the time being, as I was also worried about the fact that my EF had fallen about 10% since starting treatment. Instead, I enrolled in a clinical trial where I am to get Kadcyla until July, as I wanted to be more aggressive than getting Herceptin alone. 

I was psyched about the trial until the news about Perjeta greatly extending survival in MBC patients came out. Now I'm questioning my entire treatment plan. On one hand, I want to be getting the best treatment possible and would hate to find out that Kadcyla is less effective. On the other hand, I got a very good response from the AC+THP protocol but not a complete one. So logic would follow that since adding Perjeta didn't completely kill the cancer, it would make sense to try something new. And just from reading the Stage IV board, a lot of people do seem to respond well to Kadcyla.

I have decided that I do need to get another opinion from an oncologist who specializes in Her2+ cancer. I currently have some ideas and I am pursuing that. I just wanted to pick the brains of the breastcancer.org folks too.

ben50

Both sound like good options to me. From the way you describe it, it sounds like you KNOW you're getting Kadcyla from this trail. If this is the case, than it sounds like an awesome option. Kadcyla is super Herceptin and I would be super happy knowing my wife got that that in addition to H and P. But if it's like the typical clinical trail, you don't know which arm you're on and you could be receiving a placebo. I remember hearing those same options before we started chemo: the TDM-1 trail if we didn't achieve a pCR. It's definitely not a bad place to be -- especially if you know you're on the experimental arm -- but you could also push for Perjeta too. Try different oncologists, second opinions, etc. It really seems like getting adjuvant Perjeta (at this point) seems to be primarily determined by who your onc happens to be. Interestingly enough, it seems like most insurance companies are fine with it! It is true that with the recent data about Perjeta in the MBC setting coming out, we feel great knowing we were on Perjeta this whole time. But again, the information was not geared towards our BC's, so who really knows. It still may be worth fighting for, however. Either way it sounds like you are getting additional adjuvant therapy which is awesome.