HER2+ MBC with PIK3CA mutations, poor response to Perjeta, TDM1

fight2s

Hi,
My mom was diagnosed with mets to bone, liver and lungs in June 2015 (Initial diagnosis was in June 2012, HER2+ve ER-/PR-, detailed history in signature). She started with docetaxel+Perjeta+Herceptin for six cycles and then moved to Perjeta+Herceptin and then to Kadcyla(TDM1). Genetic testing of the bone mets tissue showed PIK3CA and TP53 mutations. As shown in the studies, HER2 targeted therapies did not work well (probably due to PIK3CA and TP53 mutations) and she was progression free on Perjeta+Herceptin just for 7 months and on Kadcyla for 4 months. Now she switched to Carboplatin (Paraplatin)+ Navelbine (vinorelbine).

I'm here requesting help and suggestions on the next course of action. I'm mainly looking for information on what clinical trails are apt for my mom's condition. And by the way, I'm from India and my mom is taking treatment in India where clinical trails are not available. So our oncologist does not have much information on that front. I'm planning to take my mom to US for clinical trails.

Thanks

Moderators

Hi fight2s, and welcome to Breastcancer.org!

We're so sorry to hear of your mom's diagnosis, but you've come to the right place for support, answers, and advice. We know our helpful members will be by shortly to weigh in with their thoughts and offer opinions.

Please keep us posted on how your mom is doing and what you decide! We're all thinking of you and your mom!

--The Mods

pwilmarth

Probably the best place to start is ClinicalTrials.gov. There's currently an phase III trial called the Bolero 3 trial.

If you scroll down the list you will see a list of study locations. There are several throughout the United States. If you connect to one of these locations, you will have a good place to start when you bring your mom to the United States.

Here's a listing of cancer centers in the US who are participating in studies involving these mutations.

United States,

Arizona

University of Arizona / Arizona Cancer Center AZ Onc Assoc

Tucson, Arizona, United States, 85724

University of Arizona / Arizona Cancer Center Deptof Uof A/Arizona Cancer(3)

Tucson, Arizona, United States, 85724

United States, California

University of California San Diego La Jolla - UCSD Moores Cancer

La Jolla, California, United States, 92093-0658

United States, Colorado

Rocky Mountain Cancer Centers RMCC

Greenwood Village, Colorado, United States

United States, District of Columbia

Georgetown University/Lombardi Cancer Center Dept.of Lombardi CancerCtr (3)

Washington, District of Columbia, United States, 20007-2197

United States, Florida

Comprehensive Cancer Center - Boca Raton Deerfield Beach

Boca Raton, Florida, United States, 33248

Comprehensive Cancer Center - Boca Raton Dept.of BocaRatonCompCanCtr

Boca Raton, Florida, United States, 33248

Florida Cancer Specialists DeptofFloridaCancerSpecialists

Fort Myers, Florida, United States, 33901

Memorial Hospital Memorial Cancer Institute

Hollywood, Florida, United States, 33021

MD Anderson Cancer Center - Orlando Dept.ofMDACC-Orlando(2)

Orlando, Florida, United States, 32806

United States, Georgia

Emory University School of Medicine/Winship Cancer Institute Dept.of WinshipCancerInst. (2)

Atlanta, Georgia, United States, 30322

United States, Illinois

North Shore University Health System NSU

Evanston, Illinois, United States, 60201

United States, Kansas

Kansas City Cancer Center KCCC- South (2)

Overland Park, Kansas, United States, 66210

United States, Maryland

Maryland Oncology Hematology

Owning Mills, Maryland, United States, 21117,

United States, Minnesota

Park Nicollet Institute Dept. of Park Nicollet

St. Louis Park, Minnesota, United States, 55416

United States, Missouri

St. Louis University Cancer Center SLU Cancer Center

St. Louis, Missouri, United States, 63110

United States, Nebraska

University of Nebraska Medical Center Unv Nebraska Med Ctr (2)

Omaha, Nebraska, United States, 68198

United States, Nevada

Comprehensive Cancer Centers of Nevada CCC of Nevada Henderson (4)

Las Vegas, Nevada, United States, 89109

Nevada Cancer Institute Dept. of Nevada Cancer (3)

Las Vegas, Nevada, United States, 89135

United States, New Jersey

Overlook Hospital - Carol G Simon Cancer Center Carol G Simon

Summit, New Jersey, United States, 07901

United States, New York

NYU Langone Arena Oncology Dept.ofArenaOncologyAssoc(2)

Lake Success, New York, United States, 11042

United States, North Carolina

Duke University Medical Center Dept. of DUMC (2)

Durham, North Carolina, United States, 27710

United States, Oregon

Northwest Cancer Specialists Tutlatin

Portland, Oregon, United States, 97210

United States, Pennsylvania

University of Pittsburgh Cancer Institute DeptofMageeWomen'sHospital(2)

Pittsburgh, Pennsylvania, United States, 15232

United States, Tennessee

The Jones Clinic Dept .of The Jones Clinic (3)

Germantown, Tennessee, United States, 38138

Sarah Cannon Research Institute Dept.ofSarahCannonCancerCtr(6)

Nashville, Tennessee, United States, 37203

United States, Texas

University of Texas Southwestern Medical Center University of TX SW Med Ctr(2)

Dallas, Texas, United States, 75390-8852

Texas Oncology, P.A. Presbyterian Hospital (2)

Dallas, Texas, United States, 75246

Texas Oncology, P.A. Texas Onc - Amarillo

Dallas, Texas, United States, 75246

Oncology, P.A. Texas Oncology - Sammons

Dallas, Texas, United States, 75246

Texas Oncology, P.A. Midtown

Dallas, Texas, United States, 75251

Texas Cancer Center ( Medical City Dallas Hospital) Dept. of Texas Cancer Ctr. (2)

Dallas, Texas, United States, 75230

University of Texas/MD Anderson Cancer Center Dept of MD Anderson (17)

Houston, Texas, United States, 77030-4009

Baylor College of Medicine Baylor

Houston, Texas, United States, 77030

Longview Cancer Center Longview Cancer Center (2)

Longview, Texas, United States, 75601

Cancer Care Centers of South Texas / HOAST CCC of So. TX- San Antonio(2)

San Antonio, Texas, United States, 78229

South Texas Oncology and Hematology, PA South Texas Oncology (2)

San Antonio, Texas, United States, 78258

Tyler Cancer Center Dept.ofTylerCancerCtr. (2)

Tyler, Texas, United States, 75702

United States, Utah

Utah Cancer Specialists Utah Cancer (2)

Salt Lake City, Utah, United States, 84106

United States, Virginia

Virginia Cancer Specialists, PC Dept.ofFairfaxNo.VA (2)

Fairfax, Virginia, United States, 22031

Virginia Oncology Associates Dept. of VOA (2)

Norfolk, Virginia, United States, 23502

United States, Washington

Swedish Cancer Institute Swedish Cancer Institute

Seattle, Washington, United States, 98104

United States, Wisconsin

St Vincent Hospital Green Bay Oncology

Green Bay, Wisconsin, United States, 54301

fight2s

Hi pwilmarth,Thanks for the info. My mom took everolimus for a month but she could not tolerate the side effects and had to stop.
I have collected some of the clinical trails which are specific to HER2+ ER-/PR- condition as listed below.
My confusion is how to select the better suited one among these.
Will genetic profiling of the tissue help in selecting a suitable trail.
And is there a way to consult experts in HER2+ breast cancer who can guide me make that decision before coming to US .

Phase 3
Neratinib Plus Capecitabine https://clinicaltrials.gov/ct2/show/study/NCT01808...

Phase 2
Targeted
Lapatinib, Everolimus and Capecitabine https://clinicaltrials.gov/ct2/show/NCT01783756
Poziotinib https://clinicaltrials.gov/ct2/show/NCT02659514
ONT-380 with Capecitabine & Trastuzumab https://clinicaltrials.gov/ct2/show/study/NCT02614...
Everolimus, Trastuzumab And Vinorelbine https://clinicaltrials.gov/ct2/show/NCT01305941
Ribociclib with TDM1 https://clinicaltrials.gov/ct2/show/NCT02657343
Neratinib https://clinicaltrials.gov/ct2/show/study/NCT01953...
Palbociclib with TDM1 https://clinicaltrials.gov/ct2/show/NCT01976169
Enzalutamide With Trastuzumab https://clinicaltrials.gov/ct2/show/study/NCT02091...
Eribulin Mesylate, Trastuzumab, and Pertuzumab https://clinicaltrials.gov/ct2/show/NCT01912963
Gemcitabine, Trastuzumab, and Pertuzumab https://clinicaltrials.gov/ct2/show/NCT02252887
https://clinicaltrials.gov/ct2/show/NCT02139358
Cabozantinib With Trastuzumab https://clinicaltrials.gov/ct2/show/NCT02260531
PD 0332991 https://clinicaltrials.gov/ct2/show/NCT01037790
PIK3CA
Albumin-Bound Rapamycin https://clinicaltrials.gov/ct2/show/NCT02646319
BGJ398/BYL719 https://clinicaltrials.gov/ct2/show/NCT01928459
https://clinicaltrials.gov/ct2/show/NCT02038010
LJM716, BYL719 and Trastuzumab https://clinicaltrials.gov/ct2/show/NCT02167854
PM01183 https://clinicaltrials.gov/ct2/show/NCT01525589
Taselisib https://clinicaltrials.gov/ct2/show/NCT02390427
Immunotherapy
Pembrolizumab + TDM1 https://clinicaltrials.gov/ct2/show/NCT02318901

Phase 1
PIK3CA
Temsirolimus With Metformin https://clinicaltrials.gov/ct2/show/NCT01529593
BKM120 or BYL719 https://clinicaltrials.gov/ct2/show/study/NCT01300...
AZD5363 https://clinicaltrials.gov/ct2/show/NCT01226316
Targeted
Ruxolitinib With Trastuzumab https://clinicaltrials.gov/ct2/show/NCT02066532
TDM1 With Abraxane and Lapatinib https://clinicaltrials.gov/ct2/show/NCT02073916
T-DM1 With Neratinib https://clinicaltrials.gov/ct2/show/NCT02236000
Ganetespib, Paclitaxel, Trastuzumab and Pertuzumab https://clinicaltrials.gov/ct2/show/NCT02060253
Pyrotinib https://clinicaltrials.gov/ct2/show/NCT02500199 FS102 https://clinicaltrials.gov/ct2/show/NCT02286219
Vorinostat With Paclitaxel and Carboplatin https://clinicaltrials.gov/ct2/show/NCT01249443 MEDI4276 https://clinicaltrials.gov/ct2/show/NCT02576548 https://clinicaltrials.gov/ct2/show/NCT01421524 BAY1125976 https://clinicaltrials.gov/ct2/show/NCT01915576
Ribocilcib (LEE011) https://clinicaltrials.gov/ct2/show/NCT02599363
Immunotherapy
Autologous Dendritic Cells Loaded With Oncofetal Antigen/iLRP https://clinicaltrials.gov/ct2/show/NCT00715832 https://clinicaltrials.gov/ct2/show/NCT02479230 https://clinicaltrials.gov/ct2/show/NCT01376505 https://clinicaltrials.gov/ct2/show/NCT02048709
TAA-Specific CTLS https://clinicaltrials.gov/ct2/show/NCT02239861 https://clinicaltrials.gov/ct2/show/NCT02276300
AVX901 https://clinicaltrials.gov/ct2/show/NCT01526473

pwilmarth

Yes, genetic profiling will help. Any of the major cancer centers have physicians who can help you with this

pwilmarth

Remote Second Opinions for Breast Cancer

You might try this option. The University of Colorado has one of the leading breast cancer specialists in the country and they are very active in a number of clinical trials.

fight2s

Sure will try. Thanks.

pwilmarth

It turns out that the University of Colorado isn't the only major cancer center that offers online second opinions. There are at least three others

Look into online second opinion services such as those at the Cleveland Clinic, Johns Hopkins, and Harvard-affiliated Partners HealthCare.

All four of these centers are part of the National Cancer Institute's centers.