herceptin/perjeta/taxol combination

bfekigjkh

My wife just finished her first 3 months of chemo. Her 2nd

regimen is beginning in a couple weeks. Her oncol just changed

the planned treatment. She is now scheduled for herceptin/perjeta/taxol

for 3 months as her 2nd phase. Her condition was IDC,tumor in breast,

lymph nodes under arm cancerous, clean on scan for the rest of the body.

Since she began her first chemo, her resting heart rate has been averaging

110+. When she walks up a flight of steps, 130+. Initially she was supposed

to have 3 months of slightly less dangerous chemo, as her second phase

followed by 48 weeks of "maintenance" for the her2. My concern is that, with a

year and a half of treatment which has been proven to cause heart

problems/congestive heart failure, her odds of surviving have just dropped

significantly. Is it normal to prescribe the combo I've mentioned for cancer

that had spread to lymph nodes by the breast but no other organs? NOTE:

I've posted on other cancer boards before, just not for this specific question.

If you work for a pharma company that produces chemo, please don't tell me

that chemo is perfectly safe. If you MUST insist that your products are without

risk, you should identify yourself as being biased, due to working for a company

that produces chemo.

Thanks.

hhuey

this is my course of action currently..12 weeks of this infusion because I am Her2 positive

Beatmon

Were there new biopsy results that changed her plan of care or CT or Pet? On herceptin and perjeta she should have heart function checked quarterly.

And to my knowledge there is no one from pharmacy on this site. We do have a wonderful radiologist who gives his time to help posters figure out what their scans read...in plain English.

Italychick

What chemo was she given for the first three months? How old is she? What size was her tumor, and how many lymph nodes contain cancer? What grade is her tumor?

Even though chemo treatment seems standard, it varies based on individuals. I was given taxotere, and taxol is supposed to be less harsh, but I'm not 100% sure. I could have chosen either taxol or taxotere, but I elected to go pretty aggressive, and I also wanted carboplatin as part of my chemo because I have read that Her2 cancer likes to metastasize to the brain, and I think carboplatin crosses the blood brain barrier, but I'm not completely sure. I'm suspecting she initially had adriamyacin and cytoxan? I have seen Her2 positive women do adriamycin and cytoxan, followed by taxotere with perjeta and Herceptin, that is a pretty standard protocol. So maybe they changed her from taxotere to taxol because it is less harsh? I'm just guessing here since there isn't really enough information posted.

They should be doing either muga scans or echos to test her heart function before Herceptin and during Herceptin. Has she had any heart function tests? I will say my pulse was elevated during treatment but I seem to have no issues post chemo.

Her2 positive cancer isn't something to mess around with. I was afraid of potential heart issues, but more afraid to no do the Herceptin, honestly. So maybe ask questions about the treatment change, and why, until you are comfortable with the answers you receive. Only your doctors can tell you why they are electing certain treatment protocols, but they should be giving you answers if you have concerns.

Best of luck to you and your wife.

bfekigjkh

There were no new biopsy results, no other tests conducted to check on the cancer since the chemo began, which is the main reason I'm concerned. I saw an article published by an oncologist who was castigating his peers because he felt they were prescribing chemo for patients unnecessarily, either when chemo wouldn't help, or prescribing too many doses or too many different types of chemo together. Since the onco's can purchase chemo from the pharma and resell to the patient, of course there's the opportunity to prescribe more to profit more. On another forum, I had someone attacking me because they said chemo was perfectly safe. It turns out that person worked for a pharma company that provided chemo. Then I was challenged and told that I had to provide proof that chemo wasn't safe, and links to the document by the onco that had come out against his peers. I left a comment about how they weren't paying me for my time, and they could use google as well as I could, after which I was banned. Oh well. Now I'm here. Thanks for your response.

dcdrogers

Hi bf,

I received chemo TCHP from Dec 2016 to Mar 2017. I had 2 lymph nodes light up during scans, only 1 of which was biopsied and came back positive for cancer. I'm also HER+ so I have a little bit in common with your wife. However, my treatment remained the same throughout chemo. Since my MO knew I would be getting Herceptin she scheduled a baseline Echo before my first treatment.

I just checked my records online and my heart rate has reached as high as 123 bpm in its resting state. (keep in mind I was/am taking Prednisone (steroid) for a related condition). My MO noted that my heart rate seemed higher following treatment and she thought that this may have been due to the Neulasta injection that I received 24 hours after each treatment. I needed the Neulasta to keep my WBC up so discontinuing to test this theory out was not an option.

FWIW.... I receive an Echo quarterly to monitor heart function. My ejection fraction (ef) before I began Herceptin was 64. Now after 12 treatments it is still holding steady at 61. I have 5/6 treatments left of Herceptin before I'm done.

I also want to note that I have high blood pressure. This really sky-rocketed once I was placed on steroids. I take medication that does a great job at controlling my bp. The steroids (for me at least) caused increased high blood pressure AND heart rate. I had to continue taking Prednisone even though I was also was required to take the Dexamethasone as a pre-med around chemo treatment (day before and day after).

Since completing Chemo and being on Herceptin only, my resting heart rate has ranged from 76 to 106.

~Dee

illimae

The chemo combination of Taxol with H & P is pretty standard. I would be concerned though if your wife is not having an echo every few months to check the ejection fraction (EF) rate, which sometime drops due to Herceptin. As I understand it, they consider having the patient take a break from Herceptin if the EF drops more than 10% of normal. My normal was 60-65, initially during chemo it dropped to 47% but increased to 58% where it has remained. There is also a 5% possible variance by tech/machine, since the echo is somewhat subjective.

Doc's tend to talk in circles, rather than give direct answers to direct questions. It's tough but keep on them until you're satisfied.