Herceptin every 3 weeks?

Hi nylady - I think most women are on the same protocol that your onc is suggesting. I had TCH from April - July and get Herceptin every 3 weeks now. I honestly found the chemo to be easier than I ever anticipated. I didn't have any of the major side effects - swings between constipation/diarrhea were common, aches after the Neulasta shot, etc. - I did suffer from anemia which got progressively worse, but it improved rapidly after treatment. Through it, I worked, traveled, and carried on life fairly normally (with some days spent mainly in bed.) But I don't have any side effects from the Herceptin - I go straight from work and drive home in time for dinner.

You're going to do fine! It's hard for me to believe that I was diagnosed almost a year ago. This site has been a huge help - you're in the right place for support and advice.

Best wishes to you,

Sue

Hi nylady,

I am also on TCH every three weeks and when I finish with the chemo next month, I will continue on with just Herceptin every three weeks until next fall.  I think that this is the standard with this regimen.   As Sue said, this is very doable with just a few down days each time.  Best of luck to you.

Anne

I get it every three weeks, but I just read some interesting infomation on herceptin, mostly about the the half life of herceptin being 25 days, weekly the half life was 5.8 days. range 1-32 days.  I still don't understand it all but found it interesting And that it said that it may be in curculation for up to 18 weeks.  I have to ask my onc what this means, does it mean that after I'm finally finished in October it will stay in my body for up to 18 weeks and should I have anothe Muga Scan after that time period, my onc must really be fed up with my questions.

Description: Trastuzumab (rhMAb HER2) is a recombinant DNA-derived humanized monoclonal antibody against the HER2 protein and is indicated for the treatment of metastatic breast carcinomas that overexpress HER2. HER2 overexpression is seen in 25-30% of breast cancers and is associated with aggressive disease and decreased overall survival. Use of trastuzumab should be limited to patients with documented overexpression of the HER2 protein (3+). Trastuzumab is an IgG₁ kappa immunoglobulin that contains a human framework region, which surrounds the murine regions responsible for binding to HER2. This type of humanized monoclonal antibody tends to have less immunogenicity. Trastuzumab is produced by a mammalian cell (Chinese hamster ovary) suspension culture. Trastuzumab is approved for use in metastatic breast carcinoma as first line treatment when used in combination with paclitaxel or as a second or third line agent when used alone in patients who have failed one or more chemotherapy regimens. In previously treated metastatic breast cancer patients, trastuzumab as a single agent yielded a median overall response rate of 23%.[1801] In combination with first-line combination chemotherapy, trastuzumab significantly increases time to disease progression, overall response rate, median duration of response, and one-year survival as compared to combination chemotherapy alone. The risk of death was reduced 18-20% in subgroups given trastuzumab.[2317] Trastuzumab was originally approved by the FDA in September 1998 for metastatic disease; in November 2006 it received expanded FDA approval for the adjuvant treatment of early breast cancer, in combination with chemotherapy.

Mechanism of Action: Trastuzumab is a mediator of antibody dependent cell-mediated cytotoxicity via natural killer cells and monocytes. Trastuzumab specifically inhibits the proliferation of and is cytotoxic to tumor cells that overexpress HER2 protein. Although the exact cytotoxic mechanism is not clearly understood, trastuzumab binds to the HER2 protein on the surface of tumor cells. In cells treated with trastuzumab, the HER2 receptor is downregulated, cyclin-dependent kinase inhibitor p27 accumulates, and cell cycle arrest occurs. Trastuzumab also inhibits the constitutive HER2 cleavage/shedding mediated by metalloproteases, which may correlate with the clinical activity of trastuzumab.[1802] The c-erbB2 gene is an oncogene that encodes for the HER2 transmembrane receptor protein (185 Kd), which is structurally related to the epidermal growth factor receptor. The HER2 protein is overexpressed or amplified or both in several human malignancies including breast, ovarian, and colon cancers. The overexpression of HER2 in tumor cells is closely associated with increased angiogenesis and expression of vascular epidermal growth factor (VEGF); when the VEGF pathway is inhibited, tumor growth is suppressed.[2318]

An in vitro study examined the efficacy of trastuzumab plus various chemotherapy agents in various breast cancer cell lines. Synergistic interactions were observed in all cell lines studied for trastuzumab plus carboplatin, hydroxycyclophosphamide, docetaxel, and vinorelbine. Additive interactions were noted in all cell lines for trastuzumab plus doxorubicin, epirubicin, and paclitaxel. Interactions between trastuzumab and gemcitabine were were synergistic at low concentrations and antagonistic at high concentrations. In one cell line, the combination of docetaxel, carboplatin, and trastuzumab was synergistic.[5603]

Pharmacokinetics: Trastuzumab is given as an intravenous infusion. Short infusions of 10-500 mg weekly demonstrated dose-dependent pharmacokinetics. When given in combination with paclitaxel, mean serum trough concentrations of trastuzumab were 1.5-fold higher than when given in combination with an anthracycline and cyclophosphamide. When given with the usual loading dose of 4 mg/kg and 2 mg/kg weekly the average half-life was 5.8 days (range 1-32 days). However, later studies estimate the half-life to be approximately 25 days and that trastuzumab may persist in the circulation for up to 18 weeks (range 15-22 weeks). Elimination of trastuzumab does not seem to be affected by age or moderate renal dysfunction (i.e., serum creatinine up to 2 mg/dl).

Snowyday,

I had echo-cardiograms every three months while on herceptin with the last one coinciding with my last dose of herceptin.

I asked my onc at my next three month checkup if I needed anymore echo-cardiograms.   She said that because my heart function had not been effected by the herceptin I did not need anymore echo-cardiograms. 

I guess any additional scans will depend on your heart function during treatment.

I had my last herceptin Dec 26 and my tx were every 3 weeks.  I did fine with them. I was a TCH so had the herceptin with the chemo for the first 6 tx. 

I did mine every 3 weeks too. Had 4FAC then 4TH then H alone to complete the year. 2 years NED since finishing H. )))

Right now I am doing the Herceptin every week with Taxol.  My 12th (the last) is this week.  Then I switch to Herceptin every 3 weeks for a year.

Congrats on NED Rocktobermom!