Anyone doing Perjeta for early-stage (pre-surgery)?
I was just diagnosed, post core needle biopsy, IDC ER+/PR-/HER2+. I am 42. The tumor is 2cm.
I am meeting with onc tomorrow. Rush is to discuss whether I am a candidate for neoadjuvant perjeta in combination with Herceptin and chemo. I know Perjeta was only just approved for this use (1-2 months ago). Anyone out there with early-stage BC going this route?
Comments
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I just finished 3x perjeta, which I started 1/2 through my TCH therapy. Pre-surgery, clinical staging IIIa. I have surgery scheduled 1/6. I will let you know results after surgery. I do have an MRI next week.
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hi oranje mama
i was diagnosed last month (also ER+,PR-,HER2+) and strongly advised to do neoadjuvant therapy including perjeta. I'm getting my port this Fri and start treatment Monday (gulp.) It was very hard to imagine "just letting the cancer stay in me" while getting treatment, but everything I've read says this is newest/best treatment for our kind of cancer. Bottom line, I have decided to trust my oncologist, who has been great about addressing all my concerns. Best of luck and God's blessings on both of us! -
hi, I was diagnosed this past July and chose to do neoadjuvant chemo. I started with AC x4 and then perjeta got approved. I requested to go on it and finally my doc agreed. Now I am getting Taxotere, Herceptin and Perjeta x3. I have one more Perjeta treatment to go.....
Research is showing that treatment of HER2 breast Cancer with dual blockades (ie Herceotin and perjeta) favors an improved chance of the patient achieving pCR (pathological complete response; confirmed after surgery). pCR can be a prognostic indicator.
Good luck with your appointment
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LeanneF, Marytn, Girlstrong -
Thanks so much for your responses. I'll probably have more questions after meeting with the oncologist later today.
Marytn, good luck with starting on Monday. The sooner you start, the sooner you are killing the cancer, right? Chemo is the part of treatment that scares me the most. Maybe there's a benefit in getting it over with first?
Girlstrong - did going on Perjeta mean that you had to extend the number of chemo cycles? Do you have any evidence yet of whether/how the treatment is working?
So glad these boards are here for us to connect! -
Hi oranje_mama: The addition of Perjeta did not extend my number of chemo cycles. I was originally planned for AC x4 (every 3 weeks) followed by THx12 (weekly) and Herceptin for 1 year. Now with the new regimen, I will have had...AC x4 (every 3 weeks) followed by THP x 3 (every 3 weeks) and Herceptin for 1 year. In the first scenario I would have had chemo for 24 weeks, in the new scenoario I am getting chemo for a total 21 weeks. Not much difference but different meds with different doses and frequencies. So far the new medicine is working, my docs are pleased and confirm that things are definitely getting much smaller. The only new side effect from the Perjeta was a rash after the first dose, but steroids took care of that. Feel free to coontinue to ask questions and good luck with your appointment. -
Hi Oranje_Mama,
I am still on Perjeta and Herceptin and have been since last January right after dx. My Onc says that surgery is my choice at this point because its simply not really necessary as the Herceptin and Perjeta are keeping the buggers at bay. My tumors are still there but appear to be in necrosis. The chemo sucked; I won't lie. I wish I didn't do it at all but in my situation they wanted to "de-bulk" the tumors. It reduced their size but did not get rid of them totally. I would rather have not done any chemo at all and just did the Herception and Perjeta (P&H), but I don't think you can split them up that way.
I will be on the P&H for the foreseeable future, but when I get into remission for an extended period of time, then my onc will see about stopping. The nice thing is that I am not having any side effects from the P&H.
Whilst you are undergoing treatment, I suspect you will be having your heart checked with an echocardiogram, and the tumor with an ultra-sound after several weeks of tx. Ask your Onc if they haven't volunteered this to you already.
I was 42 (and just had a baby 10 months earlier) when I was dx. Its nervewracking to say the least at first, but connecting with others has really helped!
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After meeting with the oncologist, I feel optimistic about this new treatment. She is recommending neoadjuvant TCH + Herceptin + Perjeta for 6 cycles, continuing Herceptin for the remainder of the year, + surgery + rads + tamoxifen for 5-10 years. I read her as very optimistic that the tumor will be gone by the time of surgery.
I've got to wait for the MRI results to see whether there is any indication in lymph nodes or other breast. But both my surgeon and oncologist seem very optimistic about this.
I'm actually feeling good about this. -
I may very well be going this route, too. I meet with the oncologist sometime later this week. I have been advised to do neoadjuvent and am certainly going to ask about the updated treatment for Her 2 +++ cancer. My surgery originally scheduled for Dec. 12 has been cancelled and I am moving on to chemo first. I have barely gotten my arms around the need for chemo following surgery let alone having it right now but I guess that is the way it is. Good luck. Since you are meeting with you oncologist before I am if you can share what your options are that would be great. -
I had neoadjuvant 2 years ago...pcr with FEC-DH (similar to ACTH) at the time I was really stressed that they didn't do surgery first but my onc's really believed that with her2's over a certain size this is the best course of treatment - and now 2yrs later I have to agree - this is the way cancer treatment is going. They can adjust the chemo to your tumor if it is not responding which you cant do once you remove it. I have pCR after treatment which I am grateful for
you ladies getting neo adjuvant perjeta are very lucky - I understand the pcR rates are much higher with this dual blockade -
Hi Waterdog,
We seem to be on about the same timeline . . . .
The options I've been given are TCH + Perjeta then surgery (waiting on MRI results but leaning toward lumpectomy) then rads OR surgery first then TCH then rads. I will not avoid chemo. Chemo will be 6 cycles of TCH whether before or after surgery. The only difference is that with before, I will also get Perjeta.
The one potential effect (I'm still not 100% clear on this, need to go over it again with BS) of chemo first is that when they do the surgery, they will likely do a sentinel node biopsy - and if that shows positive during surgery, they will need to be more aggressive in taking out nodes since chemo is already completed.
But sounds like you may not have the choice of surgery v. chemo first. The SEs of Herceptin and Perjeta seems to be really minor/remote. My MO could not identify any risk/downside to adding Perjeta and doing chemo first. That was strongly her recommendation. She thought chances of PCR (pathologic complete response) from TCH + Perjeta were high. Surgery would still be needed to take out the tumor marker and do the sentinel node biopsy. -
Hi all,
So good to hear from other women getting the same treatment - neoadjuvant chemo. Mine is TCH + Perjeta on a 3-week cycle. For me it was a no-brainer when I heard about the possibility of PCR or at least a less invasive surgery. I started TCH on Oct 8, then Perjeta was approved before my second tx, so my Onc added it to the therapy. My 4th chemo (3rd Perjeta) is tomorrow - hooray, I'm over halfway there! Glad to know that starting Perjeta later won't extend my chemo.
SEs haven't been too bad so far. Taxotere is the worst (bitter/metallic taste the first couple weeks, and sometimes mouth sores) but diet changes and "magic" mouth rinse help. Hair loss, of course, but mine has only been partial so far. Oh and this cycle I have sore, bruised-looking fingernails. I got some Evonail solution to try, and hoping it works! Herceptin gives me allergy-like runny nose and eyes, but not a biggie. I just carry handkerchiefs all the time.
It's so encouraging to hear the positive outcomes for those of you who have finished the therapy. Glad to have this forum! -
So I met with my oncologist yesterday and here is what I am doing neoadjuvant - port on Wednesday followed Thursday with chemo. First four rounds of adriamycin and cytoxan, then four rounds of perjeta, herceptin and taxator (forgive my spelling), surgery, radiation and then continued perjeta, herceptin for one year. On year of tamox then followed by post menopausal er inhibitor if that's where I am. Does this sound about right? Absolutely overwhelming. I think I was OK until I went to the oncologist's office and saw where I would be for the next 24 weeks. Been teary ever since. -
Hi Waterdog, We'll be starting at the same time. I get the port on Tuesday with chemo starting Thursday. I'll be doing taxotere, paraplatin, herceptin (TCH) and perjeta for 6 cycles, every 3 weeks. My oncologist said I would continue only with Herceptin for the whole year. My understanding is that perjeta is only approved for use pre-surgery, not post-surgery. But I'll ask about this.
I will also have surgery after a rest period from chemo. Right now I'm hoping that it will be minor - a lumpectomy and sentinel node biopsy. MO and BS are optimistic that all that will remain of the mass at the time of surgery will be the marker in the tumor. MO did recommend that I do the gene testing even though I have no family history of BC, just because of my age (I'm 42). I haven't figured out whether my insurance will cover that (or if it's not covered, what it will cost). If I am positive for the gene then I will think about BMX.
I've also been really teary the last few days. Terrible timing at work - I have been in a process leading to a promotion, very intensive (writing papers, giving a board presentation, psychological assessments, cognitive tests . . .) In fact I had to give the board presentation the tuesday after I got the BIRAD 5 mammo on Friday. I was on the phone with the BS scheduling the biopsy just before the presentation. Talk about stress. I heard on Wed. that not only I am not being made director this year, they did not do what I believed was the only other alternative - postpone me for a year - and instead told me that I was not going forward from this stage in the process. It came as a total shock to me and my boss. Lots of politics (primarily politics . . .) involved and I am just the victim. I had a "final report" meeting on Friday and I broke down in tears. Between the impending start of chemo and this work crap, it just pushed me over the edge. I totally hear you on being teary.
For some comic relief, I offer this story - my 6 yr old daughter is obsessed with my pending hair loss. She was very upset at first, but this has morphed into total, utter fascination. Why is it going to fall out? when? can she cut it? will I wear her dress-up wig? and on and on. This morning she was lying in bed with me, studying my face very closely. Then she said: "Mommy, when your hair is gone, I think you'll still look like a girl." Phew, that's a relief! Made me laugh! -
Waterdog - yes that sounds right. I had 6 rounds of taxotere/carboplatin/herceptin/perjeta every 3 weeks, then surgery. Now I'm doing 4 rounds of adriamycin/cytoxan. Next I'll have radiation. And continuing herceptin & perjeta every 3 weeks.
Oranje - I believe the FDA has recently made perjeta more available but don't have details. I know I will continue to have it for a year. -
Well, just back from a pre-chemo meeting with my oncologist who has just returned from the San Antonio Breast Cancer Symposium. I will not be getting Perjeta after all. Apparently, latest trials show that it did not increase effectiveness of hormone positive cancer (which mine is). My doc says that standard of care will be re-written in January to be TCH (only) for ER+, HER2+ cancer. 5 yr disease-free survival rate is 92%, higher than was previously published.
Also, I'll be getting TCH every 3 weeks, but H every week, for 18 weeks, then switching to H every 3 weeks for the remainder of the year. -
Hi Oranje mama, do you know the name of the study? I have just finished 10 rounds of Abraxane ( like Taxol) with herceptin & Perjeta every three weeks. I will continue the Perjeta & Herceptin for 1 yr total... So hard to keep up with everything, sometimes I gorge on the Internet...not good:( as I always feel worse about some aspect. Best of luck to you! -
oranje - It will be interesting to see if the 're-write' is only for hormone plus cancers. I wonder about those of us who are HER2 + and ER/PR negative since we don't have as many treatment options.
I read some of the NEOALTO study from the SABS. That seems to show good neoadjuvent results with Herceptin & Tykerb. Last April my MO said we'd save Tykerb for 'down the road', so I did Herceptin & Perjeta. -
Sorry, I didn't catch the name of the study, but it did prove effective for ER-/PR-, HER2+ cancers. So I believe the "re-write" will apply only to ER+/PR+, HER2+ cancers. -
Hi,
We just wanted to clarify something, namely that ER status doesn’t matter with Perjeta because Perjeta is indicated for HER2+ breast cancer.
What does PERJETA treat?
PERJETA® (pertuzumab) is approved for use in combination with Herceptin® (trastuzumab) and docetaxel (chemotherapy) in people who have HER2-positive breast cancer that has spread to different parts of the body (metastatic) and who have not received anti-HER2 therapy or chemotherapy for metastatic breast cancer.
Our copy here on Breastcancer.org is here: http://www.breastcancer.org/treatment/targeted_therapies/perjeta and is based on the above indications statement from Genentech.
We hope that this is helpful.
Best,
The Mods
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Perjeta has been recently FDA approved for early stage bc in conjunction with Herceptin also, Oct 1, 2013.
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I'm well aware that Perjeta was approved on Oct. 1st for early stage neoadjuvant treatment of HER2+ cancer. I was going to be taking Perjeta . . . in fact, originally this was the reason for me to do neoadjuvant, because Perjeta is not available for early stage treatment post-surgery. My cancer is currently operable as a lumpectomy now (it is 2.1cm). However, my oncologist just returned from San Antonio and recommended to me, based on the studies she heard discussed there, that I NOT take Perjeta after all because it did not prove to make a difference as compared to Herceptin alone for ER+ cancer. She said that she believes the standard of care will be rewritten in January so that the standard for ER+ HER2+ early stage cancer will be TCH only (not Perjeta). She said the study she heard discussed did show increased effectiveness when Perjeta was used on ER- cancer.
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oranje - I know things are changing, but I think the Mods are right about one thing. Perjeta was designed for HER2+ and it didn't matter if you were ER/PR positive or negative. However there are so many hormonal treatments if you're ER/PR positive that may be a better way to go.
The NEOALTO study from the SABS was about Tykerb & Herceptin as neoadjuvent treatment and that did evaluate positive results & effectiveness & pCR only for people who were ER/PR negative and Her2+ (unless I totally mis-read everything & didn't understand the MOD's podcast from San Antonio)
Thanks O'connor for confirming the date of the FDA approval to use of Perjeta for early stage BC. I was able to get it because I have a recurrence or mets.
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MinusTwo, I think you are correct. I believe what my MO was mainly saying was she didn't think that Perjeta would make any material difference for ER+ cancer, based on what she heard in San Antonio, and that she didn't expect to see numbers any better than those reported that effectiveness of the the TCH regimen for HER2+ cancer early stage treatment, which is showing 92% disease-free survival in 5 (or maybe she said 4) years. I will also get hormonal treatment, lump & rads.
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Oranje - glad to see on another site that you're done w/your first chemo & not overwhelmed. # 1 down !!!
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yes, waiting for the other shoe to drop, but cautiously optimistic
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Yep, ER/PR negative, Her2+++, starting neoadjuvent TCHP on Tuesday.
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I too am on this regiment. TCH and perjeta-Just did round two of six yesterday. Waiting on brac test to come back for them to determine what type of surgery I will have after chemo. I am triple positive, stage 2.
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I am doing Perjeta in conjunction with Herceptin, Taxotere and Carboplatin for Stage 2 HER2 pos invasive breast cancer. I had an ultrasound performed a couple days ago and after just 3 chemo treatments my tumor has shrunk over 75% in volume. My breast cancer surgeon told me that by the time of surgery she will need the marker to even find the residual scar tissue from the biopsy. I am thrilled with the results and thankful that this neoadjuvant combination was made available just when I was diagnosed. (I am ER PR-)
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Jan - wow that is great news. Just the perfect reaction that everyone hopes for. I love it when a BS weighs in with such positive feedback.
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jan, love your news! Hoping for the same.
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