Perjeta use with Hepceptin in stage IA breast cancer

Hi Katmil!

I had four Perjeta infusions as part of my neoadjuvant (before surgery) chemo regimen. However, I was not Stage IA but Stage IIIA, and I had my Perjeta with Taxol and Herceptin.

Yes, Perjeta is new and most of us who have received it have been Stage II or more. Personally, I don't think you will find any studies about Perjeta's impact on the survival of early stage cancer patients. In fact, since it's an expensive drug, it's surprising that your insurance is willing to pay for it, given your early stage. (It's normally recommended for women who have tumors that are two centimeters or larger.) So, I think your MO is marching to her own drummer here rather than following standard practices. You could always ask for a second opinion, if you think will give you better arguments against resuming Perjeta infusions.

In retrospect, I'm happy I got the Perjeta because it's a powerful drug and has shown very good results overall for women who are HER2+. I should note that chemo wiped out my lump and cleared my lymph node which allowed me to have a lumpectomy rather than a mastectomy.

I am sorry that you had such awful diarrhea with Perjeta. I had diarrhea during my 12 weeks of Taxol+Herceptin(+Perjeta, every three weeks). But, it was mild and I was able to control it with Immodium.

Best wishes!

Yes, I've continued on with Herceptin since surgery. I don't really experience any side effects from Herceptin alone. That may just be me, of course. I'm doing OK on Aromasin. I'm actually premenopausal, but am being put into chemical menopause via Zoladex. On Aromasin, I've had hot flashes and mood swings. My MO put me on Celexa (SSRI), and the mood swings went away. (Hot flashes, I can live with, but I'd rather not feel teary all the time.)

There are guidelines about standard practices; one of my fellow triple positives looked up the info on Perjeta and discovered that she probably didn't get it because her tumor was small. I wish I could give you a link to those guidelines as they might give you an argument against further Perjeta. But, I'm not sure what she was looking at, exactly.

If your MO insists on further Perjeta, you could 1) refuse to pursue that line of treatment or 2) agree to get it, with the stipulation that you go to the infusion center a few days after the Perjeta to get pumped full of IV fluids (before you become dehydrated by diarrhea). Also, some ladies just change MOs. Sometimes, our ideas about appropriate treatment clash with those of our doctors, and we need to move on to doctors who share our perspectives.

Best wishes!

Hi!

It was the National Comprehensive Cancer Network guidelines for breast cancer. Good luck!

My MO is of the opinion that Perjeta mixed with Taxotere is what causes the big D - since Taxotere is so hard on your digestive lining to start with, adding Perjeta makes it worse - she feels that perjeta alone isn't that big of a D problem (should be easily controlled w/immodium).

Hope this helps? If I were you, I'd be willing to at least give it a try w/out the taxotere. Good luck!