Herceptin trials limit recurrence treatment?


Question from Sharon: By entering a Herceptin trial after a mastectomy and finishing chemo and radiotherapy treatment for early breast cancer, are you limiting treatment if the cancer does reoccur and you've already had Herceptin?
Answers - Eric Winer, M.D. The trials are very carefully looking at whether Herceptin can help prevent recurrences. If, in fact, Herceptin does help prevent recurrences, then it becomes somewhat less of an issue whether this changes treatment options at the time of the cancer recurring—because fewer women will have recurrences, because more women are doing better. But this is something we don't know the answer to yet.

If a woman receives Herceptin as part of her trial and then subsequently has a recurrence of cancer, it would not be out of the question to treat with Herceptin again. It would very much depend on the time course of the recurrence. Many doctors might want to re-biopsy the cancer to confirm the HER2/neu status of the cancer.
Musa Mayer In the treatment of metastatic breast cancer with Herceptin, some doctors—after one particular combination with Herceptin and a chemotherapy—will keep their patients on Herceptin and go to another chemotherapy until that one fails, and sometimes even another. So it has seemed to me as if resistance to the drug often develops more slowly than resistance to chemotherapy drugs, but I'm not sure that's supported by research.
Eric Winer, M.D. I think it's supported by the hope that in years ahead we'll be able to prove or disprove this with the ongoing trials. Once a treatment has been shown to be useful in the adjuvant setting—Herceptin is not there yet—that it is preventing recurrence in women with early stage breast cancer, we generally use that treatment and don't worry about limiting options later on, since the real goal is to prevent a problem later on. If we prevent the recurrence, then we don't have to worry about how to treat a recurrence.
Musa Mayer It's not as important these days, since we have many more treatments for metastatic breast cancer, to feel that you must save a treatment in case you have a recurrence. When I started working with women who have metastatic disease 7-8 years ago, there were relatively few treatments available. Since about 1995, there have been significant advances—drugs like Taxol, Taxotere, the aromatase inhibitors, Herceptin—and there are others in the drug development pipeline now that will further extend women's lives even when they cannot be cured.

On Wednesday, September 17, 2003, our Ask-the-Expert Online Conference was called Metastatic Breast Cancer. Musa Mayer, Eric P. Winer, M.D., and Marisa Weiss, M.D. answered your questions about treatment and quality of life issues related to advanced (metastatic) breast cancer.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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