Lebermetastasen

[Andi]

Bei meiner Mutter wurden im Oktober 2001 Lebermetastasen festgestellt. Bereits Ende 1994 wurde meine Mutter (erfolgreich) ein Brustknoten entfernt, der bis dahin noch keine Lymphknoten befallen hatte. In den letzten Jahren sind auch keine weiteren Erkrankungen aufgetreten.
Daher ist war der Schock um so größer, als die Lebermetastasen (die Leber ist mit Metastasen durchzogen) aufgrund einer akuten Gelbsucht diagnostiziert wurden. Aufgrund des Gelbsucht wurde die Chemo-Therapie (CMF) nach dem 2. Mal abgesetzt. Aufgrund des verschlechternden Allgemeinzustandes befindet sich meine Ma derzeit im Krankenhaus, wo sie jetzt nach einer Woche Intensiv (aufgrund von Blutungen aus Varizen in der Speiseröhre) jetzt wieder auf eine normale Station verlegt wurde.
Eine weitere Chemo kann derzeit nicht durchgeführt werden. Allerdings ist sie Her2 doppelt positiv getestet. Daher meine Frage, ob eine Therapie mit Herceptin auch allein als Mono-Therapie durchgeführt werden kann und ob es bereits Erfahrungen bei dieser Therapie bei Lebermetastasen gibt.

[Prof. Wust]

RE: Lebermetastasen


Ihre Frage ist zu bejahen. Allerdings darf man hierbei nicht zuviel erwarten. Ansprechen von 10-20 %. Und ganz ohne Nebenwirkungen ist das Herceptin auch nicht. Lesen Sie selbst (aus Medline).

First-line, single-agent Herceptin(trastuzumab) in metastatic breast cancer: a preliminary report.
AU: Vogel,-C; Cobleigh,-M-A; Tripathy,-D; Gutheil,-J-C; Harris,-L-N; Fehrenbacher,-L; Slamon,-D-J; Murphy,-M; Novotny,-W-F; Burchmore,-M; Shak,-S; Stewart,-S-J
AD: University of Miami School of Medicine, Miami, FL, USA. [email protected]
SO: Eur-J-Cancer. 2001 Jan; 37 Suppl 1S25-9
AB: Following confirmation of the appropriate dosage, safety and potential efficacy of Hercep-tin(trastuzumab) in small-scale phase I and II trials involving patients with refractory disease, a large trial was conducted in 222 patients with breast cancer who had relapsed after one or two chemotherapy regimens for their metastatic disease. The results showed a positive and durable overall response rate (15% according to a response evaluation committee (REC) assessment) using trastuzumab monotherapy (initial dose 4 mg/kg intravenously (i.v.) followed by 2 mg/kg i.v. weekly). In another recently completed phase II trial, 113 patients were randomised to two dose levels (initial dose of 4 mg/kg i.v. dose followed by 2 mg/kg i.v. weekly, or initial dose of 8 mg/kg followed by 4 mg/kg i.v. weekly) of single-agent trastuzumab as first-line therapy for metastatic disease. The preliminary overall response rate was 23% based on investigator assessment, and tolerability was excellent as in previous trials; efficacy was similar in both dose groups, but the side-effects tended to be more frequent in the higher dose group. The preferred dosage is the-refore the same as that currently recommended, i.e. an initial dose of 4 mg/kg i.v. followed by 2 mg/kg weekly i.v. until disease progression.

Multinational study of the efficacy and safety of humanized anti-HER2 monoclonal antibody in women who have HER2-overexpressing metastatic breast cancer that has progressed after chemotherapy for metastatic disease.
AU: Cobleigh,-M-A; Vogel,-C-L; Tripathy,-D; Robert,-N-J; Scholl,-S; Fehrenbacher,-L; Wolter,-J-M; Paton,-V; Shak,-S; Lieberman,-G; Slamon,-D-J
AD: Rush-Presbyterian-St Luke's Medical Center, Chicago, IL 60612, USA.
SO: J-Clin-Oncol. 1999 Sep; 17(9): 2639-48
AB: PURPOSE: Overexpression of the HER2 protein occurs in 25% to 30% of human breast cancers and leads to a particularly aggressive form of the disease. Efficacy and safety of recom-binant humanized anti-HER2 monoclonal antibody as a single agent was evaluated in women with HER2-overexpressing metastatic breast cancer that had progressed after chemotherapy for metastatic disease. PATIENTS AND METHODS: Two hundred twenty-two women, with HER2-overexpressing metastatic breast cancer that had progressed after one or two chemotherapy regimens, were enrolled. Patients received a loading dose of 4 mg/kg intravenously, followed by a 2-mg/kg maintenance dose at weekly intervals. RESULTS: Study patients had advanced me-tastatic disease and had received extensive prior therapy. A blinded, independent response evaluation committee identified eight complete and 26 partial responses, for an objective re-sponse rate of 15% in the intent-to-treat population (95% confidence interval, 11% to 21%). The median duration of response was 9.1 months; the median duration of survival was 13 months. The most common adverse events, which occurred in approximately 40% of patients, were infu-sion-associated fever and/or chills that usually occurred only during the first infusion, and were of mild to moderate severity. These symptoms were treated successfully with acetaminophen and/or diphenhydramine. The most clinically significant adverse event was cardiac dysfunction, which occurred in 4.7% of patients. Only 1% of patients discontinued the study because of treatment-related adverse events. CONCLUSION: Recombinant humanized anti-HER2 monoclonal antibody, administered as a single agent, produces durable objective responses and is well tolerated by women with HER2-overexpressing metastatic breast cancer that has progressed after chemotherapy for metastatic disease. Side effects that are commonly observed with chemotherapy, such as alopecia, mucositis, and neutropenia, are rarely seen.