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Mar 22, 2020 11:35PM
morrigan - some oncologists would like their triple positive patients to leave their ports in for a period of time after last Herceptin. The rationale behind this is that if Her2+ driven recurrence happens, it generally happens in the first 2-3 years post-treatment. This was the feeling of my particular doctor and I had no issues keeping my port, I had it in for the following six years, but there is nothing wrong with removing your port at the first opportunity - many don't want the reminder and/or their docs have no problem with the decision to take it out.
rljes - I had my port placed at the tie of BMX (I had surgery first) but I due to unrelated skin issues that prompted four additional surgeries, and the discovery of positive nodes requiring ALND, I did not start chemo/Herceptin until 14 weeks after the port placement. My port was never flushed during this time because I think everyone kind of forgot it was there, and I was unaware that it needed to be flushed. It worked perfectly on the first infusion, but I did have it flushed every six weeks post-chemo.
On the subject of testing estrogen - if you are post-menopausal and on AI drugs you can have an extra-sensitive estrogens test done and this gives you a plasma reading of estrogen, but unless you know what your level was before starting you will not know how much the drug has reduced that number. Generally, if you are post-menopausal, you have under 30pg/ml, but this number varies per person, some people even have single digit results on the plasma test when not on an AI. All three aromatase inhibitors Arimidex (anastrazole), Femara (letrozole), and Aromasin (exemestane) work well at significantly reducing the estrogen that is created by the conversion of androgens to estrogen by the enzyme aromatase. When this class of drugs may stop working is when a patient develops resistance, which is usually associated with advanced disease, but can also happen in some early stage patients. This is the reason that when you look at trials for hormonal suppression drugs they are measuring years of disease free survival, and not always the percentage of plasma estrogen reduction. For those on tamoxifen, circulating estrogen is not reduced, rather the drug blocks the estrogen receptors on the breast cells, so estrogen level testing would not be necessary other than initially to double check menopausal status.
byhisgrace - you had asked earlier whether Herceptin is made from a mouse protein - it is a mouse/human chimeric, which as I understand it, is a combination. For dosing, if you receive it every three weeks you receive a loading dose, then a reduced dose that is calculated by BSA (body surface area) - also true for chemo drugs. If you receive Herceptin weekly - either with Taxol only - or with Taxol after AC, I believe you also receive a loading dose, then a reduced dose for the remaining weekly infusions. Most weekly Taxol/Herceptin patients move to every three weeks once the chemo portion is done, so the dose effectively triples at that time through the end of infusions. This is one reason you are weighed each time you come in for an infusion, so they can do the calculation of mg of drug per kg of weight. I personally feel that a slower infusion of Herceptin is preferable to help combat some side effects, particularly any bone or joint pain. All of my Herceptin infusions during my six chemo infusions (Taxotere/Carboplatin/Herceptin) were done over 90 mins. My first Herceptin only was done more rapidly and I had hip and leg pain. My infusion was slowed at my request back to 90 mins, no further problems.
BMX w/ TE 11/1/10, ALND 12/6/10. 15 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present.
9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ (IHC)
9/27/2010, DCIS, Stage 0, Grade 3