Topic: Kadcyla for residual disease after neo adjuvant chemo

Forum: HER2+ (Positive) Breast Cancer — Testing, treatment, side effects, and more.

Posted on: Oct 30, 2019 12:20PM

Posted on: Oct 30, 2019 12:20PM

neeli wrote:

Hi All,

Starting a new Kadcyla thread as there wasn't one before. I will be starting Kadcyla soon as there was residual disease from surgery pathology report. Kadcyla for 14 cycles is what is recommended. Any of you who have already been on Kadcyla please share how it is going for you.

Dx 4/24/2019, DCIS/IDC, Right, Grade 3, 3/10 nodes, ER+/PR+, HER2+, Chemotherapy 6/5/2019 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 6/5/2019 Herceptin (trastuzumab) Targeted Therapy 6/5/2019 Perjeta (pertuzumab) Surgery 10/17/2019 Mastectomy: Right Targeted Therapy 11/7/2019 Kadcyla (T-DM1, ado-trastuzumab) Radiation Therapy 12/5/2019 Whole breast: Breast, Chest wall
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Sep 1, 2022 09:34PM noodlesg wrote:

Hi Sarah! How are you? I sadly caught covid since the last time I posted. It wasn't really that bad for me, but I am delayed from my next Kadcyla. That worries me more than covid actually, but there is nothing I can do. I dodged covid for sooooo long, it is so frustrating. It takes not being able to get treatment to realize how much you really want it.

On the bright side, my liver values continue to get better. The result from my last blood work was 34 AST (down from 40) 27 ALT (down from 38). My bilirubin also went down from from 15 to 10 (the onco told me she also looks at this number) . So hopefully, I can get my next kadcyla next week.

I went in for a second opinion after my surgery, and the oncologist I spoke to recommended Nerlynx for 1 year. He said there are some unpleasant side effects (diarrhea being the worst), but he said I should do it. My current oncologist hasn't mentioned it to me yet. She is more focused on endocrine therapy at the moment, and just started me on tamoxifen.

I hope #10 goes well for you. Double digits already! Getting closer to the finish line. Way to go.

Did you go get yr hair done? Mine is a bit weird now, I have been going for this pixie cut look, but like yours, the bottom is getting long and it's just all over the place. I just don't want to cut it. I don't know what to do so I do nothing. hahaahah

All the best! Have a great weekend.

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Sep 22, 2022 06:24AM sarah_78 wrote:

Hi noodlesg,

I had a vacation and feel so relaxed. Now I remember you told me you had a vacation too, this was so much needed. Feel like a new person. Of course vacation and hair dresser I went right before vacation played a role too. He cut my hair in a way that it looks like a hair cut now, not like some hair growing from my head, if you know what I mean. Once that looked half way decent, my self confidence came back because I can go out without putting on a hat and worry about how terrible it looks if I have to take it off. I hope yours grew enough so you can get a hair cut too :-) Much recommended.

I had a check up on Monday, mammo/ultrasound etc, all look normal for now, phew. I have the 11th Kadcyla tomorrow and liver values continue to sink, made it to 62 AST and 42 ALT (down from 71 and 54 respectively). And that when I drank 2 times 1 small glass of wine with dinner and of course once Limoncello which was offer the house Happy I thought I could let it go a little during vacation!

I asked Nerlynx to my onc/gyn who is the director of the breast center and he said that it made no difference in survival rates, it only delays the reoccurrence but if it comes back, it is observed to be more aggressive so one has the same time to live if that happens. So I guess that is a no for me. I read in another (German language) forum that some doctors explained that Nerlynx is also hard on the liver, like Kadcyla so if it reoccurs, it limits your options (Entertu for example is a good drug but it is better if your liver is in a good shape to take it). Try to ask all these questions before deciding on Nerlynx.

Hope you are doing well, how is Tamoxifen? Hope Covid was gentle on you. You resumed your treatment?

Wish you a wonderful weekend too.


DIagnosed at 43, Hodgkin's Survivor (at 33) Chemotherapy 9/24/2021 Other Targeted Therapy 2/1/2022 Kadcyla (T-DM1, ado-trastuzumab) Targeted Therapy 3/1/2022 Kadcyla (T-DM1, ado-trastuzumab) Dx IDC/DCIS, Left, 5cm, Stage IIIA, Grade 3, 2/11 nodes, ER-/PR-, HER2+, IHC
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Oct 7, 2022 08:06PM noodlesg wrote:

Hi Sarah,

So glad to hear that you went on vacation! And the haircut, too! My family and I have been doing our fair share of revenge travel, and it feels great. Plus, now that I have caught covid, I'm not so nervous about catching it anymore. Thankfully my neutrophils have held in the normal range during kadcyla. To be honest, my covid symptoms were quite mild, but I was given a course of the anti-viral paxlovid pills.

I still feel like I need to wait a bit longer for the haircut. It's still at such an awkward stage, and I style it with gel to look like a short pixie. It's starting to get a bit to long for the gel to hold on top, so I have been looking for hair bands. I think I'm about 2-3 cycles behind you, so maybe in a month's time!

I was wondering if I can ask you a few questions please. I'm so glad that both our liver values have improved, and have maintained at an almost normal level. It seems kind of like we found a way to solve the problem together! However, when I did my last blood work, I noticed a trend that my platelets and red blood start starting to drop. They are both still in the normal range (platelet is 266, but it started at 357) and red blood count is 4.02 mil/uL (started at 4.84). I was wondering if yours were the same? If so, have you taken any vitamins made any changes to your diet to improve the numbers?

A couple of months ago, I had a follow-up mammogram and ultrasound. My doctors mentioned a PET scan in the future, and I never realized that this was normal protocol. I always thought it was done if you had symptoms of mets. I was wondering if this was also the standard protocol at the place where you are being treated?

Hope all is well with you. Sending lots and lots of positivity your way. Chat soon :)

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Oct 14, 2022 03:39PM sarah_78 wrote:

Dear noodlesg,

I am glad to hear you are travelling and having quality family time. I haven't caught Covid yet and dreading it, you were lucky to have it mild. Some colleagues caught it 2 weeks ago and they are still struggling with it.

As for hair cut, the hair dresser didn't cut mine everywhere but only where it was too long and didn't look good. Now mine grew a bit longer but still slower than normal. I started Kadcyla at the end of February, in 8 months it would have normally grown twice as much but since it is looking somehow normal now, I don't mind anymore so much.

My thrombocytes are also slowly creeping down. I started with about 270-280, went down all the way to 120, then after holiday, less stress and a lot of fish I suppose, went up to 170. This week they measured 140. As long as it is above 100, they say they don't delay the therapy. I do however can feel the difference, especially when I cut my hand, it takes forever to stop. Also little nose bleeds because of dry nose takes much longer to stop. Moreover 2 weeks ago I had my period that was rather liquid too (lost a lot of blood). Your values now being about 250 doesn't sound too bad. what is the lowest point they get alarmed? I had been thinking it this way, sometimes during chemo they give pills'/shots to make sure the patient doesn't get a blood clot from the port. So maybe it isn't too bad after all, assuming you also have a port. I think beet root juice should help a bit with platelets too, you are still drinking it? I drink 2-3 times 330ml last week before Kadcyla before blood test. Fatty fish, which I found to be helpful is something you can try as well.

My red blood count is on the lower end of the healthy spectrum but i don't mind it too much either. When it gets too low I can feel it, I get cold fingertips easily. Right now I am managing it. Today it was my 12th treatment, so I guess I will be able to get it 2 more times with how the values look right now. Creatinine is another value that is low for me, today I asked, the doctor said it is better low than high. I just checked though, it might indicate liver problem. I will try not to get too worried and roll with it, it is so close to the lower end of normal range.

As for PT Scan, they don't do it here unless there is an indication of recurrence. The scan would stress me a lot but after that you feel much better. I had once a PET scan after Hodgkin treatment, about 12 years ago, that was a point when doctor said it looked good and we removed the port so it was like a clean page after that if that makes sense. If you aren't scanned, there is always that "what if" at the back of your mind. So perhaps it isn't too bad after all. Will you be keeping the port longer? Do you also go to a rehabilitation at the end of the treatment? I signed up for a 3 week program here, starting from 12th December, not sure what to expect.

Lots of love, cheers, Sarah

DIagnosed at 43, Hodgkin's Survivor (at 33) Chemotherapy 9/24/2021 Other Targeted Therapy 2/1/2022 Kadcyla (T-DM1, ado-trastuzumab) Targeted Therapy 3/1/2022 Kadcyla (T-DM1, ado-trastuzumab) Dx IDC/DCIS, Left, 5cm, Stage IIIA, Grade 3, 2/11 nodes, ER-/PR-, HER2+, IHC
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Oct 24, 2022 09:46PM noodlesg wrote:

Hi Sarah,

How are you? Thanks for your sharing your stats. I get so hung up on numbers sometimes, and I think even my doctor tells me that I worry too much and to just take a day at a time. She said she didn't anticipate that my platelet count will be an issue, but did say 100 was the threshold. I do have a port, so happy I decided to get it, despite not wanting it in the beginning. I still drink the beetroot juice, I'm starting to not like the taste, but my liver numbers have been so good that I will force myself to continue.

How are you feeling after #12? Are you excited to finish the treatment? I get #10 soon, and I go from being happy the treatment is almost complete to being anxious about what will happen after. My onco has never mentioned any rehabilitation program for me, I don't think we do it here. Curious to know what it is :) I am triple positive, so I will still need to continue hormone therapy for what feels like an eternity.

I totally agree with you about the scans, I just anticipate a lot of anxiety and stress. I'm sure afterwards I will be happy to have it done, it's just getting there. My onco did say that the port was to be removed after we are finished with kadcyla, but I was hugely disappointed when I heard that I needed more infusions post surgery, so I tell myself not to think about it for now.

Good luck on your last 2 kadcyla! Sending hugs your way.

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Nov 8, 2022 08:45AM sarah_78 wrote:

Dear noodlesg,

I feel fine after 13th infusion last Friday, one more to go for me on the 25th of November. That will be the last one, I will bake almond choco muffins and invited my psycho-oncologist to come and eat with us. I hope that day won't be too hectic in chemo station, sometimes a patient might have a problem and all doctors and nurses then start running around.

As for the last cycle now, thrombocytes are 145, liver values are 43-58, I am glad I made it so far without any major problems. The worst I have right now is nose bleed, which is a little annoying but nothing too bad. Hemoglobin is at 11 when normal range start at 12, but it is due to the last heavy period, it has to do with the lower than usual thrombocyte situation together with not having it for almost 1 year, they say it might regulate in time, crossing fingers.

I will then have an end of treatment appointment with my gyn onc who is also my surgeon. So many things to ask. I know he will be checking me each 3 months with ultrasound but not sure what to do with port or when to get a reconstruction. I am lopsided now with one breast and not sure if I am in for another major surgery. He is a really good doctor and encourages me to have a positive outlook on things, tells me the chances that this comes back is low and I shouldn't be too worries until it is necessary, I'll take his word for it.

Rehabilitation or "end of treatment treatment" is standard in Germany. It takes 3 weeks, you stay in a clinic with people who had similar health problems. They offer psychological and physical treatment depending on your needs, mostly a lot of sport and getting over things to start new. I was very sceptical at first but I will try and hope it does me some good.

You will be on hormone therapy, which is extra medication of course but then think about it as something which lowers the chance of it coming back. You might feel like you are more protected as opposed to me, who will have nothing.

I feel like soon I will be finished and they will expect me to return to normal like a switch but it might take much longer to get my life on track. Just looking around the flat, everything is everywhere, things on top of things, I need to start somewhere to get things in order. My inner image is very close to how my flat looks if that makes sense. I delayed so many thoughts and things I needed to do for such a long time, just to focus on finishing the treatment and now I don't know where to start.

One step at a time is the right approach I believe, or a day at a time like your doctor said.

Do let me know how you are doing, you are so close to the finish line too.

Hugs and best wishes


DIagnosed at 43, Hodgkin's Survivor (at 33) Chemotherapy 9/24/2021 Other Targeted Therapy 2/1/2022 Kadcyla (T-DM1, ado-trastuzumab) Targeted Therapy 3/1/2022 Kadcyla (T-DM1, ado-trastuzumab) Dx IDC/DCIS, Left, 5cm, Stage IIIA, Grade 3, 2/11 nodes, ER-/PR-, HER2+, IHC
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Nov 18, 2022 08:38PM maggiehopley wrote:

I had my 3rd Kadcyla infusion this week and so far it is going well. My bloodwork is excellent and the only side effects I am having are mild constipation and heartburn. I know it's early days yet but I'm optimistic.

Chemotherapy 5/25/2022 Taxol (paclitaxel) Targeted Therapy 5/25/2022 Kanjinti Targeted Therapy 5/25/2022 Perjeta (pertuzumab) Surgery 9/16/2022 Mastectomy (Left): Simple; Mastectomy (Right): Simple Targeted Therapy 10/1/2022 Kadcyla (T-DM1, ado-trastuzumab) Hormonal Therapy 10/1/2022 Arimidex (anastrozole) Dx IDC: Mucinous, Left, 2cm, Stage IIA, Grade 1, ER+/PR+, HER2+, IHC Dx IDC, Left, 1cm, Stage IIA, Grade 1, ER+/PR-, HER2+, IHC
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Nov 23, 2022 07:40AM sarah_78 wrote:

Hi Maggie, hope you are doing well.

I think the lack of posts in this thread shows that Kadcyla side effects are rather mild and rare.

Drink some beet root juice if your liver values slowly go up. Me and noodle found it to be helpful. I also apply a warm patch on liver from time to time, it is known to help with the enzymes.

Many hugs

DIagnosed at 43, Hodgkin's Survivor (at 33) Chemotherapy 9/24/2021 Other Targeted Therapy 2/1/2022 Kadcyla (T-DM1, ado-trastuzumab) Targeted Therapy 3/1/2022 Kadcyla (T-DM1, ado-trastuzumab) Dx IDC/DCIS, Left, 5cm, Stage IIIA, Grade 3, 2/11 nodes, ER-/PR-, HER2+, IHC
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Nov 23, 2022 09:34AM noodlesg wrote:

Hi Maggiehopley, good to hear that all is going well for you. Hope it continues that way. I have a little bit of tummy issues, too. Some days it gets a bit old, but most days am just grateful it's not worse.

Hi Sarah,

All the very best for the 25th. I wish I was there to celebrate with you, the muffins sound yummy Smile My next one will be #12, so I can see the finish line now. Thanks for the heads-up about the nose bleed, I haven't had it on kadcyla, definitely on Taxol and AC. My latest platelets was 214, so still coming down but still in the normal range. I hope it holds. The nosebleeds can be so scary.

I'm doing okay. Just looking forward to the holidays. My onco wants me to have a neulasta jab because I will be travelling at the end of the year and my WBC, although in normal range, is slowly coming down. She's afraid I would catch something. I get a bit of brain fog here and there as well, but nobody seems too concerned, or rather, there is nothing you can do about it? Also, I am almost ready to pick up the phone to call my stylist for a haircut!

I had a reconstruction at the same time as my mastectomy. I chose the have the DIEP flap, where they take fat from your tummy and move to the chest. I wanted to do it all at once and not have to go under the knife again. The surgeons warned me that I will have numbness but on top of that, I have fat necrosis, which I will probably have removed after I am done with kadcyla. So be vigilant when you are talking to the plastic surgeon and ask a lot of questions. Sometimes the doctors don't tell you everything!

The 'end of treatment' is lovely, I wish we had that as well. The social emotional can be so hard, how lovely to see that support.

Take care! Come check in on us after you're done. Thanks for all the support you've given me, it means a lot.


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