Breast Cancer India

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About Herceptin injection for Breast Cancer

Hello,

My wife is suffering from Breast cancer stage II,right side breast is removed.she is 50 yr old. Out of 06 chemo, two have been completed.At present there is not much side effect seen rather than hair loss. CBC found normal after first chemo.BP normal.

Her ER is positive in the intraductal component.

PR----- Negative

C erb B2----- Positive,score3.

Doctor advice: chemo 6 cycle .Radiation and Herceptin

would like to know:

1) about Vivitra 440 mg infusion (Zydus Cadila health care limited).

2) about HERTRAZ Mylan pharma pvt ltd.

3) Any other good herceptin medicine.

Now i need herceptin injection and i am quite confused and please tell me about where I can find them

Thanks .

SPPande

Nagpur India

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kaarenorgaard

3 years ago

As for the Herceptin medication, it is clearly needed, if she can cope with it (the heart should be monitored, because Herceptin has a side effect of making the heart weaker, while Herceptin medication is taken). It is to be taken for a year - and might be commenced as a part of the chemo, or else afterwards.

The lymph nodes must have been involved as well (if radiation is devised for a removal of the breast)?

If she is ER positive, one would normally recommend an anti hormone treatment as well (starting after chemo has ended) - if she is still premenopausal, then Tamoxifen (until she becomes post-menopausal), and if she is postmenopaisal, an aromatase inhibitor like Letroxole (or similar, there are 3 kinds of medication in that group). It must be taken for at least 5 years. So is she ER positive?

Kind regards,

Kaare (from Denmark)

kaarenorgaard

in reply to sppande

3 years ago

Hi,

Then I take it that HT means Hormone Therapy, which comes in play, because of the ER positivity. For postmenopausal that most often means an Aromatase Inhibitor (e.g. with Letrozole, and there are 2 more active substances, of which one is chosen). The Aromatase Inhibitor is taken for 5 years after the chemo (Herceptin for a year). Aromatase Inhibitor and Radiation must await the completion of the chemotherapy.

The fact that Herceptin must wait some cycles is often because the medication of the chemotherapy changes - and the initial component doesn't agree with Herceptin (they have together a too strong side effect often both deteriorating the strength of the heart).

All in all the medication planned seems all right.

If you want a second opinion on why surgery is omitted, please tell me if lymph nodes are involved, or if there are metastases, if the tumor has grown into other parts like the bone or the skin, etc. Or maybe if anesthesia is not tolerated.

Kind regards,

Kaare

ashfaqomi

3 years ago

Hi,

I have a similar case with my mother as well. My mother was ER, PR - Negative, with HER-2 high positive. Apparently, HER-2 positive means the drug Herceptin has to be given. There are alternate protocols which you might choose, but Herceptin (Medical name: Trastuzumab) is the best one available. Best one meaning chances of recurrence are very low compared to others. But the problem is, it is quite expensive.

There are 6 options available for Herceptin. They are: First price bracket - Roche Herceptin (original product, imported from Switzerland), Second price bracket - Biceltis and Herclon (Roche collaborated products with India, endorsed by Roche), Third price bracket - Hertraz, Canmab and Vivitra (Indian medicines which are bio-similar, not endorsed by Roche). MRP of the medicines are quite high, but should you buy from medicine dealers externally, it should cost you significantly less. For example - MRP of Hertraz is around 55-57k but if you buy externally, it can cost you as low as 28k. Biceltis and Herclon has a price bracket of around 40k (more or less) from medicine dealers. But you might face some problems from Hospitals as many hospitals do not allow medicine bought from outside their own pharmacies. That is something you might want to consult with your oncologist.

Another tip, is that public hospitals sometimes sell these medicines at very cheap rate for their patients. Example of this is TATA MEMORIAL MUMBAI. If you are a TATA patient, you can buy medicines from the Hospital at very low prices (Hartraz costs around 20k+ I think). But bear in mind whenever you buy medicines externally (from dealers or anywhere else), the maintenance responsibility of the drugs are solely yours. Herceptin has to kept refrigerated (not frozen - be careful, just refrigerated) at all times. Even transporting them has to be in Ice Boxes for good preservation.

The jury is still out there on the effectiveness of Bio-similar Indian Medicines, Roche claims they are not effective and has even taken them to court (to protect their market interests) while many Oncologists say they are just as effective.

My mother needs 17 cycles of Herceptin. On the advice of my Oncologist I gave her Biceltis for the first 6 cycles (with Chemotherapy) and later am currently continuing on Hertraz / Canmab only.

Regarding ER positive, I believe your patient will need to be on Hormone tablets for quite some years (maybe 5-6 depending on oncologist advice). Hormone tablets are quite cheap so you needn't worry about that.

My mother did not need Radiotherapy, I believe it was due to all lymph nodes of her were free of the disease. If lymph nodes were positive I think your patient will need radiotherapy. Again, that is something you should discuss in detail with your oncologist when you can.

Also, Herceptin has a bit of a cardiac setback. When your patient is on Herceptin, she will need to have a 2D Echo at least once every 3 months to monitor her heart condition.

Hope I was of some use to you.

Cheers!

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551972

in reply to ashfaqomi

2 years ago

(BC) ER/PR negative and HR2/new positive. Are these chemo -3 FEC Followed by 3 Docetaxel is suitable for patient.6 cycle than do surgery.

551972551972 33 minutes ago 0 Replies

Dear Sir,

Kindly suitable suggest me, we are very tense regarding this, suggest on mail - md.tauhidalam@gmail.com

My wife ( Age 35 yrs) is suffering from (Invasive Mammary Carcinoma ER/PR negative and HR2/new positive.Ki 67 30%. PET CT whole body Right breast Active lesion,size 2.7 cm and multiple Sub Pectoral and Rt axillary node Positive. Known site of Primary Malignancy. A few metabolically active Lymphadenopathy in ipsilateral axillary-subpectoral regions are likely metastic in nature.

Sir, kindly suggest me, Are these chemo -3 FEC Followed by 3 Docetaxel is suitable for patient.6 cycle than do surgery.

Another oncologist suggest - NACT is way to go forward- - as She is HR2/new Positive Ds. Ideal regimen would be Herceptin Coantaing (TCH) or AC followed by paclitaxel and Herceptin. but herceptin is very costly Around 50 thousand per Cycle ( 6 Cycles ) . so sir, very confused what to do now, between finance issue and patient.

Kindly suggest which option choose for suitable for patient.

Thanks, we are awaiting your kind reply.

ashfaqomi

in reply to 551972

2 years ago

Hi, my mother had ductal invasive carcinoma grade 2. She was ER-PR negative, HER-2 triple positive (and all 21 lymph dissected lymph nodes of hers were clear of the disease.)

She underwent MRM surgery followed by 6 cycles of DCH protocol (Docetaxel, Carboplatin, Herceptin) and further 11 cycles of only Herceptin maintenance.

Although I'm no oncologist, this is what my doctor told me:

Since she was ER-PR negative, she did not need any hormone tablets. (she might've needed them otherwise)

Lymph nodes were all clear so there wasn't need for Radiotherapy as well. (she might've needed them otherwise)

But since she was HER-2+++ chemotherapy was a must for her.

I struggled with similar financial issues and decisions as well. Herceptin is the best treatment out there, but when I told my doctors I wasn't sure if could afford Herceptin, they prescribed me a different protocol (FEC) which was more affordable.

I did my own research, and saw that no treatment is absolute. There are only lesser chance of recurrence based on treatment. With Herceptin treatment, chances of recurrence is less than 5%. Mind you it's still not 0%, 4-5 people out of 100 will still have a recurrence of the disease within 5 years even with the best treatment. So similarly, chances of recurrence with the FEC protocol is higher than Herceptin.

In the end, I went with the Herceptin protocol because unfortunately, HER2+++ is an aggressive form of cancer and I did not want to have any regrets if there was a recurrence of the disease later on.

If you read my comments above (made a year ago), you'll find ways to bring down your costs regarding treatment of Herceptin. MRP is always high, but you can buy it from medical dealers or public hospitals at cheaper rates. For example: I bought 11 cycles in of Canmab / Hertraz at Rs. 28500/- which had an MRP of Rs. 57000/- from external medical dealers. This was in November 2016, so prices might've gone down more by now. My doctor suggested I go with Roche endorsed products for the chemo cycles and later switch to cheaper Indian bio-similar products for maintenance to bring down costs, (which I did).

The treatment has landed me and my family in huge amounts of debt but my mother is doing fine now and I don't have much regrets on her treatment.

Of course not everyone's situation is the same, I'm just sharing my personal one. I hope I was a bit of help to you. Please let me know if i can be of any help furthermore.

Cheers.

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