;-)

Herceptin doesn't cross the blood-brain barrier easily.  There have
been a few tests run where they found the concentration of Herceptin
in someone's blood is 300 times higher than the concentracion of
Herceptin in the same person's spinal fluid.

What this means is that Herceptin does a pretty good job of killing
the nasties everywhere *except* in someone's nervous system.  IM
frequently less than HO this means that the increased incidence of
brain metastasis in folks who have received Herceptin is because the
drug can't get to that part of your body.

As I mentioned in another post, Herceptin is a large-molecule drug.
Your nervous system has a pretty efficient filter to keep stuff that
shouldn't get to your brain away from that area, and unfortunately
Herceptin doesn't make it through that barrier very well either.

So - it's my opinion that the folks who develop brain metastasis after
Herceptin are doing so because they're living longer than they
normally would have, not because Herceptin increases the likelihood of
brain mets.

There have been some test cases where they injected Herceptin directly
into the spine to fight brain mets but this is still being tested and
isn't approved for general use.

Being Her2 positive isn't an automatic death sentence and I don't
think there's any clinical evidence to support the idea that Her2
positive tumors metastasize quicker than other tumors.  It is
generally accepted that Her2+ tumors are a bit more aggressive than
others, but any oncologist will tell you that *any* breast tumor left
unchecked will metastasize at some point - and that some do earlier
than others.  There's simply no way to tell at what point a tumor will
start shedding cells into one's bloodstream.

So - although it's easy for me to sit here and tell someone else not
to worry, being Her2+ is *not* an automatic death sentence and does
*not* mean that the tumors shed cells faster than others or anything
awful like that.  There's simply no clinical evidence to support that
hypothesis.  It *does* mean that on average Her2+ tumors grow faster
than others, and that may (or may not) mean they metastasize quicker
but there's no clinical evidence to support that.  Each tumor is
different.

My wife Deborah is Her2+ and was diagnosed with lung metastasis even
before she had her mastectomy.  Herceptin has saved her life twice -
and more than five years out from a Stage IV diagnosis she's healthy
and reasonably happy.  As a matter of fact, if things continue to
progress the way they have been for the past sis months we'll be off
chemo again next month.

No one's telling you there's nothing to cling to, Eva - as a matter of
fact I'm telling you exactly the opposite.  It's not over until your
oncologist says it's time to give up - and that may be a long way off
- or never.

hugs -

allan

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Thank you, that's a very clear and helpful site.

I'm sorry if I got kind of hysterical there when I posted.  I was having a
really bad night.  Then I read Catharine's biography and freaked out
altogether.

Eva

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No sh.t.  I work in a nursing home, I've seen plenty of death and I even
know there are worse things than cancer.

Eva