Why I don't agree to Herceptin

Herceptin is a protein inhibitor and it attaches onto HER2 receptors (protein) on the surface of cancer cells and prevent the cancer cells from dividing and growing.  It is supposed to encourage the body's own immune cells to destroy the cancer cells.  It is also supposed to reduce the risk of cancer coming back in women whose breast cancer cells have a large number of HER2 receptors (HER2 positive breast cancer) on their surface.

My cancer cells are HER2 positive, ER positive and PR positive.

This is the second time I am having herceptin.  I had accepted herceptin very unwillingly as I had a heart attack from my very first dose in 2008.  My doctor had insisted that as my cancer cells are HER2 positive, it will be more effective if I have herceptin together with a chemo drug.

Herceptin is expensive and no government subsidy is offered. My first dose of herceptin cost me S$2636.  After medishield (insurance) and medisave, I ended up paying S$600+ in cash.  I don't understand why, as herceptin has been taken by patients in Singapore for some years now and the doctors like to recommend it to patients whose cancer cells are HER2 positive.

I had read that 40% of patients who had had herceptin for breast cancer later ended up with metastasis to the brain.  Probably because molecules of herceptin do not cross the brain blood barrier.  I brought this up to my doctor but her argument was that my cancer cells are HER2 positive and that results will be better if I have it.

In fact, when I checked the side-effects and warnings of herceptin, I should not even be prescribed herceptin.  The cancer has mets to my liver and I have a history of pleural effusion.

So, as far as oncologists are concerned, their target is the cancer cells.  Kill the cancer cells no matter what.

Herceptin has a whole list of side effects, including cardiac failure and pleural effusion.

I recalled that in 2008, after I had my third dose of herceptin, the pleural effusion came back.  Now, after the second dose and I was already coughing out phlegm.  With the third dose, it was worse.  Sometimes I would just be sitting there coughing out phlegm continuously.  If I leave home, I have to bring tissues (wet and dry ones) and plastic bags to collect the phlegm.  Herceptin not only did not work for me, it burnt a hole in my pocket and added greatly to my discomfort.

Sometimes, it is so difficult to get the phlegm out that I coughed so hard till I pulled the muscles on my back.  With the chemo and radiotherapy, my throat has become very dry.  Sometimes the phlegm irritated my throat so much that I ended up having coughing spasm, and also coughed till I vomited.

The following info is taken from this website :
http://www.breastcancer.org/research-news/20100511b

The HER2 protein receives several signals to make cells grow. These signals are called ErbB1, EeB2, and ErB4. Herceptin blocks only the ErB1 signal. Tykerb blocks the ErB1 and ErB2 signals. The experimental medicine neratinib blocks ErB1, ErB2, and ErB4. Because neratinib blocks all three signals, it is called a pan-HER2 inhibitor ("pan" means "all"). So neratinib might be a good treatment for HER2-positive breast cancers that don't respond or have stopped responding to Herceptin and/or Tykerb.

Unfortunately, neratinib is not available in Singapore yet.  I won't be surprised if this drug will cost a bomb too.