[Christine MH-UK]

I just wanted to point out that the BBC article could give the misleading impression that the followup at this point had strengthened the case for the NHS to use herceptin as a single agent.

Cancer Research UK is doing a shadow study to determine the characteristics of patients for whom herceptin by itself makes a difference. In the Lancet article there seemed to be even fewer differences between subgroups than in the one year followup. The one thing that still stands out is that grade 2s have a much bigger reduction in risk than grade 3s (54% versus 27%), although in both cases the difference is statistically significant.

It could very well be, of course, that herceptin makes the biggest difference later on, since chemo takes out the faster cells but doesn't do much against the slower cells.

I would hope that the pharmacists would have the sense to keep the herceptin at the right temperature, although some indication of when the medicine had gotten too warm would be good.

My problem is not with herceptin and a 36% difference is still solid, but just that the reduction in proven cost effectiveness could mean some rocky times ahead for patients, since some local primary care trusts are really stingey with herceptin. UK oncologists do seem to be moving more to herceptin-based chemos for early breast cancer, even though these are not yet licensed regimes (although all of the medicines are, of course, licenced).