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dlaxague · 10-22-2008, 07:55 AM

At diagnosis in 3/2001, I was told that the bad news was that the cancer was ERPR- and HER2+. The good news was that they were enrolling in a trial of adjuvant Herceptin. I did enroll but did not get the Herceptin (control arm). Losing that toss was the hardest blow of the whole experience, although now I've mellowed considerably about it, being still here and NED.

I've been listening to these podcasts (bcupdate and oncology unplugged) and I'll have to go back and see who said what and quote them properly, but the discussion was about topoIIa, HER2, and anthracyclines. A statement was made that for HER2+ topoIIA+ cancer, an anthracycline probably offered an equal benefit to Herceptin. HuH?! I'd heard it the other way round from Dennis Slamon - that if Herceptin is used, an anthracycline offers no added benefit even for topoIIa+ cancer. But said that way - it could well be that I had a topoIIa+ cancer (it wasn't tested for) and that the anthracycline trumped the no-Herceptin and that's why I'm here. Or not - no way to know for sure. But still, I liked hearing that.

AA, as I understand it, what they are saying about not giving Herceptin without chemo is two-fold. One, they do know that with some chemos, the effect of the two together is synergistic (stronger benefit when given together than the sum of the two given separately). In addition, this is the era of basing decisions on evidence. Evidence based medicine, as we see here, has its strengths and its weaknesses. There is no evidence for giving Hercptin alone in the adjuvant setting. Some oncs are more cautious than others when it comes to evidence to support their recommendations. Some have been burned, jumping on a bandwagon before the evidence was in (stem cell transplants for breast cancer was the biggest and worst example of this - read "False Hope" by Rettig). So I understand their caution. And then there are the insurance companies, usually quick to point out lack of evidence and thus deny coverage, especially for something as expensive as Herceptin. (have you noticed that it's really hard to type "Herceptin"? It goes against some principles of the fingers somehow - mine really want to put the "p" after the "c", and/or add a "g" at the end)

Debbie Laxague

10-22-2008, 07:55 AM	#24
dlaxague Senior Member Join Date: May 2006 Posts: 221	anthracycline without Herceptin At diagnosis in 3/2001, I was told that the bad news was that the cancer was ERPR- and HER2+. The good news was that they were enrolling in a trial of adjuvant Herceptin. I did enroll but did not get the Herceptin (control arm). Losing that toss was the hardest blow of the whole experience, although now I've mellowed considerably about it, being still here and NED. I've been listening to these podcasts (bcupdate and oncology unplugged) and I'll have to go back and see who said what and quote them properly, but the discussion was about topoIIa, HER2, and anthracyclines. A statement was made that for HER2+ topoIIA+ cancer, an anthracycline probably offered an equal benefit to Herceptin. HuH?! I'd heard it the other way round from Dennis Slamon - that if Herceptin is used, an anthracycline offers no added benefit even for topoIIa+ cancer. But said that way - it could well be that I had a topoIIa+ cancer (it wasn't tested for) and that the anthracycline trumped the no-Herceptin and that's why I'm here. Or not - no way to know for sure. But still, I liked hearing that. AA, as I understand it, what they are saying about not giving Herceptin without chemo is two-fold. One, they do know that with some chemos, the effect of the two together is synergistic (stronger benefit when given together than the sum of the two given separately). In addition, this is the era of basing decisions on evidence. Evidence based medicine, as we see here, has its strengths and its weaknesses. There is no evidence for giving Hercptin alone in the adjuvant setting. Some oncs are more cautious than others when it comes to evidence to support their recommendations. Some have been burned, jumping on a bandwagon before the evidence was in (stem cell transplants for breast cancer was the biggest and worst example of this - read "False Hope" by Rettig). So I understand their caution. And then there are the insurance companies, usually quick to point out lack of evidence and thus deny coverage, especially for something as expensive as Herceptin. (have you noticed that it's really hard to type "Herceptin"? It goes against some principles of the fingers somehow - mine really want to put the "p" after the "c", and/or add a "g" at the end) Debbie Laxague