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Dianne, it's always good to ask questions and seek to understand. Unfortunately, many of the answers aren't there (yet).
The trials that produced the results that caused Herceptin to become standard adjuvant treatment for HER2+ disease are where most of the data comes from. Those trials began well before 2005 - that's when they were reported and standard care changed. I do not know how old the oldest data is but you are correct - there cannot be a lot of information about 10 year survival after adjuvant Herceptin.
So, how can the medical world say it 'works in about 50% of cases'?
In those adjuvant trials, women who received Herceptin in addition to their other treatment were 50% less likely to have a recurrence than those who received just "other treatment". Other treatment being surgery, chemo and where applicable, hormonal treatment.
As you say, there is no way to know if Herceptin is working for any one individual when it's used as adjuvant treatment. The same would be said of chemo and of hormonal treatment. No way to know if it's working. If you don't get a recurrence, something worked - surgery, chemo, Herceptin, and/or hormonal treatment. One of those things or some or all of them in concert. No way to know.
As for Ralph Moss, sometimes he makes some good points but I think that in this case he is just as guilty of manipulating the data as are the media reports that he accuses of doing the same. It's true that when reporting to a public that does not understand the difference between relative and absolute risk it's easy to make something sound much better (or worse) that it is. That's not Herceptin's fault.
It's true that Herceptin benefits only a small portion of breast cancer patients, but it never claimed differently. If we use the figure of 25% of all bc being HER2+ and then the figure of Herceptin working for 50% of those - that's only 12% of all breast cancer. But anything that offers a 50% reduction in recurrence is pretty amazing, to that subgroup that benefits from that reduction.
It seems like Ralph Moss is upset with the way that media reports health news, and is taking it out on Herceptin.
I don't know what he has to say about side effects. I don't think that there are any serious side effects showing up when an anthracycline chemo is not used with Herceptin. And I'm not willing to pay to read his words. His style of making dramatic statements that require me to pay to read the rest of the argument is annoying, and imho, decreases his credibility.
He has some valid points about conflict of interest among study investigators. His is an old article and doesn't mention another troubling issue r/t finances and personal financial interests, which is lack of further study about Herceptin's possible equal benefit when used over a much shorter duration.
But no matter how he nitpicks the reporting and the details and the financial gains involved - the fact remains that a 50% decrease in recurrence exists when Herceptin is used to treat HER2+ breast cancer.
Debbie Laxague
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