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I definitely am not an expert on this topic, and hope I did not hold myself out to be an expert. Based on my limited reading in this area, for someone like Amelia who is stage IV, Her2 positive, ER positive, and pre-menopausal, I would feel safest with Herceptin and ovarian suppression and an aromatase inhibitor. (And that is the treatment I am undergoing.) I have not read all the articles referenced in this thread, and I know that there are some studies that suggest that Tamoxifin could fuel a Her2 positive cancer, and that AIs have been shown to be more effective for post-menopausal patients than Tamoxifin. I think (but I could be wrong on this), however, that if one continues the Herceptin, as Amelia is doing, that the Tamoxifen should not fuel the cancer, although it might not be as effective as an AI. (Terri was right in cautioning that a premenopausal woman should not take an AI without ovarian suppression. This could be quite dangerous.) Since Amelia's choice currently seemed to be Herceptin alone or Herceptin with Tamoxifin, I recommended the latter. This was based on my onc's comment that no one would give Herceptin without hormonal therapy to someone who was Her2 positive and Er positive. (We were talking about an AI, however.)
My strongest opinion, however, is that you (Amelia) should get a second opinion and discuss the issues raised in this thread with an oncologist at a major cancer center. You deserve to have an expert answer your questions regarding the appropriate therapy. The fact that you do research does not mean that an oncologist should not give his or her opinion on recommended treatments. Someone with expertise in this area is better able to critically read the relevant studies and to know which ones warrant the most weight than we are (or at least than I am), and should be able to explain the reasons he or she recommends a particular therapy. I will stop nagging, however, and sign off on this thread. It just makes me nervous that you might decide on your course of treatment based on postings by lay people. In my humble opinion, the way this message board can be most useful is to pose questions for one to take to an oncologist to have answered, or to suggest novel treatments to propose to an oncologist, but not as a substitute for expert medical advice. (And this is coming from someone who compulsively researched almost everything about her treatment. It just happened that at the time that I first was treated with Zoladex and then Femara, I was more obsessed with whether it was smart to stop chemotherapy than with which hormonal therapy would work best.)
Jill
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