[AlaskaAngel]

Being diagnosed and having to do treatment is a frightening time, and a time for encouragement, hope, and suggestions.

A question that I received was such a good one that I want to share it (and my response to it) with you all.

QUESTION: I just read one of your posts and wanted to ask a question about something you said. "The protective effect of chemotherapy falls off after the first 4 or 5 years." Can you give me more information about that statement?

RESPONSE: The fact that you are questioning what you read, no matter who writes it, is going to give you a strong advantage, so I encourage you to keep that healthy skepticism in figuring out your individual situation. I'm basically "just another breast cancer patient", not an expert, only I've had 7 years since treatment to stumble around trying to figure some of it out.

My observation was in regard to general breast cancer, and so it is subject to the all too annoying and common "it depends" that plagues breast cancer patients because of the wide diversity of our cancer characteristics and genetics. In looking at graphs of general breast cancer (where only 1/3 of all bc patients are HER2 positive and so have the option or benefit of choosing trastuzumab, and only about half of those patients--half of that 1/3--actually benefit from it) the improvement over the years in cancer therapies has been more muted. The graphs that I've seen for general bc patients who are treated with the available therapies have shown a very minimal, slow drop for the first 4 or 5 years, and then a sharper drop off. More recent graphs probably also show some additional extension out in time before dropping, due to the effects of the broader recent use of hormonal treatments.

For HER2 positive patients, on the whole trastuzumab has made a significant positive difference, with the curve extending much farther out before starting to drop. However, a little over half benefit from the drug and a little under half don't. That "half" of the HER2 positives who do benefit from trastuzumab are going to have a different graph than the graph for general bc patients in that the drop off for those patients who benefit from trastuzumab stays level farther out in time, and likely any drop off would consist of patients who eventually develop resistance to the trastuzumab or who develop resistance to subsequent hormonal therapy (or resistance to both).

Trastuzumab has made a positive difference for a lot of HER2s. However, I don't apologize for expressing a somewhat negative opinion. I want to give the others a head start. I want to encourage people not to do treatment and then just "move on" in the hope that is "enough", because making lifestyle changes can influence each one of our personal curves on the graphs. When I look, I see that almost half of the HER2 positives don't benefit from trastuzumab, and because they are on trastuzumab and don't know they are not benefitting from it, I want them NOT to rely on it and start working on whatever other things might work for them in the longer term. When I look, I see those who benefit, but only temporarily due to the development of eventual resistance to drugs like trastuzumab and hormonal therapies, and I want them too NOT to rely on it and to start working on whatever other things might work for them in the longer term.

Let's push those curves farther out in time for more of us!

AlaskaAngel