[Debbie L.]

I agree with the "only"!? And although they are completely different mechanisms, aren't there clues that the anti-HER2 agents increase endocrine sensitivity?

This seems such an important area to explore on two fronts. For stage IV disease, tweaking of anti-HER2 therapy and endocrine therapy could give women YEARS of chemo-free life. We do have info about Lapatinib and Letrazole, right?

What kind of experience have those on this list had, with an anti-HER2 and an endocrine agent only? What did you do when progression happened? Did you switch endocrine tx and continue the anti-HER2, or did you move to chemo?

And then there's the concept that not all ERPR-negative cancer is devoid of ER but perhaps it's just silenced and could be turned back on, which muddies it up further but also opens new possibilities for less-toxic treatments.

And especially now that we're more worried about ultra-small primary tumors when they are HER2+, it seems such a logical choice, when they are also ERPR+, to treat without chemo (using anti-HER2 and and endocrine tx).

But what about after that year of adjuvant Herceptin (or other anti-HER2)? So much we don't know. Is the endocrine tx still effective for the whole five years, after the Herceptin (or whatever) is stopped? Or maybe for triple-positive disease (tends to recur earlier?), a year of the combo is enough and then both could be stopped? Or maybe both should be continued for five (or more) year$$. So much we don't know. So much we don't know. Etc.