[agness]

Indeed, customizing treatment would be beneficial. A Foundation One study report costs from $4-7K and sequences a large lot the genes in tumor. With more HER2 patients having neoadjuvant treatment this might be challenging but really core biopsies should present more than enough material for testing. That up front expenditure could reduce the need for poorly targeted drugs and unnecessary chemo. The challenge is that patients do not know about these study options, oncologists never mention them, oncologists are not trained to read and respond to these reports, let alone use them clinically -- and their resistance extends into biased judgements about when to order them -- typically late after there is drug tesustsnce shown which limits their usefulness to patient care.

TCHP is a different regime that based upon patient reported outcomes on the breastcancer.org site has about a 50/50 chance of producing a pathologically complete response (PCR), and amongst those who didn't have a PCR there was still substantial reduction in tumor burden. In my own case, even with locally advsnced disease I suspect based on observational analysis that 4 doses was probably enough of TCHP. I was not offered any monitoring MRIs during treatment however and only had one after I completed my six rounds.

Knowing which patients need more and which less can save a lot of time, money and suffering. Plus, it would be great to have a deeper understanding of what the "more" is to help those get closest to a PCR, and also know who doesn't need a year of Herceptin.

It's all such a crap shoot still.