[Cellomomof5]

Debbie,
I was in the Phase II trial that Schoonder mentioned in her reply, completing the T-DM1 last March. Part of the reason I chose this trial over ACT + herceptin was that the Phase II trial required Adriamycin, but made Taxol optional. As a musician, I was particularly concerned about developing neuropathy, and my doctor (Eric Winer at Dana Farber) felt that with T-DM1, I could comfortably skip the Taxol altogether, and avoid that particular set of toxicities.

With the recent findings about the differing responses between two different subgroups of HER2 patients: (one of which doesn't seem to respond to Herceptin,) I am very glad that I did at least receive Adriamycin before starting a year of T-DM1. If I turn out to be part of that HER2 group that doesn't respond to herceptin, I at least want to know that I had some standard-of-care chemo as "backup."

One point I'd like to mention - I began T-DM1 exactly three weeks after my last adriamycin cycle. I had not recovered from the side effects of Adriamycin, and had a rather nasty start with T-DM1 as a result, garnering seriously high liver function counts, and a very low white count. My T-DM1 dose ended up getting reduced for a couple of cycles, but was then re-escalated to the original dose when I bounced back to normal within a few weeks. My understanding was that it was not unusual for patients in this trial to have a rough start right after adriamycin and need a few weeks to recover and adjust.

Sounds like an interesting debate!

I'm happy to be helpful in any way I can.

-Karen