[Lani]

As with most things, the problem is money. Each of the targeted agents is exorbitantly priced (and many come from different competing companies)

Best bet is for combo of different drugs from one company, eg. Roche's pertuzumab, herceptin--would be nice if could combine with off-patent drugs developed for something else. That might speed things up and avoid price constraints.

The other problem is the number of permutations and combinations and the number of patients needed to treat and the amount of time to generate data.

That is why we are moving toward so many neoadjuvant studies. Would be nice if they added pre-, during and post- bone marrows AND ctc testing to try to move things along eg, if bone marrow did not clear with treatment, would know another treatment would be necessary rather than waiting for years for the metastases to develop and cheating the patient of a possible
cure/ meaningful increased DFS, PFS, prevention of brain mets/improved QOL