[Becky]

Valerie

The 2 yrs of Herceptin versus 1 yr is part of the HERA trial which was an early bc trial done in Europe.

In that trial women were randomized AFTER adjuvant chemotherapy to one of three arms. These arms were no Herceptin, 1 yr of Herceptin or 2 yrs of Herceptin. Any chemo was acceptable but chemo and radiation had to be completed before starting the Herceptin.

The one year of Herceptin (versus no Herceptin) results were announced at ASCO May 2005 when the USA trials were announced - the spectacular results which resulted in women (like you) getting one year of Herceptin. This is started with chemotherapy because that's how the trials were done here in the USA (and ultimately, although Herceptin works very, very well when given after chemo, it does work better when started with chemo). The HERA one yr results were the same as the USA results even though HERA's Herceptin was given afterwards. The explanation for this is that there was no criteria on the kind of chemo a woman got. The only criteria for HERA was either positive nodes or a tumor larger than 1cm. Many European women did receive more inferior chemo (like CMF for example) so they benefited more than women getting FEC, AC and/or a taxane.

The 2 yrs of Herceptin arm is not over yet and the results of 1 yr vs 2 yrs is not analyzed for statistical differences yet (and remember, it is only valid for those getting Herceptin after chemo and/or rads). No one knows what 2 yrs of Herceptin would do if one got Herceptin with chemo and if there would be a difference vs 1 yr Herceptin starting with chemo.

My impression is that there will be little difference upfront but perhaps over time, there might be (such as taking Tamoxifen or an AI - they had to have done trials to say that 5 yrs is best).

It will be very interesting to see those 2 yr results and it will also be interesting to see the 6 months vs 12 months results.