[Lani]

I did not add that to the post--because I don't like to keep posting things which remind everyone that herceptin works in in the minority of patients (usually quoted as around 40%) it is given to.

I have had one other thought(actually two!)

Since herceptin needs to be stored in such a narrow range of temperatures and transported in airconditioned trucks, etc. Perhaps one variable determining whether herceptin works in patients (whether the dose they are given is maximally active) could be controlled for by putting a "smart" label on it which changes color if it ever is not at the right temperature! It costs so much to begin with, how much more could it add to the cost?

Will see if I can bring this to the attention of Genentech(if my friend will take me along to their next stockholders meeting), as well as the makers of Rituximab(for lymphoma), Gleevec (leukemia, GIST), and some of the monoclonal antibodies given for rheumatoid arthritis.

In the meantime, if you are paranoid, ask your infusion nurse how they store the Herceptin and if there are alarms on the refrigerators which go off when the temperature is STARTING to get outside the normal range and who the alarm goes to and how far away they live. From what I understand it is delivered in refrigerated trucks.

In addition, there is 43% variability in the pharmacokinetics of herceptin ie, that is the percentage of patients who metabolize it faster or slower than normal. In those patients, they have a greater(slower metabolism) or smaller(faster metabolism) level of the antibody in their blood than others. Perhaps the latter could benefit from taking it more often and the former could take it less often. The dosage and timing were set based on the average metabolism. Testing has only been done originally to set the dosage and when I have been told that it is doubted if insurance companies would want to pay for the testing (they are afraid of the cost and that some patients may need it more often) and the drug companies are not motivated as some patients may need it less often.

These two things may play very minor roles as it is clear that there are many pathways cancer uses to get around the inhibition of any one. Blocking uPA makes a lot of sense (read the full article if you can get it).

I hope the uPA blockers become available soon. This research came out of MDAnderson for those going there--ask about the progress of the uPA inhibitors.