[dlaxague]

That anthracyclines have no place in adjuvant therapy today, except in countries where Herceptin is not available. He says that anthracyclines offer additional benefit only to topoIIa+ cancer. BUT all topoIIa+ cancer is also HER2+ and thus these cancers will be treated with Herceptin (I think he prefers TCH) and so they need no anthracycline anyway (because when Herceptin is used, there is no additional benefit to using an anthracylcline, whether topoIIa+ or not). Since anthracyclines increase the risk of leukemia and heart damage, and do not offer any additional benefit to anyone, over standard chemo, there is no place for them in adjuvant treatment today, thus there is no reason to test for topoIIa. Says Slamon.

Others, the cautious ones, want to see more evidence. They are not convinced that topoIIa+ is limited to those who are also HER2+. They are not convinced that anthracyclines do not offer additional benefit to any aggressive or higher-stage cancer. They wait for more studies to be published.

I don't know who is right. My opinion is that what Dennis Slamon is saying makes good sense.

So my guess at the answers to your question:

1. The onc shares Slamon's thoughts and does not use anthracyclines anyway, so there's no reason to know topoIIa status.

2. The onc is cautiously awaiting more evidence of either:
a). a link between increased response to anthracyclines and topoIIa status.

and/or

b). evidence that Herceptin + any standard chemo is equivalent to Herceptin + anthracycline.

Debbie Laxague