[Sheila]

This was a post by Jean...

Something you should also consider:
Anthracycline drugs have use limits - which means we can only have a certain amount of Anthracycline drugs.
So, maybe you want to save those drugs if needed way way down the line in life....

Also since you were not tested for TOPO2a you really do not know if Anthroacycline drugs would be of benefit to you. This is another area of debate as the standard of care at present is not utilizing this test to determine chemo treatment. Dr. Slamon has been on the cutting edge with TOPO2a testing. I have made treatment choices based on his advice which did include a TOPO2a test. I did have the test and was negative, therefore for me A/C would not be a benefit...(as I mentioned earlier this is still very much open for debate) We'll probably be seeing declining use of anthracyclines over time, as other regimens come along, but for most women with high-risk early breast cancer, anthracyclines and taxanes remain important drugs, and most onc. are not using TOPO2a testing to select therapy outside of a clinical trial. Topo2A has recently been passed by the FDA....

Determining the best adjuvant chemotherapy program to link trastuzumab with is very much an open question. In clinical practice, AC followed by a taxane plus trastuzumab or docetaxel, carboplatin, and trastuzumab (TCH) have emerged as the most commonly used regimens. The discussion primarily focuses on the risks of cardiotoxicity.

Dr. Slamon is of the thinking (the father of herceptin) that A/C is on the way out - as treatment with TCH is becoming the standard, especially for those who are early stagers node negative.

To respond to your question of "why isn't herceptin used first" we may in the future see early stage bc treated with just hercpetin, but for now Dr. Slamon believes that the best course is chemo/and /herceptin. We will have to wait for more data to be better informed. Currently there are global adjuvant studies which are looking at hercpetin alone vs lapatinib alone and herceptin and lapatnib being administered sequentially.

Clearly the most important question for research is why do some women resist herceptin and can we identify
those tumors and treat them. There has been some provocative data using hercpetin and lapatinib. There are still many questions to be answered.