[Becky]

There will not be very many if any people here getting Herceptin 5+ years out but I will sight the HERA study to help you ponder your next steps.

The HERA study was the European version of the Herceptin adjuvant trial. In that study (which is still ongoing and everybody is awaiting the 2 yrs of Herceptin results) gave Herceptin after chemo and in some cases, after radiation too. Women entering the trial had to have positive nodes or a tumor that was larger than 1cm. Most women started Herceptin 1-6 months post chemo. As usual, in the trial, a third of the women got Herceptin for one year, a third got Herceptin for 2 yrs and the last third did not get Herceptin.

In 2005 the great results of getting Herceptin one year (along with 2 other studies that combined Herceptin with chemo) made getting a year of Herceptin Standard of care. It also ALLOWED the women who did not get Herceptin the opportunity to "cross over" and receive Herceptin regardless of how far out they were. The HERA trial allowed cross over. So, women who were in the trial in 2000 and onwards were allowed Herceptin in 2005 if they chose to. About 20% of this women did and they made a new study arm called the "observation group" - obviously made up of women who got late Herceptin (some of them very late indeed). And the results so far - the women getting the late Herceptin had statistically less recurrences than the women who did not receive Herceptin. So late Herceptin works. There is not as much time to compare these women with the women who got Herceptin from the get go but so far, late Herceptin does work.

So, for you to ponder - it does work but also, there are less recurrences as you get further out.

Also, most cardiac problems with Herceptin are reversible.