[agness]

If you have been around a while then you know that Perjeta is only a couple years in use with the locally advanced breast cancer population. Some patients and their docs are adding it on adjuvantly for earlier stage disease, such as when a patient has surgery first and learns that she is stage 3 after the fact. Research shows that HER2 responds best to a dual anti-HER targeted therapy regime, that a Herceptin and Perjeta work synergistically with the patient's immune system. Logically this means that really all HER2+ patients should be offered Perjeta, but I think insurance still fights it often and some docs fly alone (I know someone who got both Herceptin and Perjeta for a year).

Studies of neoadjuvant TCHP (Taxotere, Carboplatin, Herceptin, Perjeta), on which professionals use to adjust their practices and insurance companies use to justify their financial support, aren't due until summer 2016. Up to this point research from the stage 4 trials was just applied by the FDA to make these drugs available to stage 3/locally advanced patients. So, the data used to inform professional practices will be at least three years old when it might be used to change practices. Not good enough.

HER2+ breast cancer patients with any nodal involvement, a very high risk with our aggressive disease, should receive screening brain MRIs for several years without any push back -- it should be standard at diagnosis and annually at least. I think even better might be every six months for the first two years since for many women brain Mets are caught during adjuvant Herceptin. The sooner brain mets are caught the more options there are to treat them.

What else do you think needs to change? What didn't happen that should -- and at what disease stages? Where do you see lapses in logic, science, and disease understanding?

Let's compile our own thoughts and maybe we can build a HER2 patient manifesto from our ideas that WE can use to establish a new standard that is more appropriate to our disease.