Dear Maggie,
Wow, what a lot to deal with. I can see why you might feel as if the whole world is spinning out of control! It does sound like she has thrown a lot of different things at it, and it can be discouraging to still feel like you don't have a handle on it.
There are a lot of very knowledgable folks on this board, and I'm sure you will get plenty of good suggestions. I'll give you my reaction to some of your questions, but I'm no expert (just a patient!).
I do/did have liver mets, diagnosed in 2004 which have been stable/gone since 2005. I was curious your sister did not have a taxane, which has good activity in her2+++ cancer and is synergistic with Herceptin. I'm a big fan of Taxol because it slapped the cancer down well, and of course I loved the haircut....
First of all, there is always hope! The fact that your sister is looking and feeling well is not a small deal!
You will know more how the current regime is working when she gets new scans. Hopefully you will see things headed in the right direction.
I should probably stop there and leave the harder questions for some of the folks who are more knowledgeable about the research, but I feel chatty tonight...although I do think that "do not lose hope" is the best advice of all.
If she has not already had a "second opinion" I would definitely recommend it. Go to a comprehensive cancer center, ideally seeing someone who specializes in breast cancer. She has apparently been given some cutting edge stuff, but it always helps to get another perspective. Just be ready to have multiple opinions. The rule of thumb is 2 doctors = at least 3 opinions!!!!
Re targeted treatment for the liver mets, I assume you are talking about local treatment - RFA or surgery? It is unlikely she would be a candidate for this type of treatment with so many other areas of disease. She may qualify for something like chemoembolization where they place the chemo directly in the liver?
Re should she be retested/new biopsy? Ideally if there is tissue, she would get it retested. If not, you can get a read on the her2 situation with the Bayer Her2 serum test. It is a blood test which measures the amount of Her2 in the blood. This can be used similar to other markers to reasure response to chemo.
Re is herceptin not working/can you do anything to increase efficacy? Hard to tell, she has had so many different agents. There are some nutritional strategies which in theory downregulate Her2 and would help get better response from herceptin or delay resistance. Look for the threads on olive oil and GLA(primrose oil) as these seem to have considerable research. Here is one:
http://www.her2support.org/vbulletin...light=menendez
Omega-3/6 balance (more fish oil, less bad vegetable oils) also seems to be a big factor. There are lots of discussions on this in the forums. Try searching "Omega-3"
There's also many here who ingest lots of green tea, curcumin, others (myself included) - but you do need to be very careful with any supplements while getting chemo and always consult her doctor. And CoQ10 to protect the heart while she is on herceptin.
Re can the lapatinib and herceptin alone do the trick or will she need to add chemo? That is the question!!!! I think this is still in trials to get the data on that...so it sounds like your sister is the pioneer. Reality is, at some point she will likely need to add chemo - but the good news is that they might be synergistic with the tykerb and herceptin.
So many question, too few answers. Try to relax, see what the scans say - maybe she will get stellar results and you won't have to worry about the "what's next" question for a while. It is possible to get control of the mets, lots of people have had to try several different combinations before hitting the "jackpot".
I know it's hard to stand by watching your beloved sister go through this. She's lucky to have you. Keep the faith. Don't give up.
Chris