[Lani]

I think either circulating tumor cells and/or bone marrow biopsies should be examined in all new her2+ diagnosed patients before they start herceptin and , say, 6 and 12 months after starting herceptin. Since noone knows how long herceptin should be given, since breast cancer appears to be a stem cell cancer (dormant , slowly dividing cells in bone marrow give rise to recurrences) and since chemo has been shown to only get rid of the quickly dividing cells and not the bone marrow dormant cells, I think it would be great way to evaluate the success of a course of treatment, rather than waiting for a bone to break or a seizure to occur or a patient to turn yellow. Should recurrence/progression be detected earlier, perhaps it would no longer be so massive that it overwhelms the treatment (too many cells have too many "tricks up their sleeves" to elude the pathways involved in the treatment type. )

Braun et all from Germany are starting a trial to see how these sequential bone marrows come out.

The crazy thing is., when asked why bone marrow are not done more often on breast cancer patients, oncologists answers that patients wouldn't put up with it because they don't like them, just as they say patients would rather take daily pills than a once a month shot for antihormonal therapy.
How can they talk about patients not liking bone marrow biopsies (the first of which can be done under anaesthesia of the operation) and the others under local anaesthesia, when they so freely treat them with chemotherapy agents which are I am sure much more noxious and unpleasant. Similarly, how can they decide for a patient that they don't like shots and prefer daily pills. I have heard this over and over again and I just don't get it!