[Becky]

Jessica explained things very well in regard to local versus distant recurrence. A local recurrence does NOT mean you are Stage 4 but a distal recurrence does (ie: mets to bone, lung, liver etc).

Also, another lump in either breast could be a recurrence or a brand new cancer therefore pathology testing is very important. In a local recurrence, it does not mean Herceptin (or chemo for that matter) did not work. Most local recurrence occur at or near the scar. Scar tissue does not have very good circulation and IV drugs usually do not penetrate well at these sites.

If one progresses to Stage 4 or progresses while stage 4 and has used Herceptin, it does not mean that Herceptin does not work in some regard. Herceptin is a magic bullet - in some cases that bullet kills and in others it wounds but does not kill. I think Herceptin always helps but in some of us, there are other receptors that are also active in our cancers but not blocked because no one has discovered them to come up with a drug for that receptor yet. That is why research is so important to all of us.

Tykerb not only works differently but it also works on the Her1 pathway (although the drug does not work well on women who are only Her1 and not Her2 as well. That is why the criteria for using Tykerb is that you are Her2+) so there is that added benefit of blocking Her1 (which many of us don't even know if we are positive or not).

If you did recur, your oncologist might try something else with Herceptin first and see if you progressed before trying Tykerb (making an assumption based on real time not years in the future because there could be a zillion other choices then). Because Herceptin mixed with a different chemo might just do the trick and you might want to save Tykerb for later or see what other drugs and combos work best with Tykerb (via all the trials they will be combining the drug with to see what works best).

Have a nice weekend