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This seems to go against all the findings of the HERA and No. American combined studies which showed in the adjuvant setting that herceptin decreased the incidence of recurrence when combined with chemo by almost 50% IRRESPECTIVE of whether the her2+ bc was ER+ or ER-
From my attendance at various bc meetings and listening to the audiotapes of other meetings, Dr. Hudis seems to be someone who is very hesitant to give up the "gold standard" treatment of carpet bombing breast cancer with non-specific chemotherapies in this age of "smart bomb" targeted therapies.
He may or may not end up being right, but publishing these opinions as guidelines as he does in the New England Journal of Medicine gives ammunition to insurance companies wishing to deny treatment to patients. He may just be publishing what he believes to be state of the art, but dollars to doughnuts (ooh, I love these old sayings) I bet this "state of the art" will change in less than six months, but insurance companies will hold onto this article for years, citing it as a reason not to pay for "variations from the theme" If those who published these articles took a few minutes to think of the consequences to individual patients, they might phrase their "findings" or "conclusions" differently
Until we can dissect the different types of breast cancer and better detect which have metastasized early eg with isolated tumor cllls in bone marrow or Circulating tumor cells in peripheral blood to better decipher which subtypes respond best to which treatments, such blanket statements serve as a disservice, I think, by pressuring oncologists NOT to offer treatment options which might be the best for an individual patient.
A lot of lip-service has been paid to individualizing treatment, then articles like this seem to back-track by producing the same "cookbook" formulas to be followed unquestioning as these "pronouncements" come from one of the meccas of cancer treatment.
Sorry about editorializing, but at least I identify what I am doing.
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