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I think it is important to remember that "more" treatment is not necessarily "better" treatment. My onc asked me if I knew how they decided on one year of adjuvant Herceptin as the optimum tx, and I said no. He said, "Well, they had to pick a number!" I did a little research later, and found that the toxicity trials had determined that a year of Herceptin was "safe," so this is what they based the protocol on. Since Herceptin has been administered in the adjuvant setting, it appears many more women than those in the trials experience some type of cardiac damage, from reduced LVEF to outright heart failure. I think the duration of tx should be tailored to the stage of the disease, rather than all stages 1a through IIIC get the same protocol. The cardiotoxicity of the drug needs to be considered, and, if early stagers can do perfectly well with under 1 year of tx, it makes sense to reduce the duration of tx and the potential for heart damage.
Hopeful
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