[Gina]

Hi, Julie,

Moderate fluctuations in the serum her-2 are to be expected. I would not panic yet...but I would watch the marker carefully to see if it goes on what I call "a run" which means heading up steadily like 11, 22, 44, 88, and as you have already experienced, even a rise just over 22 can be devasting to your health....many of us have experienced this same phenomenon.

Also, keep in mind that everything depends on the relationship to when you had the marker pulled and when you had your most recent dose of herceptin.

That is why I always recommend that folks get the serum her-2 (and all other markers and blood work) drawn just minutes BEFORE your regularly scheduled dose of herceptin. I have been "lucky" (yeah right...hee hee) to be able to play around with this marker since 2002 and here is what I have noticed in me. If the marker is pulled one week after my regular every 3 week herceptin dose, my number is very low...if it is pulled two weeks after my regular herceptin dose, the number is moderately high, if pulled at three weeks, just minutes before my next dose, it will be at its peak. Therefore, after years of testing this out, I now just have the marker pulled just before my next dose because that is the highest point of the trough, I believe they call it, and that way, I can compare apples to apples every time. If over time, I see the marker creeping up or if it goes on a run, then I know I am in trouble and have to take immediate action.

In your case, you could have gotten a really low read a short time after herceptin and a slightly higher read the second time if the test were taken a bit longer time after herceptin. Oncologists, overall, do not understand much about the serum her-2 marker and often don't realize how crucial it is to pull it on a regular schedule. Generally what happens is they pull it only when you beg them to or when you see them during an office visit. You need to do the serial testing and you need to do it on schedule...that said, though, better to get it any way you can than not to be able to get it at all. The numbers can later always be matched to where you were in your herceptin cycle by someone who knows what they mean...

If you think you might have been in two different places in your herceptin cycle when the numbers were taken, I would advise you to keep watching the number carefully, but try to have the serum her-2 marker taken at the same time in your herceptin cycle, EVERY TIME, otherwise, it is really hard to interpret the data.

Good luck,
Gina