[Lani]

when they reviewed the adjuvant her2 studies they found that some people who responded to herceptin were really not that her2 + as they thought when they rereviewed their her2 findings.

As you know there are two ways tumors are usually classified as to her2 status, one is IHC where her2 is judged as 1+ 2+ or 3+ and the other is FISH where until now anything over a FISH ratio of 2.2 was considered her2 amplified. As FISH is more expensive to run, many studies qualified people who were her3+ or her2+, who subsequently underwent FISH testing and were found to be >2.2

Yes, I believe you are right in that these authors' intent at revisiting her2 positivity cut-off was to determine if there was a group with her2 positive, albeit to a lesser extent, which would impact adversely on their survival--and they found that there was.

The clinical implication of this and the reason I posted this, as itis attempting to identify a cut off marker which makes sure there aren't patients who could potentially could benefit from herceptin who are not being given the chance to receive it.

I have not heard of any attempts to increase any value for her2 which determined who would get herceptin (I am certain government and insurance company beancounters would love to, but at this year's SABCS they presented more interim results from the adjuvant trials which showed that the response to herceptin was not directly tied to the absolute value of FISH, as long as it was greater than the value admitting patients to the trial)

Just because I have not heard of it, certainly does not mean it doesn't exist, so feel free to post the information should you come across it.

By the way, I don't think they feel they have completely solved the mystery of why some patients responded to herceptin whom they did not expect to. I think some were even 1+if I recall correctly. As usual, we probably only understand a tiny portion of the puzzle.