[Becky]

Dear Brenda

I think it depends on if you are newly diagnosed or if you have recurred to Stage 4 disease

If newly diagnosed - older Standard of Care (since Herceptin has been okayed in early disease) was 4 AC followed by Herceptin for a year. This is what women were given since May 2005 that were Stage 1. Since 2006, it was shown that 6 TCH worked as well as 4 AC followed by taxol with Herceptin except that AC causes more cardiotoxicity and can cause leukemia more often in the future than TCH. Also, there have been studies that taxane + herceptin has synergistic effects so it works better (for some women) than herceptin alone. In early disease, chemo is used so the disease does not recur. That is the aim - to be cured. Now a days, since taxanes work so well with women who have Her2 disease (regardless of hormone status), oncs like to at least combine Herceptin with one.

In Stage 4 disease (those who have recurred and never had chemo to begin with), oncs like to try a taxane with Herceptin in hopes of a complete remission much like in early disease. However, for women who have recurred, sometimes less is more. Perhaps Herceptin alone (sometimes combined with an antihormonal if the women is hormone positive) can retard or delay disease progression and give a great quality of life for many, many years. Then, if progression does occur, differing chemo regimes can be done. However, I think if the recurrence is bad - raging liver mets let's say - there is no choice but to knock those mets back as fast as you can.

Lastly, its the onc (or cancer center's tumor board) who may just plain ole like certain chemos or combos. I like vanilla ice cream the best and you may like chocolate. So it can just be personal preference.

I think literature and studies say a taxane + Herceptin works best but I had them separately and next week, it will be 4 yrs for me so something worked so far.

Love to you