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the problem would seem to be to be certain that the drug
being delivered is the right one and not one that the tumor is inherently resistant to or you have increased its blood supply (nutrition and therefore ability to grow and survive) needlesslessly and even made it more resilient.
Similarly, if you believe in the stem cell theory of breast cancer, you may be increasing the blood supply to the tumor, most of which are more differentiated cells and killing more of them off with the usual chemo agents, but actually increasing the blood supply to the micrometastatic deposits in the bone marrow and elsewhere, perhaps "awakening" them from their dormant state.
It may work differently in some tumors than in others, even between different her2+ tumors.
All of this is speculation of course....but it seems much of what is "understood" may to a lesser or greater extent be speculation as well!
Just thinking "outloud"
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