[Becky]

I think the first thing will be the final results of the HERA trial where women received either no Herceptin, one year of Herceptin or 2 years of Herceptin. The Herceptin was given after chemo (within 6 months of chemo completion) and any type of chemo could have been used. Criteria was node positive or a tumor was that was greater than one centimeter.

The interim results of one year Herceptin vs no Herceptin was equal to the USA study of combining with AC followed by TH or TCH. Although the USA study of concurrent with chemo vs sequential (after chemo) says that with chemo is better (5 yr interim given at SABCS says 34% reduction with chemo vs 30% reduction without chemo).

HERA study's "same as" results is MOST likely due to the fact that there was no standardized chemo regime so you are seeing that chemo that is considered inferior for Her2+ (like CMF for example) was considerably "upgraded" for Her2s.

That said, the 1 yr of Herceptin vs 2 yrs of Herceptin results for the HERA trial have not been released yet. It has been a long, long time so I think there were not any upfront superior results to report. Perhaps long term, there will be better results for 2 yrs but everybody in the know (like Dr. Eric Winer) do not think the results for 2 yrs will be any better. If that is true, then one has to wonder if 6 months of Herceptin is just as good as 12 months. After all, 15 to 20 years ago, women received AC (adriamycin and cytoxan) once a month for 12 months and then in trial found that 4 cycles 3 weeks apart was just as good.

Certainly if 1 yr is just as good as 2 yrs, it begs the question if 6 months is as good as 12 months. However, it will be extremely difficult to trial that to a woman with Her2 bc. Another way to evaluate this is to look at women who had to stop Herceptin because of low muga/echo. Even on this board we know of women who had to stop Herceptin early. Those women should be analyzed mega big time and how their recurrence rates stack up against those who could take the full year (just thinking out loud here). That would be interesting to see for sure.