[AlaskaAngel]

When there has been only one type of therapy applied for decades and it was chosen at a time of desperation with far less knowledge, and it becomes the "standard" of care that everything else has to be tied to and measured against, it is easy to fail to question whether or not that therapy itself -- or any of the support drugs administered in support of that therapy, such as steroids or blood stimulators, or the drugs used to treat side effects -- is actually causing recurrences. This is especially possible because we are using a therapy that is known to be randomly effective, so we never have a way of verifying its negative effects in terms of whether or not it is stimulating the growth of the cancer. It is quite possible that trastuzumab alone may work for some patients where trastuzumab plus chemotherapy would not.

In desperation we have accepted the consistently rather minimal track record of chemotherapy itself as a treatment for breast cancer. The majority of breast cancer patients do not have the choice of adding trastuzumab to their regimen.

Also, in terms of economics there are people who are not able to afford both chemotherapy and the monoclonal antibody and who would rather choose between the two if they have only so much money to spend, regardless of which choice they would like to make. Much of the discussion here has been based on the assumption that everyone has some form of financial access to whatever regimen is currently authorized, and for some patients that is not true. As it stands now, those patients are left to do entirely without. This includes patients in countries that are far less able to afford these extensive and expensive treatments. In behalf of those patients I see a ray of hope in the FinHer trials.

In actual care with early stage breast cancer patients, I would agree that there are a significant number who are choosing to forego the combination of chemotherapy and trastuzumab altogether because they are unable to access trastuzumab alone.

AlaskaAngel