[Debbie L.]

Hi Lani, thanks for the reply. I actually share much of your soapbox with you (if there's room up there, smile), about personalizing and targeting treatment.

I think what I was trying to say was that if we could personalize primary treatment well enough, there would be no need for DTC study. And that would be my first choice.

The other thing is that I'm worried about those who do have circulating DTCs and/or poor neoadjuvant responses. Of course, worried that we don't have something to offer them but also wondering if we should even be doing a test that gives them bad news without offering a course of action based on that news.

I have had it drilled into me (as a nurse, not oncology-related) that you should never do a test unless you know that the results of the test will dictate action. So I guess where that leaves me right now for DTCs is saying that they could be studied in trials, and probably not in trials designed just to look at DTCs -- but as adjuncts to other trials that are looking at more pragmatic and immediately-useful things.

As for better understanding of pathways -- I just don't know. The more we learn about that, and especially about the clever ways cells have to activate other pathways in response to inhibition of the one we think is the driver -- the more complex it all becomes and the less likely it seems to me that we'll be able to stop cancer with this approach. But that's just my uneducated gut-reaction opinion. I hope I'm wrong.

Debbie Laxague