|
Hi Anne,
I'm not sure if I undertand your question but I'll take a whack at it anyway. In clinical trials there are a number of different categories researches use (for instance "overall survival" "disease free survival" "time to progression" ). Most clinical trials for breast cancer, if I'm not mistaken, are in the metastatic, where the key categories have to do with extending life, pure and simple. But in the neoadjuvant setting that's not exactly a relevant category: so researchers look for "surrogate" markers. "Complete response"--i.e. the tumor and any palpable lymph nodes disappear--is taken by some docs as evidence that disease has been eradicated, though it's not exactly proveable. Likewise, there are plenty of people who think that the neoadjuvant success with herceptin indicates that the results of the adjuvant herceptin trials will also be good ones. Herceptin is not good at treating very "bulky" disease, so the idea is to use it when it can do its best work.
As for your second point, if I understand it, there is something psychologically and emotionally compelling about treating the primary first through surgery: the "just get it out" urge. But there's lots of evidence that treating first systemically is more important that addressing the issue of the primary tumor.
Hope this helps.
Jeff
|