[Christine MH-UK]

Hi Chelee,

As Saleboat has pointed out, at study at San Antonio in December found that the AC->taxol+herceptin-> rest of year of herceptin was not significantly better than HCT->rest of year of herceptin. Dr Slamon, herceptin's discover and the person who conducted the HCT study stated that he felt that herceptin should not be used close to anthracyclines unless patients had tested positive for topo II, which makes cancers sensitive to anthracyclines, since only 1/3 of her2+++ patients on his trial had this trait. One of the things he pointed out is that although the patients on the AC combination who developed congestive heart failure improved after herceptin was stopped, their hearts did not recover fully and many showed some serious, possibly permanent damage as much as 18 months later. Slamon made clear that he thought that people had generally underestimated the risks of anthracyclines before herceptin, assuming that the heart damage fully reversed itself if herceptin was stopped. Other oncologists, however, have been much more reluctant to drop anthracyclines for her2 patients, because AC tends to work so well in general.

It might be a good idea to check out your TOPOII status before asking for anthracyclines. Also, if you really want to get AC, it might be better leaving it to the end of your treatment, since the one trial, Finher, where no heart damage was found used an anthracycline (epirubicin, which tends to be a bit more heart-friendly anyway) only after herceptin. An accompanying article in the New England Journal of Medicine explained that anthracyclines can cause the heart to give out signals that make herceptin more damaging to the heart, which is why giving herceptin-based chemo before anthracyclines may be less problematic.

It will be interesting to see what is said about herceptin and the heart at ASCO this year, which should be coming up in the next few weeks.

Best wishes,

Christine