[Lani]

as professors of economics say: "it all comes down to a cost/benefit analysis"

Every patient must, in an imperfect world, gather the best info they can, evaluate whether that info is more likely or not to reflect the truth & be trusted ( how it was gathered, methodology, statistics, short- vs long-term results, whether data is representative, who paid for the study etc), and decide how the treatment fits their goals, tolerance of risk, tolerance of side-effects, likelihood of being able to complete the treatment, how they perceive their own risk &how much weight they give to each of these variables in the "big picture" and add in their own "intuition" about how each factor will play out.

Everyone places different weights on the likelihood they themselves will get for example diarrhea, how they tolerate it, how they can manage it with their job/lifestyle, how long they could alter their job.lifestyle if they had to, how long they could tolerate it & if it is worth it for a few absolute percentage points of avoiding recurrence which are actually a large percentage of relative percentage(eg if your likelihood it would not recur went from 98% to 99% that seems like a small difference...but your risk of recurrence went down by 50%--from 2% to 1%!)

These are totally personal individual things and I could never think of advising another person on this...only providing them info so they know what things to take into consideration and how to go about weighting the importance of each of them in looking at the overall picture (the same way you would in choosing a new cellphone)

Just so you know, at least 2 longterm trial publications have come out showing no difference in adding neoadjuvant lapatinib to herceptin when chemo was given as well & these papers looked much further out in the timeline of survival--so, perhaps the "education of the puppy dog" effect of chemo made the combination work less well, perhaps resistnce develops later, perhaps it is the nondividing dormant cells in the bone marrow that are the source of the recurrence surviving the treatment while the "sleep" sitting there like mold sits in your shower stall after you bleach it, adopting a spore form, waiting for moist conditions to come to life and plagure your bathroom again... and perhaps some other explanation.

More studies & more time will add to the picture, as will subdividng out the different subsubtypes of her2+ bc.



When making a treatment decisions there are no hard & fast right answers (disconcerting!), but that means personal preferences & input from intuition can play a part (a consolation!)

Debbie:
Also the overriding variable may be that when the additional costs are added in, I doubt insurance cos. & govts will pay for every her2+ patient 2 expensive medications instead of one, for just a few absolute percentage pts of increased survival. They will require biomarkers or genomic analysis etc tied to thpse who will fail without the addition of a 2nd expensive drig I would predict.



Hope this helps!