[AlaskaAngel]

The confusion is understandable, in part because it becomes less of a factual discussion and more of an emotional one.

Unfortunately, it is too easy to generalize about the effectiveness of trastuzumab due to the lack of scientifically based trials to demonstrate who benefits from the addition of chemotherapy and who does not.

Drug development customarily is done through testing a therapy upon a specific population, using specific characteristics and parameters for what demonstrates effectiveness and what does not. It then applies only to the specific population that had the specified characteristics required for the trial.

The original trials primarily were specifically designed not to include early stage HER2 bc patients with tumors under 2 cm or patients with negative nodes, and included the requirement for those patients who did qualify with those characteristics to receive trastuzumab AND chemotherapy.

Applying the results of those trials to the group of patients who were not included in the clinical trial and who were early stage then led to the unfortunate and UNPROVEN general practice of combining chemotherapy with trastuzumab.

There is uncertainty as to what extent the addition of chemotherapy is merited because of the lack of proof based on the combination therapy used in the first place as part of the clinical trials used to demonstrate "the effectiveness of trastuzumab".

There are those whose cancer simply does not respond to trastuzumab plus chemo. For that group, their chance to have some other form of therapy that IS effective for them sooner is thus delayed and damaged by the use of trastuzumab plus chemo.

Add to that the number of patients whose cancer remains in remission without trastuzumab but with chemotherapy.

Add to that the unidentified number of patients whose cancer would remain in remission without trastuzumab but who genuinely may have benefitted instead from some other treatment leading to menopause other than chemopause, such as other methods of ovarian ablation.

As long as we have infinite amounts of drugs and money to fund all the cost-intensive treatments and all the testing involved and huge loss of productivity, we don't do the homework to find out who benefits and who does not from which therapies. It is emotionally appealing, but poor use of resources.

We continue to apply blanket therapy to the broad group of early stage patients at great personal and general cost that would be better spent on patients that have been scientifically proven to benefit.