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Gina,
I read a blurb last year that said the Baylor group had experimented with pre-operative Herceptin and reported that a low Ki-67 marker (which correlates to the proliferation rate) predicted for response to Herceptin. That, coupled with the recent findings that some Her2++ patients also responded to it, would give credence, IMO, to your theory about the proper dosing and its relationship to relative tumor burden being the key. The flip side of this is, what were the maximum toxicity levels tolerable for Herceptin? Part of the problem is the heart damage issue - Herceptin may work so long as you can get the tumor burden to a level that falls within the efficacy of the current dosing regimens. This may explain the "synergy" with chemotherapy.
Hopeful
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