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Tom
please read my post regarding why they don't test bone marrows on newly diagnosed patients and then again after treatment.
I do believe in the stem cell theory of breast cancer--that those cells in the bone marrow are dormant and divide only once in a blue moon until the environment is right for recurrence. That is why those cells in the bone marrow are not affected by cytotoxic chemotherapy.
I like to think that those stem cells or progenitor cells have her2 on the surface and that herceptin can clear them from the bone marrow. I read today an interesting article showing it cleared tumor cells from the bone marrow of metastatic breast cancer patients when chemotherapy hadn't.
Another theory is that herceptin can't work as well to stimulate the immune system to kill the her2neu cancer cells if there isn't some antigen around to acquaint the immune system with. I like to think that radiation therapy creates enough antigen for the immune system to recognize without necessarily having had chemotherapy.
So optimistically one can HOPE that the herceptin and radiation therapy alone might have cleared any cells in the bone marrow, but this is sheer speculation. I wish bone marrow biopsies before and after the main avenues of treatment to follow the results of treatment would become routine. We might be able to see whether those pesky stem cells that behave like "mold spores" in your shower were merely hiding in dormancy or truly eliminated.
All of what I have been speculating about is unknown as clinical trials looking to see if less does just as well as more are almost never done. Look how long it has taken for the accelerated partial breast clinical trials to get done and how few there are (no drug companies paying for them among other things)
The usual rationale given regarding why they do not try less is because they could get sued for not giving people the best known treatment (therefore they just add the new treatment on top of it and see if the results improve).
The group they would be most inclined to do less for , older patients like your mother--make bad candidates for clinical trials as they are likely to die of other causes before results are known regarding the subject matter of the trial.
From what I understand, tykerb will be allowed only in metastatic cases to start with. How long it will take before they use it in the adjuvant setting is unknown. Perhaps some kind oncologist would "complete" the one year of adjuvant antiher2 therapy with tykerb once it is available to be used off-label. If you hear differently, please let us all know right away!
Have never been called a propeller-head before. Is that why I am a "dizzy
dame"?
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