To be reported at San Antonio,

['lizbeth]

Phil,

I think we are both getting frustrated with the "system".

I appreciate the study on Tykerb, Herceptin & Taxol. I know that when I was making my chemo decision this information would have been golden. I would have loved the opportunity to have neoadjuvant treatment. Better yet - if I had know about Rational Therapeutics in Long Beach I would have insisted on testing instead of agonizing over what chemo would be more effective for me.

The neoadjuvant study is quicker. The NeoAlto study started enrolling in 2008 and just finished it secondary end point mid 2013. They will follow the patients for 10 years.

I was mistaken on less chemo, I see they also have FEC after surgery.

I am with you about the side effects, the taxanes and Tykerb have severe side effects. I've heard Slamon mentioning finding treatments that offer a higher quality of life. I am extremely grateful that he has given this consideration.

I too was shocked that this "bc action" group ask not to grant early approval for TDM1. I do not choose to be represented by this group. Frankly - I would not deprive stage IV women of an opportunity to have life saving treatment. Asking for a delay was morally irresponsible. I am ashamed of them.

Phil, honestly I think the research community is advancing science so rapidly that soon the FDA and medical community will be forced to adapt to a new paradigm. The randomized trial system is becoming obsolete. We all realize that many patients require more than one targeted therapy to overcome their cancer, so the NeoAlto trial is part of the problem of the system. Even if functional profiling showed this combination to be best for a specific population of women - would they be able to receive it, if it were not incorporated into standard of care?

The question that now begs to be answered is specifically who benefits from this treatment. Not how many women out of 100 benefit. But which women in this 100 benefit.