T. Sund,
I am not a medical expert, but I have done a lot of reading since my dx a year ago, and, strictly IMO, here are my thoughts in response to your questions:
1. There has been no study to date comparing Herceptin + chemo to Herceptin + homonal therapy. The TaNDEM study conducted by Roche demonstrated that AI's + Herceptin doubled the time to progression of postmenopausal metastatic bc patients over AI's alone:
http://www.medicalnewstoday.com/medi...=69898&nfid=al. Herceptin has been demonstrated to improve results both when administered with chemo
http://content.nejm.org/cgi/content/full/353/16/1673 AND following chemo:
http://content.nejm.org/cgi/content/full/353/16/1659. There is evidence that some clinicians are offering Herceptin without chemo for some incidences of early stage bc. It is known that Herceptin is active in the body without chemo; however, too little is know about its actual mechanism of action on cancer cells to determine how it is efficacious against it.
2. In a radonmized trial, complete hormonal blockade versus epirubicin-based chemotherapy in premenopausal, one-to-three node positive, hormone positive bc patients was demonstrated to be equivalent treatment:
http://annonc.oxfordjournals.org/cgi...ract/17/8/1221.
3. The efficacy of Herceptin has not been shown to depend on hormonal status. As with other drugs, there are classes of patients who respond better to the drug than others. Researchers are currently attempting to identify this patient group, to be able to accurately prescribe Herceptin only to those who will likely respond to it. Unfortunately, Her2+ status alone is not a good enough marker for this.
4. If you are interested in reviewing the findings of the Early Breast Cancer Trialists Collaborative Group on the natural history of ER+ vs. ER- bc, with or without chemo, hormonal therapy or both, the link to their site where you can download the provisional pdf is here:
http://www.ctsu.ox.ac.uk/~ebctcg/.
By and large, the bc patient population that derives the least benefit from chemo is hormone postive, node negative, postmenopausal patients.
Hope this helps,
Hopeful