Talk me down!

News from the San Antonio Breast Cancer Symposium:

 http://curetoday.com/index.cfm/fuseaction/article.showArticleByTumorType/id/805/tumorCategory/Breast/article_id/1600

 This is great information, and I am so grateful for this research. Kiri is currently enrolled in an identical trial, comparing neoadjuvant chemotherapy with taxol plus herceptin & lapatinib, taxol plus herceptin only and taxol plus lapatinib only, randomized into three arms. She was put in the taxol plus lapatinib only arm. Initially I was thrilled as lapatinib seems to cross the BBB, as herceptin doesn't. But the results of the earlier study indicated total tumor response in 50% of the combo arm and only 25% of the lapatinib/taxol only arm, with the worst SE's in the taxol/lapatinib arm.

 Lapatinib is not currenty approved for neoadjuvant chemotherapy (I'm pretty sure herceptin is) so there is no way she can request the combination treatment.  And I am of several minds about this (as if I have a mind left at this point).

1, Kiri is 25 and I have been told clearly from the get-go to "step away from the computer and let me handle this and don't take over like you ALWAYS DO, Mom." I'm sure she and her extremely competent harvard team at Dana-Farber will discuss this and come to a conclusion that they're all happy with.

2. This is a clinical trial, and this is what you sign up for when you sign up for a clinical trial: chances. The opportunity to contribute to research that will help others down the line. And the chance you might not end up in the most successful section.

3. She WILL get herceptin, after her surgery, for a year. So maybe the combination sequentially will be just as effective. 

4. Lapatinib is a small-cell molecule and works from the inside, as opposed to herceptin, which is a large molecule and works from the outside, which may explain the difference in the physical response. I am just guessing here. Kiri's tumor is getting softer, becoming more like a sponge. It's pretty much the same size from the outside. So maybe it's just a matter of a different effect on the cells.

5. In terms of shrinking her tumor to the point where she could get away with a lumpectomy rather than a mastectomy, the herceptin/lapatinib treatment might have been a clear preference. But she has extensive DCIS, which would probably necessitate a mastectomy anyway.

(Are you girls beginning to appreciate how good I am at rationalization yet? GRIN)

6. I did read, somewhere, I think, that significant shrinkage of tumor cells via neoadjuvant therapy was also sometimes associated with a similarly significant increase  in circulating tumor cells, as if this "melting away" of the tumor had only released cells into the bloodstream. But to be honest, I don't think tht's the case with Herceptin--I think it really does destroy the HER2+ cells. Still, the correlation between preoperative shrinkage and long-term NED isn't entirely clear.

7. Kiri is at a great place, getting great treatment. I have to trust she will be taken care of. 

8. There is not enough alcohol in the world....