What do you feel will be the next best treatment on the horizon?

Injectable Herceptin.

Some tumors grow in the presence of Her2 because they have Her2 receptors in the cells. There are two Her2 tests: FISH test and IHC test. They give one of four results: Her2-0, Her2-1+, Her2-2+, Her2-3+.

(Sometimes one of the two tests will give you one result and the other test will give you a different result. One of the tests is considered more accurate than the other, but both are subjective. I think they are both staining tests, where they stain a bit of your tumor with a reagent and then the pathologist sort of judges what percentage of your tumor cells have Her2 receptors, often with the help of a computer, but I'm not sure about that.)

Her2-0 literally means no Her2 receptors on your tumor cells, hence "Her2-zero."

Her2-1+ means a small number of Her2 receptors on your tumor cells.

Her2-2+ means a moderate number of Her2 receptors.

Her2-3+ means you have a lot of Her2 receptors, also said you "overexpress" Her2, or it is also said that Her2 is "overamplified." ONLY IN THIS CASE are you called "Her2 positive." If your path report simply states your tumor is Her2 positive, or "overexpresses" Her2, or Her2 is "amplified," that means you are Her2-3+.

Her2-0, Her2-1+ and Her2-2+ are all called Her2-negative, but in reality Her2-1+ and Her2-2+ are Her2-low because they have a small number of Her2 receptors. It was previously thought that Herceptin would only help patients that overexpress Her2, meaning those who are Her2-3+. Now they are testing to see if it actually helps people who are "Her2-negative but low Her2" meaning Her2-1+ and Her2-2+. The small studies they've done so far indicate it just might. But it is controversial in the onc. field. That's why they are doing the phase III trial. Dr. Soon Paik is the researcher who has been spearheading this research for past x number of years.

Her2-0 (Her2-zero) means Herceptin is definitely of no use to you. Neither are some of the vaccines currently in trial, because they operate on the Her2 protein. BUT nevertheless, to be Her2-0 is a great thing. Her2 makes your cancer more aggressive, and the more Her2 you have the more aggressive your tumor is likely to be. Patients who are Her2-0 are often 100% ER+ which has the best prognosis as doctors have really figured out how to stop estrogen in the body. I think at least 80% of breast cancers have SOME Her2 receptors.

edited to add: Sometimes a path report will state the Her2 test shows an "equivocal" result of Her2-2+. That means you are on the borderline between Her2 positive and Her2 negative. It's not an exact science.

You're welcome, hopefour. What trial were you trying to get on? 

And do you have a copy of your path report? If so, what does it say about Her2? (You can PM me if you want)

To be grade 1 and extremely low Her2 or possibly Her2-0, with only four nodes positive, is very favorable. I would be happy to be in your situation.