Living with Breast Cancer

Drug Shortages

2/3/2012 (9:26:47am)Tags: noneComments: (4)

As infuriated as I am about Komen's decision, I am more upset by the growing crisis around drug shortages. Although there are problems with lots of drugs, not just cancer ones, the impact of shortages for cancer patients is huge. This article from Medscape is the first one I have seen that suggests that some people are dying more quickly because treatments were not available. Surely this is a complicated problem and one that cannot be totally blamed on corporate greed or government inaction. But there must be a solution, and it likely will take government intervention/policy to make quick changes--and that is not so easy in the current political milieu and strong oppostion to government interference with the free market.

Here is the beginning and then a link:

Drug Shortages Are Speeding Cancer Deaths, Survey Says

ASCO President Calls for Reimbursement Reform

Nick Mulcahy

February 2, 2012 — Cancer drug shortages hastened the deaths of some patients in 2011, according to a small survey of American clinicians, conducted by a for-profit research firm, that was released this week.

This dire news comes the same week that the Drug Shortage Prevention Act was introduced in the US House of Representatives by John Carney (D-Delaware) and Larry Bucshon (R-Indiana).

The legislative action is too late for some patients, the survey results suggest.

The survey involved 206 clinicians, nearly all of whom (99%) were board-certified in medical oncology or hematology/oncology.

In a section of the survey that asked about a clinician's experience in the previous year, 40% (n = 82) indicated that "a patient died sooner due to drug shortages." The majority of these respondents said that such an event was infrequent and happened only "a few times" in the previous year.

Conversely, 60% of respondents said that the shortages did not hasten any patient deaths.

http://www.medscape.com/viewarticle/757980

Untitled

2/2/2012 (10:16:44am)Tags: noneComments: (4)

For Shame, Susan G. Komen Foundation

2/1/2012 (9:30:41am)Tags: noneComments: (5)

I was horrified and infuriated yesterday afternoon to learn of the Susan G. Komen Foundation's decision to withdraw all support from Planned Parenthood. As you may know, in addition to their commitment to birth control, abortions, and other GYN care, Planned Parenthood is the largest national provider of health care to women and does a great deal of breast cancer screening. This decision will make it more difficult, if not impossible, for many under-resourced women to secure annual exams and mammograms.

My mother was pretty much apolitical, but Planned Parenthood was sacred in our household. For all of her adult life, she sent them money, and I have continued her tradition. My personal experience with the Komen Foundation was been very positive, and, in spite of other disagreements with some of their politics (e.g. the eventually reversed decision to uninvite Israeli scientists from a conference in Egypt several years ago), I have defended them for all the good work that they do. Their grants to breast cancer scientists and community organizations are second only to those given by the federal goverment.

Here is an excellent article from the New York Times about this decision. Before I include it, however, I am attaching a link to a petition from CREDO that urges Komen's Board to reconsider. I hope that you will consider signing it.

http://tinyurl.com/7fffqty

January 31, 2012

Cancer Charity Halts Grants to Planned Parenthood

By THE ASSOCIATED PRESS

NEW YORK (AP) - The nation's leading breast-cancer charity, Susan G. Komen for the Cure, is halting its partnerships with Planned Parenthood affiliates - creating a bitter rift, linked to the abortion debate, between two iconic organizations that have assisted millions of women.

The change will mean a cutoff of hundreds of thousands of dollars in grants, mainly for breast exams. Planned Parenthood says the move results from Komen bowing to pressure from anti-abortion activists. Komen says the key reason is that Planned Parenthood is under investigation in Congress - a probe launched by a conservative Republican who was urged to act by anti-abortion groups.

The rupture, which has not been publicly announced as it unfolded, is wrenching for some of those who've learned about it and admire both organizations.

"We're kind of reeling," said Patrick Hurd, who is CEO of Planned Parenthood of Southeastern Virginia - recipient of a 2010 grant from Komen - and whose wife, Betsi, is a
veteran of several Komen fundraising races and is currently battling breast cancer. "It sounds almost trite, going through this with Betsi, but cancer doesn't care if you're pro-choice, anti-choice, progressive, conservative," Hurd said. "Victims of cancer could care
less about people's politics."

Planned Parenthood said the Komen grants totaled roughly $680,000 last year and $580,000 the year before, going to at least 19 of its affiliates for breast-cancer screening and other breast-health services.

Komen spokeswoman Leslie Aun said the cutoff results from the charity's newly adopted criteria barring grants to organizations that are under investigation by local, state or federal authorities. According to Komen, this applies to Planned Parenthood because it's the focus of,an inquiry launched by Rep. Cliff Stearns, R-Fla., seeking to determine whether public money was improperly spent on abortions.

Cecile Richards, president of the Planned Parenthood Federation of America, has depicted Stearns' probe as politically motivated and said she was dismayed that it had contributed to Komen's decision to halt the grants to PPFA affiliates.

"It's hard to understand how an organization with whom we share a mission of saving women's lives could have bowed to this kind of bullying," Richards told The Associated Press. "It's really hurtful."

Planned Parenthood has been a perennial target of protests, boycotts and funding cutoffs because of its role as the largest provider of abortions in the United States. Its nearly 800 health centers nationwide provide an array of other services, including birth control, testing
for sexually transmitted diseases, and cancer screening.
According to Planned Parenthood, its centers performed more than 4 million breast exams over the past five years, including nearly 170,000 as a result of Komen grants.

Komen, founded in 1982, has invested more than $1.9 billion since then in breast-cancer research, health services and advocacy. Its Race for the Cure fundraising events have become a global phenomenon.

For all its mainstream popularity, however, Komen has been a target of anti-abortion groups since it began its partnerships with Planned Parenthood in 2005.

Life Decisions International includes Komen on its "boycott list" of companies and organizations that support or collaborate with Planned Parenthood. In December, Lifeway Christian Resources, the publishing division of the Southern Baptist Convention announced
a recall of pink Bibles it had sold because some of the money generated for Komen was being routed to Planned Parenthood.

Aun, the Komen spokeswoman, said such pressure tactics were not the reason for the funding cutoff and cited Stearns' House investigation as a key factor.
That investigation, which has no set timetable, was launched in September when Stearns asked Planned Parenthood for more than a decade's worth of documents.

Stearns, in a statement emailed to the AP on Monday, said he is still working with Planned Parenthood on getting the requested documents. He said he is looking into possible
violations of state and local reporting requirements, as well as allegations of financial abuse, and would consider holding a hearing depending on what he learns. Many of the allegations were outlined in a report presented to Stearns last year by Americans United for Life, a national anti-abortion group, which urged him to investigate. Democrats and Planned Parenthood supporters have assailed the probe as an unwarranted political ploy.

Komen, while not publicly announcing its decision to halt the grants, has conveyed the news to its 100-plus U.S. affiliates. Richards said she was informed via a phone call from Komen's president, Elizabeth Thompson, in December. "It was incredibly surprising," Richards said. "It wasn't even a conversation - it was an
announcement."Richards subsequently sent a letter to Komen's top leaders - CEO Nancy Brinker and board
chairman Dr. LaSalle D. Leffall, Jr. - requesting a meeting with the board and asserting that Komen had misrepresented Planned Parenthood's funding-eligibility status in some states. According to Planned Parenthood, the Komen leaders replied to Richards with a brief letter
ignoring the request for a meeting, defending the new grant criteria, and adding, "We understand the disappointment of any organization that is affected by these policy and strategy updates."

Aun, in a telephone interview, said Komen was not accusing Planned Parenthood of any wrongdoing. "We want to maintain a positive relationship with them," she said. "We're not making any judgment." Richards said Planned Parenthood is intent on raising funds quickly to replace the lost grants
so that women in need do not go without breast-screening services. Already, the family foundation of Dallas oilman/philanthropist Lee Fikes and his wife, Amy, has donated $250,000 for this purpose, Planned Parenthood said.

The Komen decision was perplexing to Dottie Lamm, a Denver newspaper columnist and breast cancer survivor. She has done fundraising for Planned Parenthood, participated in
several Races for the Cure, and serves on an honorary advisory council for the local Komen affiliate. "It really makes me sad," said Lamm, wife of former Colorado Gov. Richard Lamm. "I kind of suspect there's a political agenda that got to Komen ... I hope it can be worked out."

Stephanie Kight, a vice president with Planned Parenthood of Orange and San Bernardino Counties, said her affiliate in Southern California received a Komen grant for 2011 and was able to obtain an additional grant of $120,000 for 2012 by signing the deal with its local Komen counterpart just before Komen's new criteria took effect. Under the criteria, no further grants will be allowed unless the pending House inquiry is resolved in Planned Parenthood's favor.

Kight said her conversations with local Komen leaders indicated there was a shared sense of frustration over the national Komen decision. "One of the things these organizations share is the trust of women across the United States," Kight said. "That's what we're concerned about - not losing the trust of these women, who turn to both of us at their most difficult moments."

Teleconference re Targeted Therapies

1/31/2012 (9:09:05am)Tags: noneComments: (4)

From Living Beyond Breast Cancer:

Our Expert Answers Your Questions about Targeted Therapies and Personalized Medicine

Register now for our next free teleconference, Understanding Hormonal Therapies, on Wednesday, Feb. 8 from 12:00 p.m. – 1:15 p.m. ET. Learn more.

Minetta C. Liu, MD, will explore the different types of hormonal therapies, their side effects, and how you can lessen their impact on your quality of life.

You may also be interested in Hormonal Therapies: Tamoxifen and Beyond.

Teleconference on Understanding Hormonal Therapies

During the month of January, our expert, Robert A. Somer, MD, answered your questions about targeted therapies and how they are used to personalize breast cancer treatment. Learn more.

Topics covered include:

• How the standard 5-year regimen for tamoxifen was determined
• Recent developments in targeted therapies and breast cancer vaccines
• Research on matching drugs to specific cancer subtypes
• Choosing an aromatase inhibitor

Read the questions and answers here.

Neoadjuvant Therapy

1/31/2012 (8:50:58am)Tags: noneComments: (4)

This is a good summary from MedScape (written by Lidia Shapira, MD who is at MGH) about the use and value of neoadjuvant chemotherapy. I have written before about this, but Dr Shapira's summary is succinct and clear. To remind you: neoadjuvant chemotherapy means chemo before surgery, and is sometimes recommended when women have a large primary tumor (with the hope of shrinking it so a mastectomy will not be necessary) or an aggressive cancer (when the need is to quickly get the chemo out into the body). Here it is:

Consensus Guidelines: Neoadjuvant Therapy in Breast Cancer
Lidia Schapira, MD
Posted: 01/27/2012
Recommendations From an International Consensus Conference on the Current Status and Future of Neoadjuvant Systemic Therapy in Primary Breast Cancer
Kaufmann M, von Minckwitz G, Mamounas EP, et al
Ann Surg Oncol. 2011 Dec 23.

Study Summary
This article summarizes the recommendations from a panel of experts that met in Biedenkopf, Germany, in September 2010. This was the fourth meeting of this group, which comprised experts in medical oncology, breast
surgery, diagnostics, radiology, radiation oncology, pathology, and genomics -- 6 of whom were from the United States and 13 from Europe. Panel members were charged with reviewing all available data from published prospective clinical trials of neoadjuvant therapy as well as unpublished presentations made at major scientific meetings.

The major recommendations concerned 5 management issues.
Goals and indications of neoadjuvant therapy. The most important clinical goals remain to improve disease-free and overall survival and enable more limited surgery. Neoadjuvant therapy increases the rates of conservation for patients with locally advanced disease. There is still controversy about proper management in patients whose response to neoadjuvant therapy is suboptimal, as well as the extent of axillary surgery in patients who had involved nodes at presentation. Any patient who is a candidate for adjuvant systemic therapy can be considered for neoadjuvant treatment. However, neoadjuvant therapy should not be recommended if there is any uncertainty about the appropriateness of or need for systemic therapy.

Assessing response to therapy. Pathologic complete response (pCR) should be defined as the absence of invasive cancer in both breast and lymph nodes. The presence, extent, and classification of ductal carcinoma in situ should be reported separately. pCR has been consistently shown to be associated with excellent long-term survival. That said, 60%-85% of patients treated with neoadjuvant therapy do not achieve pCR. It is important to bear in mind that the differences between treatment arms in clinical trials may not translate into survival differences. To monitor response to therapy, physical examination and standard pathologic, staging, and receptor studies should be performed.

The group recommended imaging studies of axillary nodes and diagnostic fine-needle aspiration biopsy for patients in whom incomplete response is suspected. Sentinel node biopsy should be considered for patients with a clinically negative axilla. For those with an initially uninvolved axilla, the group recommends sentinel lymph node biopsy after neoadjuvant therapy. No data support the use of imaging modalities during neoadjuvant therapy, and practices vary.

Treatment options. In practice, the same regimens should be used for neoadjuvant therapy as for adjuvant therapy. All chemotherapy should be provided before surgery, not split into preoperative and postoperative phases. Trastuzumab-based chemotherapy is indicated for patients with human epidermal growth factor receptor-positive (HER+) disease. Given recent studies showing the efficacy of anti-HER2 therapy alone without chemotherapy, this could be considered in the future. Neoajduvant endocrine therapy with aromatase inhibition is effective for
postmenopausal woman with estrogen receptor-positive (ER+) disease.
Role of surgery and radiation therapy. Surgery is necessary in every patient. In cases of clinical complete remission, resection is still required. After breast-conserving therapy, radiation is indicated to decrease the risk for local recurrence. In general, radiation is guided by the initial clinical stage and pathologic findings at the time of surgery.

Follow-up care. In cases of a switch in receptors (estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2) between the initial biopsy and the biopsy obtained at the time of surgery, patients with at least 1 ER+ biopsy should be given adjuvant endocrine therapy. For HER2+ disease, 1 year of trastuzumab therapy
is also considered the standard of care.

Viewpoint
This article is a helpful review of state-of-the-art neoadjuvant therapy for breast cancer. We are well aware of the benefits for research, but this focus on treatment of patients in a nonresearch setting is clear and sets the standards we should use routinely.
These experts remind us of areas of ongoing controversy. Axillary staging needs to be personalized: Fine-needle aspiration biopsy of suspicious axillary nodes is a useful resource, but sentinel node biopsy remains essential for patients with a clinically negative axilla. Practices vary considerably in terms of the frequency and type of imaging studies that are used during neoadjuvant therapy. Perhaps the most valuable reminder for medical oncologists is to choose regimens with a proven track record in the
adjuvant setting and to make judicious recommendations for additional treatment after a suboptimal response to neoadjuvant chemotherapy. These situations remain challenging, and we hope that future trials will provide direction and guidance.
Medscape Hematology-Oncology © 2012 WebMD, LLC

Can Treatment Cost More than it is Worth

1/30/2012 (9:47:27am)Tags: noneComments: (8)

This is an extremely provocative and important editorial from The Oncologist. It makes the point that some very expensive, think thousands of dollars, new cancer treatments have been proven to extend life by days, not weeks, not months. A comparison is given: What if you went to the doctor with pneumoia and were told that a new antibiotic, that cost $16,000, would extend your life by ten days. Would you pay for it? Would society pay for it?

I strongly urge you to read this and begin to think about your responses and the possible individual and larger implications.  Here is an excerpt and then a link. Comments, please!

Is There Such a Thing as a Cancer Treatment That Isn’t

Worth Its Cost?

Timothy Gilligan

However, costs per patient are not constant. The modest
decline in cancer mortality has been accompanied by a dramatic
rise in the cost of care. For example, new drugs that resulted
in nearly doubling the median survival time of patients
with metastatic colorectal cancer from 1 year to almost 2 years
were accompanied by a 340-fold increase in drug costs [2]. For
localized prostate cancer, new, much more expensive treatments
such as proton therapy have been widely adopted with
only very scant scientific evidence as to whether or not they
produce superior outcomes for patients [3]. For metastatic
prostate cancer, the sipuleucel-T vaccine increases survival by
a little more than 4 months but costs $93,000 per patient,
whereas the $400 per month ketoconazole has been replaced
by the $5,000 per month abiraterone with no evidence that it
produces superior outcomes. In pancreatic cancer, adding erlotinib
to gemcitabine increases overall survival by 10 days,
from 5.91 months to 6.24 months, at an additional cost of
!$4,300 per month. If a patient takes erolotinib for 3.75
months, the median time to progression, then those additional
10 days cost !$16,000. Imagine going to a doctor with pneumonia
and being told that for $16,000 you could obtain an antibiotic
that would extend your life by 10 days.

http://theoncologist.alphamedpress.org/content/17/1/3.full.pdf+html

New Online Support Community

1/30/2012 (9:36:27am)Tags: noneComments: (6)

I received this email from David Tabatsky, the editor of the popular Chicken Soup for the XXXX series.

Breast Cancer Activism

1/29/2012 (12:26:14pm)Tags: noneComments: (10)

This is a really interesting article about the evolution of advocacy and activism in breast cancer. Blessedly, we have come a really long way since the words could not be spoken. I work with a number of women whose mothers had breast cancer and one of their shared strong memories is the enforced silence about the illness, and the almost shame that accompanied it. Although I personally think that the whole October pink movement is way overdone and ridiculous and all about marketing and profits, I would rather have that complaint than the quiet of the 1950s. I give you the abstract from the Journal of Womens Health and then a link (note that you will have to click on the pdf) to read more:

A Historical Perspective on Breast Cancer Activism in the United States: From Education and Support to Partnership in Scientific Research

Janet R Osuch, M.D., M.S.,1 Kami Silk, Ph.D.,2 Carole Price, A.S.N.,3 Janice Barlow, R.N., B.S.N., C.N.P.,4 Karen Miller,5 Ann Hernick, B.S.B.A.,4 and Ann Fonfa, B.P.S.6

Abstract

Breast cancer remained a hidden disease among women in the United States until the 20th century. It was initially brought into the open with public revelations from individual women, which was followed by the development of support groups and ultimately the formation of political activist groups with various prior- ities. Those concerned with toxic environmental exposures as a potential cause of breast cancer organized, demonstrated, and lobbied for research funding and eventually became partners in the research that arose from their efforts. One representative example was the Breast Cancer and Environment Research Centers (BCERC) Project (2003–2010), supported by the National Institute of Environmental Health Sciences (NIEHS) and the National Cancer Institute (NCI). The BCERC embedded a Community Outreach and Translational Core into its formal organizational infrastructure to ensure advocate involvement in the standing scientific subcommittees of BCERC, the first project funded by NIEHS and NCI to do so. The formal integration of advocates as partners in scientific studies focused on breast cancer is embedded in a rich history of action on the part of many courageous women. This article describes the historical evolution of breast cancer activism in the United States, which provided a critical foundation for the formation of BCERC. This description is followed by a discussion of BCERC as an example of the transdisciplinary research model, a paradigm that strives for inclusion of multiple stakeholders and increased interaction between scientists from a wide spec- trum of disciplines, advocates, and lay audiences in order to more effectively conduct critical research and to translate and disseminate its findings.

http://online.liebertpub.com/doi/abs/10.1089/jwh.2011.2862?journalCode=jwh

FDA and Supplements

1/28/2012 (7:40:34am)Tags: FDA supplements CAMComments: (4)

This is an interesting article from Medscape about the FDA not being tough enough on supplements, specifically on the information included with them. Americans spend gazillions of dollars every year on pills and other things that promise the world, and it increasingly seems like a racket. People with cancer may be especially vulnerable to thse false promises. Who wouldn't want to believe that taking extract of wart hog (or whatever) will keep the cancer away?

Here it is:

Visit us online at www.MedPageToday.com

FDA Supplement Guidance Not Strict Enough, MD Says

By Emily P. Walker, Washington Correspondent, MedPage Today Reviewed by January 26, 2012

Review

A | A | A | A

An FDA proposal to require dietary supplement manufacturers to submit data proving their product is safe doesn't go far enough, according to a physician writing in the New England Journal of Medicine.

More than 100 million Americans spend more than $28 billion on vitamins, minerals, herbal ingredients, amino acids and other natural products in the form of dietary supplements each year, "assuming they are both safe and effective," wrote Pieter A. Cohen, MD, of Harvard Medical School and the Cambridge Health Alliance.

But they have no assurance that the products are safe because FDA regulation of supplements is too weak, Cohen wrote in a Perspective piece.

By law, ingredients that were used and sold in supplements prior to 1994 can be marketed without any proof that they are safe or effective. But under a law called the Dietary Supplement Health and Education Act (DSHEA), manufacturers of any ingredient introduced after 1994 must provide the FDA with evidence supporting "a reasonable expectation of safety."

Cohen said that part of the law "has thus far not been enforced."

Since DSHEA became law more than 15 years ago, the number of supplements on the market has gone from 4,000 to more than 55,000. Since 1994, the FDA has received proper notification for 170 new supplement ingredients, "undoubtedly a small fraction of the ingredients for which safety data should have been submitted," Cohen said.

The FDA has mounted a new effort to discourage the sale and use of nutritional supplements that contain ingredients that are regulated as drugs. Last year, the agency issued draft guidance meant to inform supplement manufacturers about what information they must submit to the FDA, including spelling out when an ingredient is considered old and when it's considered new. (A synthetically produced replica of a botanical product, for instance, would be considered new).

In addition, the FDA is proposing that the guidance call for in vitro, animal, and long-term tolerability testing for supplements that would be marketed at higher doses than those historically ingested.

"The FDA's guidance provides a thoughtful framework for evaluating the safety of new ingredients and if implemented it would lead to substantial improvement in safety," Cohen wrote, but he said he didn't think the FDA goes far enough.

He said under the guidance, companies can use historical data (instead of clinical trials) to prove that a supplement is safe, and Cohen said that the FDA can't assess the safety of new products scientifically without experimental data.

Cohen also said that under the guidance, manufacturers would not be required to submit both favorable and unfavorable data to the FDA, so they could cherry-pick only positive data to submit.

The dietary supplement industry largely opposes the draft regulation.

One opponent is the Natural Products Association, whose 1,900 members include small health food stores and large supplement manufacturers. The group submitted its official response to the FDA's proposal in November and said the agency is "overstepping" and that the rules would have a "chilling effect" on the dietary supplement industry.

"The draft guidance as currently written sets up inappropriate barriers to market entry, imposes food additive criteria, and requires multiple ... notifications beyond those required by law," the group wrote.Cohen said it's true that the proposed requirements would impose similar standards on supplements and food additives.

"Industry advocates are correct insofar as DSHEA does not hold established (pre-1994) supplement ingredients to the same safety standards as food additives: a chemical preservative sprayed inside a can of tomato soup or the purple dye in Jell-O requires much more evidence of safety than ingredients used in supplements," Cohen wrote.

Cohen urged the FDA to not change its proposal because of protests from industry.

"If the FDA succumbs to industry pressure, the public health consequences will be significant, as hundreds of thousands of Americans continue to turn to new supplements to sustain their health and treat their ailments," he said.

The FDA is accepting comments on the draft guidance until Feb. 1.

Neoadjuvant Therapy for Her2 Positive

1/27/2012 (7:36:35am)Tags: neoadjuvant her2 positiveComments: (10)

As you likely know, the usual sequence of treatment for early breast cancer is surgery, chemotherapy, then radiation if needed. There are increasing numbers of variations to this routine as care becomes more individualized and different pathologies are better understood. As an aside, over the many years that I have been in the field, there have been a number of trials that looked at different ways to sequence adjuvant therapy. For a while, "sandwich" schedules were common: half the chemo, then radiation, then the other half of chemo. You can well imagine how hard it was for women to return for the second half!

Anyway, neoadjuvant therapy refers to situations in which chemotherapy is given after diagnosis but before surgery. This is often done when a tumor is large, and the hope is to shrink it enough to avoid the necessity of a mastectomy. It may also be done when the cancer is thought to be especially aggressive, so chemo seems more urgent. This is a report from BreastCancer.org about a study reported in Lancet that suggests the best way to manage this for women who have her2 positive breast cancers. This is the beginning and then a link:

Dual HER2 Blockade Better than One as Neoadjuvant Treatment
Charles Bankhead

What breastcancer.org says about this article.

Treatment given to weaken and destroy breast cancer BEFORE surgery is called neoadjuvant treatment. Treatment before surgery isn't routinely used to treat early-stage breast cancer, but may be used if the cancer is large or aggressive. Treatment before surgery is more commonly used for breast cancer that has spread outside the breast to other tissue in the breast area (locally advanced breast cancer). One or more chemotherapy medicines are usually the neoadjuvant treatments used.
Two studies looked at neoadjuvant treatment for HER2-positive breast cancer.
One study, called NeoALTTO, found that giving both Herceptin (chemical name: trastuzumab) and Tykerb (chemical name: lapatinib) with the chemotherapy medicine Taxol (chemical name: paclitaxel) before surgery to treat early-stage or locally advanced HER2-positive breast cancer offered more benefits than giving only Herceptin and Taxol or only Tykerb and Taxol.
The other study, called GeparQuinto, found that Herceptin given with chemotherapy is more effective than Tykerb given with chemotherapy before surgery to treat early-stage or locally advanced HER2-positive breast cancer.

http://tinyurl.com/72gjnhw

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