HER-2 Breast cancers

*First line treatment Herceptin -Taxane
improves Response rates, progression free survival, and overall survival.
A 1 year of Herceptin seems to will all other duration

*Pertuzumab seems to work best when combine to Herceptin and Taxane  with Median survival of
1.5 Years  (Cleopatra )--The triplet is FDA approved for first line

*Lapatinib has been reported inferior to Trastuzumab, it is an option after all is completed though.
With the arrival of Pertuzumab, it will find a role in cases where it is combined to Herceptin.

*Navelbine is the other chemotherapy drug frequently used as an alternative to Taxane.

* The standard first line in Metastatic Breast cancer is stolen from the jaw of the of the above options however by the T-DM-1 based combination.  Alone or combined to Pertuzumab.
T-DM-1 is Trastuzumab emtansine.   The close challenger is Herceptin -Pertuzumab and Taxane (whihc was the standard until T-DM1 got approved!

* To conquer Her-2 resistance, It appears you need to complete full circle a BOLERO DANCE.
It is either BOLERO 1 which use Herceptin-Taxol- Everolimus
or BOLERO 3 which dance to the pace of Herceptin-Vinorelbine-Everolimus
will see not only which dance is easier on our patients
but also confirm that MTOR is the answer to HER-2 resistance!

*DR HOPE S RUGO who we thank for most these comments had another take when it comes to
standard of care and therapeutic options.  She suggested that
The first line / standard be :  Pertuzumab - Trastuzumab - Taxol as prime line of defense in Metastatic Her-2
Second line :  T-DM1as a single agent
third line:    Lapatinib-Xeloda            

REMEMBER THE PATIENT NEEDS TO BE HER-2 POSITIVE  BEFORE YOU START READING THIS!