The researchers evaluated disease-free survival and overall survival at five years. The addition of the one year of Herceptin improved both disease-free and overall survival. The disease-free survival rates at five years were 75 percent in the ACT group, 84 percent in the ACTH group and 81 percent in the TCH group.

Overall survival was 87 percent for the ACT group, 92 percent for the ACTH and 91 percent in the TCH group.

However, the rates of congestive heart failure and other cardiac problems were higher in the ACTH group than in the TCH group. Twenty-one of those on ACTH had congestive heart failure, compared with four in the TCH group.

There were fewer reports of side effects such as joint pain and vomiting with the TCH group compared with the ACTH group, Slamon found. "And you get comparable effects," he noted.

Sanofi-Aventis and Genentech (which makes Herceptin) funded the study; Slamon reports receiving honoraria and reimbursement for travel expenses from both companies.

The latest report echoes findings from several previous ones, Slamon said. Doctors have been using the TCH regimen in women at risk for cardiac problems; it is approved by the U.S. Food and Drug Administration. "We're saying it should be used for everybody," Slamon said. "We are saying we think it is the standard of care, with comparable effects, and you lose all the anthracycline toxicity."

However, Dr. Daniel F. Hayes, clinical director of the breast oncology program at the University of Michigan Comprehensive Cancer Center in Ann Arbor, disagreed.

"I think TCH is a standard of care, it's not the standard of care," he said.

"Herceptin itself can cause heart failure," Hayes said. In the study, there were fewer cases of it in those who got Herceptin without anthracyclines, but it did still occur.

He suggests a risk-adapted approach, in which a doctor would decide which
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