Fig. 4

Monitoring sHER2 levels in 4 patients who eventually developed recurred diseases. Serum samples of these patients were collected periodically and tested using MBB-HER2 ELISA. Treatments and recurrence / metastasis were indicated. a Patient#10004 failed to respond to adjuvant therapies and had a local recurrence. After bilateral mastectomy, sHER steadily went up, even in the presence of radiation and additional Herceptin treatments. Brain metastasis was identified during the sHER2 rising phase, and eventually the patient developed liver metastasis. b Patient#10048 showed a drop of sHER2 after chemo/Herceptin treatments and mastectomy. After about 2 months of staying at the bottom, sHER2 gradually went up after local recurrence was identified. The patient was treated with several kinds of chemotherapies with Herceptin, but sHER2 kept surging. Eventually the navelbine/Herceptin combination was able to change the course of rising sHER2 levels. c In patient #10041, sHER2 responded to the initial chemo/Herceptin treatment and dropped to < 2 ng/ml. The level rebounded to ~ 4 ng/ml during the Herceptin alone treatment. After radiation, the level was reduced again to a very low level (<1 ng/ml). However, sHER2 level rose again and brain metastasis was identified. d sHER2 levels in #10061 was restricted in a very narrow range over the course of treatment. After bilateral mastectomy and radiation, sHER2 gradually bottomed out at 2 ng/ml. In less than 2 months, sHER2 rose from 2 ng/ml to 4 ng/ml. Two months later, brain metastasis was detected. Serum samples right before metastasis was not available and it is not clear if the upward trend of sHER2 continued until brain metastasis. Treatments: A: Adriamycin; Cy: Cytoxan; T: Taxol; H: Herceptin; X: Xeloda; Ha: Halaven; L: Lapatinib; Na: Navelbine; Rad: radiation