"Combining two drugs that target an aggressive type of breast cancer known as HERpositive appears to work better than using either drug alone researchers report. The dualdrug approach greatly boosted the chances of eliminating microscopic signs of early cancer by the time a woman was due to have surgery said researcher Dr. Jose Baselga chief of hematologyoncology at Massachusetts General Hospital Cancer Center and a professor of medicine at Harvard Medical School. The study was published online Jan.  in The Lancet. The two drugs are Tykerb lapatinib and Herceptin trastuzumab. Using both together resulted in a  percent response compared with a  percent response in women given Herceptin alone. Those given Tykerb alone had a  percent response. What we observed was a massive improvement in response Baselga said. GlaxoSmithKline the maker of Tykerb helped fund the study. Lapatinib was approved for advanced breast cancer in  Baselga said. The question we had was what is the efficacy if we give it in earlystage breast cancer prior to surgery Baselga and his colleagues conducted a trial treating  women from  countries. All had HERpositive breast cancers. All had tumors larger than about threefourths of an inch. In HERpositive breast cancer test results are positive for a protein called human epidermal growth factor receptor  which promotes cancer cell growth. In the study  women got Tykerb  Herceptin and the other  both drugs. All had the drug regimen before surgery with Taxol paclitaxel a standard chemotherapy added after six weeks. After  more weeks of treatment the women had surgery. At that point researchers evaluated who had better responses. The women continued the treatments for one more year allowing researchers to follow them and see how the approaches affected survival. Baselga stressed that the study looked only at women with earlystage HERpositive breast cancers and that the drug Tykerb is approved now only for advanced breast cancers. The study is well done and important said Dr. Len Lichtenfeld deputy chief medical officer for the American Cancer Society. The two drugs he said affect the same pathway but do it in a different way. While the combination showed a better response rate there is also an increased level of side effects he noted. While no major heart problems occurred those on Tykerb alone or the twodrug combination had more diarrhea. Liverenzyme alterations were also more frequent when Tykerb was used. GlaxoSmithKline notes that liver toxicity with the drug may be severe and that deaths have been reported although the cause of the deaths has not been determined. The important question however has not been answered yet Lichtenfeld said. Thats the effect on overall survival in using the twodrug approach. The researchers are continuing to evaluate that. Cost is another consideration Tykerb runs about  a month wholesale and retail prices could be higher. In another study published online Jan.  in The Lancet Oncology researchers from Germany reported that Tykerb is less beneficial than Herceptin as a singledrug therapy. They assigned  women with HERpositive breast cancer to get standard chemotherapy plus Herceptin or Tykerb. They looked to see which drug was better at eliminating invasive cancer in the breast and metastatic cells in the lymph nodes. While  percent of those in the Herceptin group had this response  percent of the Tykerb group did. The study was funded by drug makers GlaxoSmithKline Roche and SanofiAventis. Baselga reports receiving honoraria from Roche other coauthors report receiving speaking fees or honoraria from GlaxoSmithKline and fees from other drug companies. More information To learn more about breast cancer including HERpositive cancers visit the American Cancer Society http SOURCES Jose Basegla M.D. Ph.D. chief hematologyoncology Massachusetts General Hospital Cancer Center and professor medicine Harvard Medical School Boston Len Lichtenfeld M.D. deputy chief medical officer American Cancer Society Jan.   The Lancet The Lancet Oncology online"