October 7, 2011
Progress against HER2-Positive Breast Cancer
(Ivanhoe Newswire) -- The future looks bright for patients with HER2-positive breast cancer. A paper published in the October 6, 2011 issue of the New England Journal of Medicine (NEJM), shows that new treatment regimens, providing a lower risk of cardio toxicity, are an acceptable and effective option for patients.
The new study, by the Breast Cancer International Research Group, answers a critical question raised by four previously published trials; are adjuvant anthracyclines necessary for the treatment of HER2-positive breast cancer?
The four previous trials showed that a different drug, trastuzumab, was effective against HER2. More importantly, the trials showed that adjuvant trastuzumab substantially reduced the rates of recurrence and death in patients with early-stage disease. Adjuvant is the term used to describe a drug that is used to enhance the effectiveness of another.
In the new study, researchers compared a chemotherapy regimen called AC-T (cyclophosphamide with the anthracycline doxorubicin) plus 52 weeks of trastuzumab, with a nonanthracycline regimen called TCH (docetaxel and carboplatin) plus trastuzumab.
Unfortunately, the results did not show the superiority of TCH over AC-T plus trastuzumab as researchers hoped. The two regimens were comparable. However, the results did show that the TCH group had lower rates of cardiac dysfunction and fewer cases of leukemia.
These results confirm that TCH is an additional, but not the only, standard of care for adjuvant treatment of HER2-positive breast cancer in early stages.
Now that you have options, which regimen should you choose? The authors say different risk factors and preexisting conditions, that may cause a higher risk of cardio toxicity, should be used to determine the correct course of action.
Bernard Fisher of the National Surgical Adjuvant Breast and Bowel Project once said, "The hallmark of a good clinical trial is that it raises more questions than it answers."
According to the authors of the study, results of this and other randomized trials of adjuvant trastuzumab versus no trastuzumab did just that. Three additional questions were raised during the trials;
1. Which HER2-positive patients do not benefit from an adjuvant trastuzumab regimen?
2. Are there HER2-negative patients who might benefit from it?
3. Can anti-HER2 therapies be improved?
These questions can only be answered with further research and trials.
SOURCE: NEJM published online October 6, 2011