View Full Version : HER2-Positive Disease: No Need for Chemo?

Sat 2nd February '13, 6:31pm

Kathy D. Miller, MD: Hello. I am Kathy Miller, Associate Professor of Medicine at Indiana University School of Medicine in Indianapolis. Welcome to this edition of Medscape Oncology Insights, coming to you from the 2012 San Antonio Breast Cancer Symposium.

Joining me today is Dr. Josť Baselga, Professor of Medicine at Harvard Medical School in Boston in Massachusetts and recently named Physician-in-Chief of the Memorial Sloan-Kettering Cancer Center in New York. Welcome, Josť. It's nice to have you here.

Josť M. Baselga, MD, PhD: Thank you very much, Kathy.

Trastuzumab: Is the Adjuvant Duration Finally Set?

Dr. Miller: You have been at the forefront of HER2-targeted therapies since their inception. It has been an incredible decade, and I want to talk about some of the recent advances and where the field is moving. Let's start with the adjuvant setting. The original trials, by and large, gave people trastuzumab for a year. It was a nice round number but an empirically derived number. We have seen a couple of trials now that have explored different durations, either 2 years or 6 months. Have we learned anything about the duration? Have we settled in on a year being the right duration?

Dr. Baselga: We have, but not in full. I would say that 90% of the question is answered. At this meeting we are going to present the final data on the HERA study,[1] the big European study that compared 1-year vs 2-year duration, and I think the answer is final.

Dr. Miller: It was a long time in coming. We have been waiting for those 2-year results since we first saw the 1-year results back in 2005. Is there any hint of a trend on the horizon that longer might be better?

Dr. Baselga: None whatsoever. It took so long as a reflection of HER2 biology. Basically, after 5 years, patients just don't accrue the number of events that we were observing and the analyses were event driven, and it became very minimal. That one is settled, not to be reopened. One year is as good as 2 years.

Dr. Miller: What about shorter treatment? In that same 2005 session, we heard tantalizing results from the small Finn HER trial[2] (giving patients only 9 weeks of therapy), suggesting that within the boundaries of cross-trial comparisons, it might produce the same benefit.

Dr. Baselga: In that respect, a number of studies are still ongoing. One has been presented and that was the French study led by Xavier Pivot,[3] and this was presented at the European Society of Medical Oncology meeting just a few weeks ago. It seems that 6 months is not as good as 1 year. However, some of the subgroups still need to mature, because [the inferiority of 6-month duration] might not apply to all the subgroups. The studies that are still ongoing might shed some light on this. Today, with the data we have, 1 year is still the standard. That is what I would do and what the community would recommend, but I would stay tuned for the subgroup analyses and the final maturation data on 6 months vs 1 year.

Dr. Miller: So, 1 year for right now, but in the future we might be able to select patients not just for getting trastuzumab but for different durations?

Dr. Baselga: I would think so.

This message comes from Medscape at http://www.medscape.com/viewarticle/776321?src=wnl_edit_medp_honc&spon=7

Sat 19th October '13, 8:59pm
Basically HER2-positive cancer patients may be able to get targeted neoadjuvant therapy with lapatinib & trastuzumab without chemotherapy, according to findings of a study by the Translational Breast Cancer Research Consortium (TBCRC).This phase II, single-arm, multicenter study was carried out at sites across the United States between 2008 & 2010. Sixty-four HER2-positive ladies with invasive stage II-III illness deemed eligible for evaluation received a nonchemotherapy process of trastuzumab (four mg/kg loading dose, followed by two mg/kg one time every week) & lapatinib (1000 mg one time every day) over 12 weeks. Patients with estrogen- receptor (ER) or progesterone-receptor (PR)positive tumors also received every day dose of letrozole (two.5 mg). I am happy to found and get more information collect here.