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Cancer Answers Pertuzumab, Traztuzumab, and Docetaxel in HER2-Positive Breast Cancer

Category: Breast Cancer

Summary of Article By Swain et al New England Journal Of Medicine 2015; 372:724-734

 

1. Comparison of placebo + traztuzumab + docetaxel versus pertuzumab + traztuzumab + docetaxel

2. Trial design – first line therapy, randomized, double-blind, placebo controlled phase 3 study

3. 808 patient underwent randomization

4. Median follow up 50 months

5. Results: “overall survival significantly improved...in HER2-positive metastatic breast cancer with the addition of pertuzumab to traztuzumab and docetaxel, as compared with the addition of placebo”.

6. Overall median survival for pertuzumab not reached at 50 months of follow up

7. Study allowed for cross over and analysis not adjusted for crossover

8. Benefit of pertuzumab likely understated due to (7)

Dr. Steven Mamus is a cancer specialist in Sarasota, Florida. Please contact us for more information. 

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21 May 2015, 08:09
 

Cancer Answers Adriamycin Based Adjuvant Chemotherapy With Traztuzumab – The Gold Standard For The Treatment Of HER2 Positive Breast Cancer?? Does The Choice Of Chemotherapy Really Matter??

Category: Breast Cancer

“Choosing the Best Traztuzumab-based Adjuvant Chemotherapy Regimen: Should We Abandon Anthracyclines” by Burstein, et al in the June 20th 2012 issue of the Journal of Clinical Oncology, provides a thoughtful analysis of current treatment practices of patients with curable early stage HER2 positive breast cancers.

The authors point out that the use of adjuvant Traztuzumab in conjunction with chemotherapy has been established as the standard of care approach for treatment of these patients in 7 prospective randomized study (NSABP-31, NCCTG N9831, HERA, FinHER, NOAH, FNCLCC-PACS 04 and BCIRG 006). For the community oncologist, the presentation of the initial data at ASCO was overwhelming. The statistical benefit was so powerful when Traztuzumab was added to patients’ treatment programs that the natural question that arose for many was simply… did the chemotherapy really matter that much, and to be more specific, did the choice of specific chemotherapeutic agents make a difference? After all, (perhaps largely unspoken by many) it was really the Traztuzumab doing the heavy lifting right??

In particular, the authors make the important point that “BCIRG 006 neither established the equivalence of TCH to ASCTH, nor excluded the real possibility that the Anthracycline-based ACTH regimen was more active then the non-Anthracycline option”. Another important issue raised by the authors is that, “the importance of Carboplatinum - the C in TCH - as adjuvant therapy is unknown”.

The authors of this very brief 3-page article are to be commended for providing a remarkably detailed, cogent and convincing case for the continued strong consideration of Anthracycline use in women with high risk HER2 positive breast cancer. Given that, until there is wide-spread use of other HER2 targeted therapies, the choice of chemotherapy drugs may well make a difference in patient outcomes.

This article was submitted by Dr. Steven Mamus, nationally renowned cancer specialist. Please contact us for more information. 

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20 August 2012, 13:43