Herceptin (trastuzumab) is the treatment of choice for women with HER2 positive breast cancer. By itself, it is associated with a risk of heart damage. What happens when it is combined with chemotherapy? Which drug combinations are best in terms of effectiveness and side-effects?
Today we'll share the two most recent studies on Herceptin in combination with chemotherapy. Both evaluated chemotherapy combinations with and without anthracyclines, such as Adriamycin and Ellence. Links may be found on the Herceptin (trastuzumab) page of our website.
TCH better than AC-T plus H as adjuvant therapy
An October 6 study in The New England Journal of Medicine evaluated the risks and benefits of Herceptin plus chemotherapy as adjuvant (after surgery) therapy for women with early-stage, HER2 positive breast cancer. The Los Angeles Times and US News and World Report/HealthDay covered the study.
The 3,222 women in the study were divided into three groups. One received Adriamycin (doxorubicin) and Cytoxan (cyclophosphamide) followed by Taxotere (docetaxel) (AC-T). One received AC-T plus 52 weeks of Herceptin (AC-T plus H). The last received Taxotere, Paraplatin (carbobplatin) and 52 weeks of Herceptin (TCH).
In terms of effectiveness, the AC-T plus H and TCH groups had similar disease-free and overall survival rates, and both were superior to the group that did not receive Herceptin.
In terms of side-effects, the AC-T plus H group experienced "significantly higher" rates of congestive heart failure and cardiac dysfunction than the TCH group. There were seven cases of leukemia in the AC-T plus H group and one in the TCH group.
The authors concluded that the addition of one year of Hercpetin significantly improved disease-free and overall survival. The risk-benefit ratio favored the TCH combination over AC-T plus H, "given its similar efficacy, fewer acute toxic effects, and lower risks of cardiotoxicity and leukemia."
PH-FECH better than TCH as neoadjuvant therapy
A September 27 study in Cancer evaluated Herceptin plus chemotherapy as neoadjuvant (before surgery) treatment. This time, TCH came out on the bottom.
The 300 HER2 positive women were treated with either Taxol (paclitaxel) and Herceptin followed by 5-FU, Ellence (epirubicin), Cytoxan and Herceptin (PH-FECH) or Taxotere, Paraplatin and Herceptin (TCH).
Patients in the PH-FECH group experienced a higher rate of pathological complete response (pCR), meaning tumor disappearance. They also had a lower risk of recurrence and death compared to the TCH group.
In terms of side-effects, there was "no significant difference" in heart damage. However, the authors noted that the women in the PH-FECH group had "fewer cardiac comorbidities at baseline," meaning they had a lower risk of heart damage when the study started.
The authors concluded that the type of neoadjuvant therapy is predictive of pCR rate. "Although TCH is active, PH-FECH shows a higher pCR rate and RFS [relapse-free survival] advantage."
At LATESTBreastCancer.com, we'll continue to monitor research on Herceptin plus chemotherapy. Today's studies are only the two most recent. For two-years worth of news and research, please visit the Herceptin page under the Treatments tab of our website.
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