study determines optimum time 2 start herceptin in early bc pts is<12 wks after diagn
 

osis--500 patients included--could have been different with largersample size

Article | Published: 18 May 2018

Epidemiology
Impact of timing of trastuzumab initiation on long-term outcome of patients with early-stage HER2-positive breast cancer: the “one thousand HER2 patients” project
Giuseppe Gullo, Naomi Walsh, David Fennelly, Reetesh Bose, Janice Walshe, Dimitrios Tryfonopoulos, Kate O’Mahony, Lisa Hammond, Nuno Silva, Deirdre McDonnell, Josephine Ballot, Cecily Quinn, Enda W. McDermott, Denis Evoy, Ruth Prichard, James Geraghty, John Amstrong & John Crown
British Journal of Cancervolume 119, pages374–380 (2018) | Download Citation

Abstract
Background
The optimal timing of (neo)adjuvant trastuzumab initiation with respect to chemotherapy and surgery remains undefined.

Methods
Retrospective analysis of a large institutional database of HER2-positive patients who received anti-HER2 therapy. We included all Stage I to III patients treated with trastuzumab with a minimum follow up of 3 years. The date of first breast biopsy was recorded as initial diagnosis.

Results
A total of 506 patients [adjuvant: 386 (76%)-neo-adjuvant: 120 (24%)] were included. The median time-to-first-trastuzumab (TFT) from diagnosis was 12 weeks (range 1.9–122.3). Median follow-up is 73.3 months (range 1.4–176.3). TFT was significantly shorter in the neo-adjuvant than in the adjuvant cohort (median: 4.4 vs. 14 weeks, p < 0.00001). Despite the neo-adjuvant cohort having significantly more node-positive patients (75 vs. 53%, p < 0.0001), DFS rate (neo-adjuvant: 12.5 vs. adjuvant: 18%, p = 0.094) was numerically superior in neo-adjuvant patients. A TFT ≤ 12 weeks was associated with significantly superior DFS and OS over TFT > 12 weeks. Early concomitant regimens were associated with superior DFS over delayed-concomitant and sequential regimens.

Conclusions
Initiating trastuzumab more than 12 weeks from diagnosis has a negative impact on clinical outcome. Neo-adjuvant anti-HER2 therapy could be the optimal strategy to treat early stage HER2-positive breast cancer.

Re: study determines optimum time 2 start herceptin in early bc pts is<12 wks after d
 

Thanks for posting this, Lani!


My HER2 +++ tumor was only discover after my double mastectomy; it was hiding in the "healthy" breast. I had to wait to start chemo/herceptin while I healed up from another surgery to remove and test lymph nodes from the "healthy" side.


My first tumor was discovered during removal of an "infected" nipple that turned out to be Paget's disease. NO accurate mammograms, ultrasounds, or even an MRI in my case.


Time for diagnosis to first Herceptin/chemo was about 8 weeks, September to November. For the first tumor though it was longer, surgery was in July, but this tumor was not HER2+++.



Just past the 5 year mark for the first tumor and coming up on the 5 year mark for the second.



BOTH were ER+ so I continue taking Arimidex every day.


So far, so good! Nice to know I am in the ballpark for Herceptin doing the most good. :).


Carol Ann

Re: study determines optimum time 2 start herceptin in early bc pts is<12 wks after d
 

However, my timing has never been good. Diagnosed in 2004 when the first Herceptin trials were closed and Herceptin was not given yet. When initial results were given at the 2005 ASCO convention, I demanded Herceptin and got my year of it alone as chemo and radiation were already done. Something worked as I am still here and will be 14 years NED at the end of this month. Have faith always.

Re: study determines optimum time 2 start herceptin in early bc pts is<12 wks after d
 

Thanks Lani, like Becky it was several months before I began Herceptin in '05 but very pleased to still be here and healthy thirteen years later.

Re: study determines optimum time 2 start herceptin in early bc pts is<12 wks after d
 

Like Becky I had treatment later. I was dx. in 4/2005. I was told that hercetpin was not the protocol for early stage (I was stage 1 6mm.) I had lumpectomy and then radiation. I continued to search and fight for treatment. I did start TCH later. Dr. Salmon was convinced that I should and all women should be treated with Her2, regardless of being stage 1.

So far so good - I remain following up with my onc. every 6 months, I still continue to Femara.

Best Wishes,
Jean