HER2 Support Group Forums - View Single Post - Upcoming Abstracts for Her2 Breast Cancer ASCO 2014

'lizbeth · 05-18-2014, 01:41 PM

Adjuvant and neoadjuvant trastuzumab in combination with vinorelbine for HER2+ breast cancer.

Abstract No:
e11585
Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2014 ASCO Annual Meeting but not presented at the Meeting, can be found online only.

Author(s): Khashayar Esfahani, Cristiano Ferrario, Philippe Le, Lawrence C. Panasci; Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada; McGill University, Montreal, QC, Canada
Abstract Disclosures

Abstract:

Background: Growing evidence suggest that even small early stage HER2+ breast cancers (BCs) should be treated with adjuvant chemotherapy to reduce recurrence rates. Some patients are not candidate for anthracycline-based chemotherapy, given their frailty or preference to avoid chemotherapy-related toxicities. Phase III randomized trials of Herceptin with vinorelbine (HV) in metastatic breast cancer patients have shown good response rates and favorable toxicity profiles of HV over taxane-based regimens. We herein report our experience with patients receiving HV at our institution. Methods: Retrospective data was collected on all stage I-III patients receiving HV as the only chemotherapy regimen in the adjuvant and neoadjuvant settings. Most patients received HV on a weekly basis (one week off for V every 3–4 weeks) for 6 months, followed by 6 more months of H. Results: Between 2003 and 2012, 46 HER2+ patients were identified (adjuvant: n=36; neoadjuvant: n=10). Median age was 65. 81% of patients in the adjuvant arm had Stage I disease, and 61% of all patients were ER/PR+. 3 patients in the neoadjuvant arm had a complete pathological response. All patients treated in the neo-adjuvant arm have remained disease-free. Only one patient had a local recurrence following a short course of HV (3 months). She was retreated with the same regimen following surgical resection, and has remained disease-free since. Overall survival and disease-free survival were 94% and 98% respectively at 5 years of median follow-up. One patient with significant medical comorbidities died of febrile neutropenia induced sepsis, and two others died of comorbidities unrelated to their cancer or treatment. Grade 3-4 adverse effects included neutropenia (22%), febrile neutropenia (8%), fatigue and anemia (2% each). During therapy, 6 patients had an asymptomatic 10–20% drop in the LVEF (Grade 1), with complete recovery on follow-up MUGA scans. Conclusions: HV is a reasonable alternative to standard adjuvant chemotherapy for patients with non-metastatic breast cancer that are not candidates for standard chemotherapy. Further prospective data is required to establish the role of HV in stage I HER2+ BC, for which no standard treatment is defined.

05-18-2014, 01:41 PM	#5
'lizbeth Senior Member Join Date: Apr 2008 Location: Sunny San Diego Posts: 2,214	Re: Upcoming Abstracts for Her2 Breast Cancer ASCO 2014 Adjuvant and neoadjuvant trastuzumab in combination with vinorelbine for HER2+ breast cancer. Abstract No: e11585 Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2014 ASCO Annual Meeting but not presented at the Meeting, can be found online only. Author(s): Khashayar Esfahani, Cristiano Ferrario, Philippe Le, Lawrence C. Panasci; Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada; McGill University, Montreal, QC, Canada Abstract Disclosures Abstract: Background: Growing evidence suggest that even small early stage HER2+ breast cancers (BCs) should be treated with adjuvant chemotherapy to reduce recurrence rates. Some patients are not candidate for anthracycline-based chemotherapy, given their frailty or preference to avoid chemotherapy-related toxicities. Phase III randomized trials of Herceptin with vinorelbine (HV) in metastatic breast cancer patients have shown good response rates and favorable toxicity profiles of HV over taxane-based regimens. We herein report our experience with patients receiving HV at our institution. Methods: Retrospective data was collected on all stage I-III patients receiving HV as the only chemotherapy regimen in the adjuvant and neoadjuvant settings. Most patients received HV on a weekly basis (one week off for V every 3–4 weeks) for 6 months, followed by 6 more months of H. Results: Between 2003 and 2012, 46 HER2+ patients were identified (adjuvant: n=36; neoadjuvant: n=10). Median age was 65. 81% of patients in the adjuvant arm had Stage I disease, and 61% of all patients were ER/PR+. 3 patients in the neoadjuvant arm had a complete pathological response. All patients treated in the neo-adjuvant arm have remained disease-free. Only one patient had a local recurrence following a short course of HV (3 months). She was retreated with the same regimen following surgical resection, and has remained disease-free since. Overall survival and disease-free survival were 94% and 98% respectively at 5 years of median follow-up. One patient with significant medical comorbidities died of febrile neutropenia induced sepsis, and two others died of comorbidities unrelated to their cancer or treatment. Grade 3-4 adverse effects included neutropenia (22%), febrile neutropenia (8%), fatigue and anemia (2% each). During therapy, 6 patients had an asymptomatic 10–20% drop in the LVEF (Grade 1), with complete recovery on follow-up MUGA scans. Conclusions: HV is a reasonable alternative to standard adjuvant chemotherapy for patients with non-metastatic breast cancer that are not candidates for standard chemotherapy. Further prospective data is required to establish the role of HV in stage I HER2+ BC, for which no standard treatment is defined.