Herceptin for early stage BC

[tousled1]

This article appeared in the WEBMD news letter. Perhaps more doctors will use the Herceptin for early state breast cancer.

Feb. 22, 2006 -- The breast cancer drug Herceptin may help prevent breast cancer's return in some patients, new research shows.

That finding comes from a study of about 1,000 women with early breast cancer. More than one in five of those women had the HER2/neu gene, which Herceptin targets.

The HER2/neu gene overproduces a protein called HER2. That protein is tied to faster-growing tumors that are more likely to return.

The new study shows fewer recurrences of breast cancer -- over three years -- in women with the HER2/neu gene who briefly took Herceptin with chemotherapy after breast cancer surgery.

The results appear in The New England Journal of Medicine. The researchers included Heikki Joensuu, MD, of Finland's Helsinki University Central Hospital.

Double Impact

In Joensuu's study, a total of 232 women had the HER2/neu gene.

The researchers randomly assigned half of those women to take Herceptin for nine weeks, along with chemotherapy drugs Taxotere or Navelbine. The other 116 women with the HER2/neu gene got chemo, but not Herceptin.

Over three years, 89% of those taking Herceptin plus chemotherapy survived without breast cancer's return. So did 78% of those who got chemo without Herceptin.

A short course of Herceptin plus chemo drugs Taxotere or Navelbine is "effective" in such patients, the researchers write.

Women in the study also got appropriate radiation therapy after chemotherapy. Radiation therapy was required for women who underwent breast-conserving surgery (lumpectomy). Patients with hormone-sensitive tumors were also scheduled to take tamoxifen for five years.

No Heart Risks Seen

Joensuu and colleagues found that Herceptin wasn't associated with heart failure or a drop in the heart's effectiveness at pumping blood in their study. However, heart failure is identified as an important side effect that can occur in 1% to 4% of patients who get it and 10% of patients with decreased heart function, according to an accompanying editorial.

However, the study was relatively small and the ideal length of Herceptin treatment isn't clear yet, the researchers note. They add that the chemo drugs used in the study weren't among a class of chemo drugs that may act with Herceptin to raise risk of heart problems.

The study "demonstrates that [Herceptin] can be given at therapeutically active doses with negligible cardiac side effects, but whether a similar result might hold in larger numbers of patients or in women with pre-existing heart disease is now a pressing question," states a journal editorial.

Kenneth Chien, MD, PhD, wrote the editorial. He is a professor at Harvard Medical School and the director of the Cardiovascular Research Center at Massachusetts General Hospital in Boston.

[Joe]

This report caused quite a bit of interest when it was released in San Antonio last December. I believe that the consensus was that a larger trial is needed.

Should a larger trial reflect these results, it would be a Godsend for all of those countries that have socialized medicine.

Regards
Joe

vI believe the FinHer study was small yet large enough with over 200 people in the study to draw statistical significance. In other words the results are not random. Further, if you study the FinHer data, you will find that the study group or the group that got Herceptin had more disease than the control group who did not get Herceptin. Yet, interestingly, the study group had longer disease free survival than the control group. Obviously something caused these miraculous results in the study group and it's called adjuvant Herceptin.

Interestingly, the cardiac status was preserved with only 9 weeks of Herceptin in a THREE YEAR follow-up. To me this suggests that less is best, particularly when it is given before cardiotoxic chemotherapy such as AC or anthracylcines. As you may or may not know, the NEJM presented an article that suggests that anthracyclines sensitizes the heart for damage and Herceptin stimulates the damage by interfering with alternative pathways via the kinases. In other words, if you get AC treatment, get it following Herceptin, not prior to prevent cardiac damage.

In the early days of adjuvant chemo, it was used for a year or more. Now it is only used for several months for the same efficacy. I believe that further adjuvant Herceptin studies will also develop a trend for shorter therapy with less toxic burdens financially and physically.

herceptin was not offered to me when I was diagnosed 1-2004
could i do it now e and p positive her2 positive

[Lolly]

At my treatment center the oncs are now giving a year of Herceptin to early-stagers, after finishing standard treatment. Just this week when I went in for my treatment, there were 2 women receiving Herceptin for early stage, along with 3 of us "life-ers"!

To er/pr-, her2+ guest: I think you should ask for it, but I know several on this board in your shoes who've not been able to convince their oncs to give them "late" Herceptin (2+ years out from treatment). But, ask and be prepared with copies of these studies to support your case.

<3 Lolly

[Christine MH-UK]

Hi unregistered,

The FinHer results do look good, but the problem is that there is a wide confidence interval, which means that although the group studed had a 50% reduction in recurrence, the estimation for what the benefit would be in a really large group ranges from the mid 20s to almost 80 percent. As such, it is difficult to compare it directly with the other much larger trials, although it seems statistically unlikely that it would be worse than them.

The great thing about FinHer is the lack of any heart problems and giving the herceptin-based chemo first only seems logical. There are some women, after all, who never get herceptin because their hearts are too damaged by their prior treatment with adriamycin and that needs to be factored in when comparing the trials.

If the short course proves to be as successful, I'm all for it being adopted. I am half way through a year of herceptin and am really fed up of being a patient.

At present, it does seem like FinHer is best at the very least in cases where the other treatments would pose too much risk to the heart.

[Barbara2]

Hi, unregistered. I received late Herceptin 2 years and 2 months after finishing chemo. I had a heart rhythm problem that needed to be fixed after finishing the chemo, then was able to get the herceptin.

I have 12 more treatments to go.......

Barbara

but how did you talk your onc into ther herceptin after treatment ended two years prior
I am only on arimidex now

[Barbara2]

If he was in the same situation as I, he agreed that he would probably want Herceptin, too. Even though it was late.

Scroll down to "Interview with Dr. Dennis Slamon", click on the website you see there, and go to track 9, where it discusses the issue of late herceptin. Make a copy of that track, and take it to your doctor. That should be quite helpful, I would think.

Good luck.