Management of small (<1cm) lymph node negative patients with her2+ breast tumors

[Lani]

ABSTRACT: Management of small HER2 overexpressing tumours
[Breast Cancer Research and Treatment]

Overexpression of the human epidermal growth factor receptor 2 (HER2) is found in 10-20 % of breast cancers and is associated with a worse prognosis. Several large studies have established the addition of trastuzumab to chemotherapy as the gold standard in early breast cancer that overexpresses HER2. Little is known about the role of such adjuvant treatment in node-negative subcentimeter tumours ('small tumours', pT1a/b) because these patients were generally excluded from the pivotal trials. Only the BCIRG006 study published in 2011 included such tumours if high-risk features were present. Here we review the literature of small HER2-positive tumours and present a meta-analysis of retrospective studies confirming a worse outcome in terms of disease-free survival (hazard ratio 2.6, p < 0.001) and a trend for higher odds of distant recurrence at 5 years (odds ratio [OR] 2.51, p = 0.11). We discuss these findings in the light of the increased risk of grade 3 and 4 cardiac toxicity (OR 7.6, p < 0.001) and other adverse events associated with the use of trastuzumab. Such treatment may well be a valuable option in selected patients with high-risk features but physicians should exercise caution given the small absolute benefits of adjuvant chemotherapy and trastuzumab for patients with small HER2-overexpressing tumours.

[emily]

Lani,

Thanks for posting this. Do you have the citation for this as I'd like to read the entire article.

Like others I really appreciate your extensive research.

Emily

[Lani]

http://www.springerlink.com/content/n5r3h7317374v6q3/

Breast Cancer Research and Treatment
Volume 136, Number 1 (2012), 289-293, DOI: 10.1007/s10549-012-2236-9
Brief Report

Management of small HER2 overexpressing tumours

Arnoud Templeton, Alberto Ocaña, BoÅ¡tjan Å*eruga, Francisco Vera-Badillo, Lindsay Carlsson, Philippe Bedard and Eitan Amir

Hope this helps!

[Jen]

Several large studies have established the addition of "trastuzumab to chemotherapy as the gold standard in early breast cancer that overexpresses HER2. Little is known about the role of such adjuvant treatment in node-negative subcentimeter tumours ('small tumours', pT1a/b) because these patients were generally excluded from the pivotal trials." MAYBE if my Mother "Sheila" would have been able to receive Herceptin when she was diagnosed >IV she wouldn't be where she is now....Woulda, coulda, shoulda....It's all expost Facto now.

[Jean]

Lani,
A huge Thank you for posting this.
I took a lot of heat in back in my early dx. days 2005
as I was a strong advocate of having treatment regardless of node neg. and small tumors.
It was frustrating that everyone was put in one size fits all and if the size was small and node neg...well you were just fine!

Many heartfelt thanks for all your hours of research for us.

Sincerely,
Jean

[Lien]

Does anyone have access to the whole article? I would like to know the absolute risk reduction with Herceptin.

Thanx

Jacqueline

[karen z]

I have just downloaded. I don't know if there is a way to send along a pdf attachment here?
kz

[suzan w]

Yes, thank you fr this Lani!!! Unlike Jean, back in 2005, my Seattle surgeon knew the importance of Herceptin for me, small tumor, grade 1 etc. Seattle was one of the trial sites. She prescribed Herceptin for me, "off label". I communicated with Jean at the time and she was finally able to get Herceptin as well. She had to fight for it!!! Yay Jean!!! We are 2 of many lucky survivors who were able to get Herceptin for our non-metastic breast cancer.

[Jean]

Suzan,
love your signature....it sure is a long strange journey.
Sending you continued blessings.

Jean