efficacy of continuing herceptin beyond disease progression confirmed

[Lani]

J Clin Oncol. 2009 Mar 16. [Epub ahead of print] Links

Trastuzumab Beyond Progression in Human Epidermal Growth Factor Receptor 2-Positive Advanced Breast Cancer: A German Breast Group 26/Breast International Group 03-05 Study.

von Minckwitz G, du Bois A, Schmidt M, Maass N, Cufer T, de Jongh FE, Maartense E, Zielinski C, Kaufmann M, Bauer W, Baumann KH, Clemens MR, Duerr R, Uleer C, Andersson M, Stein RC, Nekljudova V, Loibl S.
GBG Forschungs GmbH, Neu-Isenburg; Dr.-Horst-Schmidt-Kliniken, Breast Unit, Wiesbaden; University Women's Hospital, Mainz; University Women's Hospital, Kiel; University Women's Hospital, Frankfurt/Main; Schwarzwald-Baar Klinikum, Villingen-Schwenningen; University Women's Hospital, Marburg; Klinikum Mutterhaus der Borromaeerinnen, Trier; Klinikum Deggendorf; and Gemeinschaftspraxis Papcke/Uleer, Hildesheim, Germany; Institute of Oncology, Ljubljana, Slovenia; Ikazia Ziekenhuis, Rotterdam; and Reinier de Graaf Gasthuis, Delft, the Netherlands; Clinical Division of Oncology, Department of Medicine I, Medical University Vienna and Central European Cooperative Oncology Group, Vienna, Austria; Rigshospitalet University Hospital, Copenhagen, Denmark; and University College London Hospitals, London, United Kingdom.
PURPOSE: Trastuzumab shows clinical activity in human epidermal growth factor receptor 2 (HER-2)-positive early and advanced breast cancer. In the German Breast Group 26/Breast International Group 03-05 trial, we investigated if trastuzumab treatment should be continued beyond progression. METHODS: Patients with HER-2-positive breast cancer that progresses during treatment with trastuzumab were randomly assigned to receive capecitabine (2,500 mg/m(2) body-surface area on days 1 through 14 [1,250 mg/m(2) semi-daily]) alone or with continuation of trastuzumab (6 mg/kg body weight) in 3-week cycles. The primary end point was time to progression. RESULTS: We randomly assigned 78 patients to capecitabine and 78 patients to capecitabine plus trastuzumab. Sixty-five events and 38 deaths in the capecitabine group and 62 events and 33 deaths in the capecitabine-plus-trastuzumab group occurred during 15.6 months of follow-up. Median times to progression were 5.6 months in the capecitabine group and 8.2 months in the capecitabine-plus-trastuzumab group with an unadjusted hazard ratio of 0.69 (95% CI, 0.48 to 0.97; two-sided log-rank P = .0338). Overall survival rates were 20.4 months (95% CI, 17.8 to 24.7) in the capecitabine group and 25.5 months (95% CI, 19.0 to 30.7) in the capecitabine-plus-trastuzumab group (P = .257). Overall response rates were 27.0% with capecitabine and 48.1% with capecitabine plus trastuzumab (odds ratio, 2.50; P = .0115). Continuation of trastuzumab beyond progression was not associated with increased toxicity. CONCLUSION: Continuation of trastuzumab plus capecitabine showed a significant improvement in overall response and time to progression compared with capecitabine alone in women with HER-2-positive breast cancer who experienced progression during trastuzumab treatment.
PMID: 19289619

[Ellie F]

Thanks Lani, don't know how you manage to find all these up to date pieces of research but please carry on you are doing a brilliant job. This couldn't have come at a better time for me. Due for second opinion next week. My herceptin was stopped recently following a recurrence as per penny pinching policy in England! Will now take this article with me to argue my case. Ellie

[Lani]

ago there was a big hullabaloo(sp?) about whether these things should be posted under articles of interest.

I try to post things that will either give hope or actually may help people find their treatment options or challenge bureaucratic decisions and beancounters

Should your progression be in your brain go to the search function in the yellow bar above and you can find lots of articles saying continued herceptin after brain mets improves survival and quality of life.

Thanks for the thanks.

[schoolteacher]

Lani,

Thanks for all the research you do.

What is capecitabine? Is that the name we use here in the states?

Amelia

[Lani]

that is the drug commonly given with Tykerb in those with metastatic breast cancer, particularly those with brain metastases

[Ellie F]

Thanks Lani. Recurrence in 3 contra lateral axillary lymph glands. Getting second opinion next week. Onc thinks they are mets but surgeon thinks may be new primary in other breast particularly as this is how my first one started and didn't show on mammogram or ultrasound until became inflammatory bc!

[Rich66]

I wonder if the inverse is true: continuing capecitabine(Xeloda) but adding Herceptin after progression on Xeloda alone.