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Old 07-19-2013, 05:15 PM   #1
'lizbeth
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Adjuvant trastuzumab in HER2-positive breast cancer.

A NEJM article on TCH vs ACTH





Adjuvant Trastuzumab in HER2-Positive Breast Cancer

Dennis Slamon, M.D., Ph.D., Wolfgang Eiermann, M.D., Nicholas Robert, M.D., Tadeusz Pienkowski, M.D., Miguel Martin, M.D., Michael Press, M.D., Ph.D., John Mackey, M.D., John Glaspy, M.D., Arlene Chan, M.D., Marek Pawlicki, M.D., Tamas Pinter, M.D., Vicente Valero, M.D., Mei-Ching Liu, M.D., Guido Sauter, M.D., Gunter von Minckwitz, M.D., Frances Visco, J.D., Valerie Bee, M.Sc., Marc Buyse, Sc.D., Belguendouz Bendahmane, M.D., Isabelle Tabah-Fisch, M.D., Mary-Ann Lindsay, Pharm.D., Alessandro Riva, M.D., and John Crown, M.D. for the Breast Cancer International Research Group
N Engl J Med 2011; 365:1273-1283October 6, 2011DOI: 10.1056/NEJMoa0910383



Background

Trastuzumab improves survival in the adjuvant treatment of HER-positive breast cancer, although combined therapy with anthracycline-based regimens has been associated with cardiac toxicity. We wanted to evaluate the efficacy and safety of a new nonanthracycline regimen with trastuzumab.
Full Text of Background...


Methods

We randomly assigned 3222 women with HER2-positive early-stage breast cancer to receive doxorubicin and cyclophosphamide followed by docetaxel every 3 weeks (AC-T), the same regimen plus 52 weeks of trastuzumab (AC-T plus trastuzumab), or docetaxel and carboplatin plus 52 weeks of trastuzumab (TCH). The primary study end point was disease-free survival. Secondary end points were overall survival and safety.
Full Text of Methods...


Results

At a median follow-up of 65 months, 656 events triggered this protocol-specified analysis. The estimated disease-free survival rates at 5 years were 75% among patients receiving AC-T, 84% among those receiving AC-T plus trastuzumab, and 81% among those receiving TCH. Estimated rates of overall survival were 87%, 92%, and 91%, respectively. No significant differences in efficacy (disease-free or overall survival) were found between the two trastuzumab regimens, whereas both were superior to AC-T. The rates of congestive heart failure and cardiac dysfunction were significantly higher in the group receiving AC-T plus trastuzumab than in the TCH group (P<0.001). Eight cases of acute leukemia were reported: seven in the groups receiving the anthracycline-based regimens and one in the TCH group subsequent to receiving an anthracycline outside the study.
Full Text of Results...


Conclusions

The addition of 1 year of adjuvant trastuzumab significantly improved disease-free and overall survival among women with HER2-positive breast cancer. The risk–benefit ratio favored the nonanthracycline TCH regimen over AC-T plus trastuzumab, given its similar efficacy, fewer acute toxic effects, and lower risks of cardiotoxicity and leukemia. (Funded by Sanofi-Aventis and Genentech; BCIRG-006 ClinicalTrials.gov number, NCT00021255.)


http://www.nejm.org/doi/full/10.1056/NEJMoa0910383
__________________
Diagnosed 2007
Stage IIb Invasive Ductal Carcinoma, Pagets, 3 of 15 positive nodes

Traditional Treatment: Mastectomy and Axillary Node Dissection followed by Taxotere, 6 treatments and 1 year of Herceptin, no radiation
Former Chemo Ninja "Takizi Zukuchiri"

Additional treatments:
GP2 vaccine, San Antonio Med Ctr
Prescriptive Exercise for Cancer Patients
ENERGY Study, UCSD La Jolla

Reconstruction: TRAM flap, partial loss, Revision

The content of my posts are meant for informational purposes only. The medical information is intended for general information only and should not be used in any way to diagnose, treat, cure, or prevent disease
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