the REALLY REALLY good news and the bad news (her2 stats outside clinical trials)

[Lani]

Good news: her2+ Stage I II III respond so well to herceptin their stats are
incredibly good

Bad news: % of Stage IVs whose first met is to the CNS is astonishingly high and even higher in those who had herceptin

SINCE SO FEW PROGRESSED TO STAGE IV THIS IS STILL GREAT NEWS AND SINCE HER2+ BRAIN METS RESPOND SO WELL TO SRS IT IS STILL RELATIVELY GOOD NEWS. NOW THEY NEED TO FIGURE OUT HOW TO PROTECT THE CNS (IE, WHETHER GIVING LAPATINIB OR OTHER DRUGS WHICH CROSS THE BBB PROPHYLACTICALLY) AND/ OR ON WHAT SCHEDULE /WHO SHOULD BE MRI'D PERIODICALLY TO CATCH THOSE CNS METS BEFORE THEY BECOME LARGE OR MULTIPLE

Curr Oncol. 2012 Aug;19(4):197-201.
Outcomes of women with early-stage breast cancer receiving adjuvant trastuzumab.
Seal MD, Speers CH, O'Reilly S, Gelmon KA, Ellard SL, Chia SK.
Source
BC Cancer Agency-Vancouver, Vancouver, BC.
Abstract
INTRODUCTION:
Large randomized trials assessing the benefit of adjuvant trastuzumab in early-stage breast cancer positive for the human epidermal growth factor receptor 2 (her2) have demonstrated a significant improvement in survival. The objective of the present study was to describe the outcomes of women who received adjuvant trastuzumab for her2-positive breast cancer in British Columbia since publicly funded population-based use was initiated in July 2005.
METHODS:
Women from British Columbia, newly diagnosed with stage i-iii breast cancer between July 2004 and December 2006, who were positive for her2 overexpression by immunohistochemistry (3+) or amplification by fluorescence in situ hybridization (ratio ≥ 2.0) were included in the study. Data were collected from the prospectively assembled BC Cancer Agency Outcomes Unit, with cases linked to the provincial pharmacy data repository to determine the proportion of women who received adjuvant trastuzumab.
RESULTS:
Our retrospective study identified 703 her2-positive patients, of whom 480 (68%) received trastuzumab. In patients receiving trastuzumab, the 2-year relapse-free survival was 96.1% [95% confidence interval (CI): 93.6% to 97.7%] and the overall survival was 99.3% (95% CI: 97.9% to 99.8%). Among node-negative and -positive patients, the 2-year relapse-free survival was 97.8% and 94.8% respectively (p = 0.09) for the trastuzumab-treated group and 90.9% and 77.3% (p = 0.01) for the group not receiving trastuzumab (n = 223). Site of first distant metastasis was the central nervous system in 19.5% of the entire cohort and in 37.5% of patients treated with trastuzumab.
DISCUSSION:
This population-based analysis of adjuvant trastuzumab use among Canadian women demonstrates highly favorable outcomes at the 2-year follow-up.
PMID: 22876145