for those with ER+her2+ breast cancer, an important article

Lani · 01-20-2009, 01:05 PM

Ann Oncol. 2009 Jan 15. [Epub ahead of print]

Role of biologic therapy and chemotherapy in hormone receptor- and HER2-positive breast cancer.

Buzdar AU.
Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
BACKGROUND: To review the efficacy of chemotherapy and human epidermal growth factor receptor 2 (HER2)-targeted therapy when used in addition to hormonal therapy for the optimal management of estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-positive (HER2+) breast cancer. Design: Literature published from January 2003 to March 2008 was reviewed to assess the use of chemotherapy and biologic therapy in addition to hormonal agents. RESULTS: Aromatase inhibitors (AIs) demonstrated greater effectiveness in the adjuvant setting than tamoxifen for the management of ER+ and HER2+ breast cancer. Evidence of cross talk between HER2- and ER-signaling pathways suggests that combined treatment with HER2 blockade and hormonal therapy may offer clinical advantages beyond those provided by hormonal therapy alone in ER+/HER2+ disease. Combined therapy with trastuzumab plus an aromatase AI significantly improves progression-free survival, response rates, and clinical benefits when compared with AI monotherapy in postmenopausal women. Several large studies demonstrated that trastuzumab significantly improves disease-free and overall survival when given in combination with, or following, chemotherapy, regardless of hormone receptor status. CONCLUSIONS: HER2-targeted therapy maybe combined with AIs for the treatment of ER+/HER2+ metastatic breast cancer in postmenopausal women. HER2-targeted therapy in combination with AIs for treatment of ER+/HER2+ early breast cancer needs to be prospectively evaluated.
PMID: 19150946

BonnieR · 01-20-2009, 03:58 PM

I am not sure I understand. Can someone interpret for me? Thanks!

Laurel · 01-20-2009, 04:38 PM

Bonnie,

It sure looks as though we triple pos. guys & gals, or perhaps even those that are E.R. + and Her-2 + should be using an A.I. even if we are not post-menopausal. At present the protocol is for us to receive Tamoxifen until we are post-menopausal. I am presumed to be peri-menopausal even though I haven't had a period since April. I will not be considered menopausal until a full year has passed without menstruating. My onc. wants to have me do a year and a half of Tamoxifen before switching to an A.I. for the remaining 3.5 years of the 5 yr course of therapy. In light of this new study I wonder if she will opt to move me off of Tamoxifen to an A.I. sooner? I will have to present this to her at my next appointment.

Many thanks to Lani for this interesting post!

Hope this helps to clarify, Bonnie!

Susan · 01-20-2009, 05:06 PM

Hi I know that my oncologist wanted me to be on AI's, so that's why I had my ooph done. I'm currently on Arimidex, but boy do my joints hurt!

Cannon · 01-20-2009, 08:05 PM

I did the same, had my ovaries removed and went on AI. There must have been some other studies on this previously, or perhaps I just heard anecdotal things.

BonnieR · 01-20-2009, 08:23 PM

Thanks Laurel! So, I am postmenopausal and on Femara. And that is a good thing.

Jean · 01-20-2009, 09:02 PM

Hi Lani,
Thank you, as always for posting the latest news that is so vital.

I especially enjoyed reading this new article since it supports what Dr. Slamon has been saying the past few years. I have been a bit concerned with the treatment of herceptin alone (maybe the future will be that) but for now the studies have been showing that herceptin works best along with chemo.

Several large studies demonstrated that trastuzumab significantly improves disease-free and overall survival when given in combination with, or following, chemotherapy, regardless of hormone receptor status.

This new article should hold very special value to those who are not sure about the chemo/hercpetin combo.
For now it is showing and demonstrating that is what we "have" that is showing results, until we can have studies showing other wise. I believe as we advance in research and drugs the day will finaly arrive when the chemo maybe dropped.

Great information in regards to AI proving to work in harmony with herceptin. If we all search back Becky has mentioned this about 2.5 yrs ago from early studies.

As I have said often to newly dx early stage sisters, the stats are not in yet - we may also soon see from studies that herceptin given to all her2....will change the face of this disease....

Each day we get a bit closer.
Thanks Lanie,

Hopeful · 01-21-2009, 12:12 AM

Jean,

I just wanted to make an observation about your statement that "the studies have been showing that herceptin works best along with chemo." The studies done in early stage patients have been to test chemo alone vs. chemo with herceptin. The combination has been more effective than chemo alone. Until there is a Herceptin only arm added to the studies, they tell us nothing about how chemo enhances Herceptin. All they tell us is that herceptin enhances chemo. We need that third arm in the study, to determine whether it is just the Herceptin, or the combination of Herceptin with chemo, that does the trick.

Hopeful

Lien · 01-21-2009, 01:10 AM

Thank you for posting this Lani. I'm one of the few who didn't have chemo or Herceptin. My onc recommended Zoladex and Arimidex when I was diagnosed almost 5 years ago. I've been on that combo and am almost (next week) 5 years out from diagnosis. Happily dancing with NED, once the stiffness in my joints has subsided, which takes about 15 minutes each morning. (As long as I keep moving I'm fine. When I wake up in the morning I feel like an old woman. I see it as practice for years to come ;-))

Jacqueline

schoolteacher · 01-21-2009, 05:43 AM

Lani,

Thank you for posting this article. I did start taking the Tamoxifen December 24, 2008, but I will keep this article to use in defense of switching to an AI.

AMelia

duga35 · 01-21-2009, 08:31 AM

I wonder if there have been any studies with men and AI. So far I'm just taking Tamoxifin. Maybe when I get past menopause my onc will start me on it. Dunno.

That was just a joke. My wife says that I have periods every month and I get cranky.

Debbie L. · 01-21-2009, 09:29 AM

This abstract is just a teaser! Don't you want to know more? "Significant" is such a vague word. I have written to ask for a full text copy but I don't know if I found a current email for Dr. Buzdar. I'll let you all know if I get a response.

Debbie Laxague

Jean · 01-21-2009, 11:47 AM

Hi Hopeful,
Just to clear up my previous post...I posted...

"what Dr. Slamon has been saying the past few years. I have been a bit concerned with the treatment of herceptin alone (maybe the future will be that) but for now the studies have been showing that herceptin works best along with chemo."

I DID not state that herceptin is enhanced by chemo, just that the combination is proving to show better results....please see link below.

Sorry if what I posted was misunderstood.

http://medicineworld.org/cancer/lead...st-cancer.html

The above article details the information of survival benefits to those who are have been treated with herceptin and chemo.

Patients in the clinical trials who received trastuzumab in combination with standard combination chemotherapy had a 52 percent decrease in disease recurrence compared to patients treated with chemotherapy alone. This difference is highly statistically significant. "This is a major advance for many thousands of women with breast cancer," said NCI Director Andrew C. von Eschenbach, M.D. "These results are one more example that we are at a major turning point in the use of targeted therapies to eliminate suffering and death from cancer," he added.

As I posted earlier this combination is proving to show improved results....herceptin in combination with chemo. Lately there have been early stage patients who are in a spin about herceptin/and/chemo if they should have the treatment. These are such difficult decisons during a very difficult time when most are shattered just hearing they have bc....let alone the fear of chemo. I believe it is important for them to understand that at the present time we only know what is offering the best benefits. Sorry if my post was confusing to anyone.

All Good Wishes,
jean

AlaskaAngel · 01-21-2009, 12:42 PM

We all are stuck in limbo and confusion by pure logic here.

I think what is tragic is that the two pieces of research that have continued to fail to be done, (herceptin given alone, and herceptin given long after chemo) are in reality, YEARS after the introduction of trastuzumab, STILL being used by sheer inference as if they were actual evidence against not doing chemo when in fact they are not evidence at all.

The result in this circumstance is a person who is experiencing serious discomfort and difficulty in trying to find a way to make a rational decision about what to do next about her situation, and the necessary scientific information to advise her remains unnecessarily limited, oncs or no oncs, cancer centers or no cancer centers.

By acquiescing to the status quo or cheering others on based on our genuine desire to see others survive, we encourage it to continue.

AlaskaAngel

Jean · 01-21-2009, 01:47 PM

The entire issue and matter regarding what treatment is the best choice...continues to be difficult. Research has not offered us the much needed answers.

One would think after years upon years of people suffering with this disease "cancer" (all types) that
we would be further along. Maybe we are and we don't appreicate the advances we have made because we badly want a cure and answers. I do not have the answers on that.

Much is still a mystery...We could all drive ourselves to insanity...dealing with the news of a bc dx is certainly enough for most to feel shattered. Add to the stress all the information that one has to search through to be certain that the proper or best treatment choices are being made.

Then we have the trials and new information that may offer help?.. brave women decide to go forward with the trials (that are showing some positive results)and endure the side effects...but do so because it offers improvement. There are just so many unknowns with fighting this disease.

Our onc's use what they have been working with, that is a known treatment to them, I have learned first hand how hard it is to have a major cancer center change their standard of practice.

It was only "yesterday" that early stage patients could not have herceptin. It is extremely painful when I have to read new members asking what treatment choices to make. As of now, we have no cure and until we do we will have to endure this mystery.

What I do know and this is how I am coping...I listen to the best dr. read as much as I can (most of what we have access to is hopeful, but again no answers) we do know that some are responding. We are all making the best decisons we can.

There are negatives with every tragic disease on this earth, side effects from meds that people must use for other serious diseases. Who said life was easy?

I am just grateful for this site - at least there is support and information.

Best Regards To All,
Jean