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Old 08-07-2018, 11:23 AM   #1
Lani
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study determines optimum time 2 start herceptin in early bc pts is<12 wks after diagn

osis--500 patients included--could have been different with largersample size

Article | Published: 18 May 2018

Epidemiology
Impact of timing of trastuzumab initiation on long-term outcome of patients with early-stage HER2-positive breast cancer: the “one thousand HER2 patients” project
Giuseppe Gullo, Naomi Walsh, David Fennelly, Reetesh Bose, Janice Walshe, Dimitrios Tryfonopoulos, Kate O’Mahony, Lisa Hammond, Nuno Silva, Deirdre McDonnell, Josephine Ballot, Cecily Quinn, Enda W. McDermott, Denis Evoy, Ruth Prichard, James Geraghty, John Amstrong & John Crown
British Journal of Cancervolume 119, pages374–380 (2018) | Download Citation

Abstract
Background
The optimal timing of (neo)adjuvant trastuzumab initiation with respect to chemotherapy and surgery remains undefined.

Methods
Retrospective analysis of a large institutional database of HER2-positive patients who received anti-HER2 therapy. We included all Stage I to III patients treated with trastuzumab with a minimum follow up of 3 years. The date of first breast biopsy was recorded as initial diagnosis.

Results
A total of 506 patients [adjuvant: 386 (76%)-neo-adjuvant: 120 (24%)] were included. The median time-to-first-trastuzumab (TFT) from diagnosis was 12 weeks (range 1.9–122.3). Median follow-up is 73.3 months (range 1.4–176.3). TFT was significantly shorter in the neo-adjuvant than in the adjuvant cohort (median: 4.4 vs. 14 weeks, p < 0.00001). Despite the neo-adjuvant cohort having significantly more node-positive patients (75 vs. 53%, p < 0.0001), DFS rate (neo-adjuvant: 12.5 vs. adjuvant: 18%, p = 0.094) was numerically superior in neo-adjuvant patients. A TFT ≤ 12 weeks was associated with significantly superior DFS and OS over TFT > 12 weeks. Early concomitant regimens were associated with superior DFS over delayed-concomitant and sequential regimens.

Conclusions
Initiating trastuzumab more than 12 weeks from diagnosis has a negative impact on clinical outcome. Neo-adjuvant anti-HER2 therapy could be the optimal strategy to treat early stage HER2-positive breast cancer.
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Old 08-07-2018, 02:12 PM   #2
Carol Ann
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Re: study determines optimum time 2 start herceptin in early bc pts is<12 wks after d

Thanks for posting this, Lani!


My HER2 +++ tumor was only discover after my double mastectomy; it was hiding in the "healthy" breast. I had to wait to start chemo/herceptin while I healed up from another surgery to remove and test lymph nodes from the "healthy" side.


My first tumor was discovered during removal of an "infected" nipple that turned out to be Paget's disease. NO accurate mammograms, ultrasounds, or even an MRI in my case.


Time for diagnosis to first Herceptin/chemo was about 8 weeks, September to November. For the first tumor though it was longer, surgery was in July, but this tumor was not HER2+++.



Just past the 5 year mark for the first tumor and coming up on the 5 year mark for the second.



BOTH were ER+ so I continue taking Arimidex every day.


So far, so good! Nice to know I am in the ballpark for Herceptin doing the most good. .


Carol Ann
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July 24, 2013: "Infected" Right Nipple and benign cyst removed, pathology report revealed Paget's, DCIS, and ILC 1.25 cm, ER+/Pro+/HER2 equivocal, Grade 2 under benign cyst, previous diagnostic mammo/ultrasound said I was perfectly healthy in both breasts.

Aug 18, 2013: MRI report says Left breast is perfectly healthy "consistent with previous studies".

Sept 2013: I insist on a bilateral mastectomy anyway. Too nervewracking to let left breast remain with higher risk after 3 cancers in right, nipple in right is already gone anyhow.

Sept 18, 2013: Bilateral mastectomy, 11 right nodes removed, ALL negative BUT -- ER+/PRO+/HER2+ tumor, 1.0 cm, Grade 2 found in a piece of "grossly unremarkable" breast tissue from prophylactic mastectomy of left breast, no nodes removed.

Oct 25, 2013: 13 left side nodes removed, ALL negative, Stage 1 across the board, NO RADS needed, YAAAAY! Port also installed.

Nov 25, 2013 Begin 6 rounds TCH.

March 10, 2014 Just finished 6th and LAST Chemo today, YAAAAAY!

March 24, 2014 Echocardiogram to make sure I'm still good for Herceptin every 3 weeks.

March 31, 2014 Echo results NORMAL, first Herceptin all by itself. Now if only my eyes would stop streaming from the Taxotere ... :)

April 21, 2014 Started Arimidex and therapy for "mild" lymphedema in left hand and arm

May 2014 Therapy completed, I have sleeves and gloves for both arms, a Flexi touch lymph pump to hook up to for an hour every day, and I've become an arm bandaging expert. :)

June 2014 Begin Fosamax to prevent osteoporosis; bone scan revealed osteopenia

Nov 17, 2014 FINAL Herceptin!

Dec 4, 2014 My right thigh muscle has been extra achy for days ... I discover a blister rash cluster on the side of my right thigh while taking a shower. Port appointment cancelled until Dec 17, my doc is working me in tomorrow afternoon to see me and the rash. My muscle at least feels less achy.

Dec 5, 2014 Yep, I have shingles. Boo! I start acyclovir and also have a prescription for a painkiller just in case for over the weekend.

Dec 17, 2014 Port is OUT!

January 2016 Shingles again and this time it started where my left breast (where the hidden HER2+++ tumor was!) used to be. My onc nurse got me a same day appointment to see my doc when I called and told her I had a rash on the site. The antiviral meds are working once again, though, so that is good news. :)
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Old 08-08-2018, 08:59 AM   #3
Becky
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Re: study determines optimum time 2 start herceptin in early bc pts is<12 wks after d

However, my timing has never been good. Diagnosed in 2004 when the first Herceptin trials were closed and Herceptin was not given yet. When initial results were given at the 2005 ASCO convention, I demanded Herceptin and got my year of it alone as chemo and radiation were already done. Something worked as I am still here and will be 14 years NED at the end of this month. Have faith always.
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Kind regards

Becky

Found lump via BSE
Diagnosed 8/04 at age 45
1.9cm tumor, ER+PR-, Her2 3+(rt side)
2 micromets to sentinel node
Stage 2A
left 3mm DCIS - low grade ER+PR+Her2 neg
lumpectomies 9/7/04
4DD AC followed by 4 DD taxol
Used Leukine instead of Neulasta
35 rads on right side only
4/05 started Tamoxifen
Started Herceptin 4 months after last Taxol due to
trial results and 2005 ASCO meeting & recommendations
Oophorectomy 8/05
Started Arimidex 9/05
Finished Herceptin (16 months) 9/06
Arimidex Only
Prolia every 6 months for osteopenia

NED 14 years!

Said Christopher Robin to Pooh: "You must remember this: You're braver than you believe and stronger than you seem and smarter than you think"
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Old 08-12-2018, 12:46 PM   #4
tricia keegan
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Re: study determines optimum time 2 start herceptin in early bc pts is<12 wks after d

Thanks Lani, like Becky it was several months before I began Herceptin in '05 but very pleased to still be here and healthy thirteen years later.
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Tricia
Dx July '05 IDC 1.9cm Triple positive 3/9 nodes positive
A/C X 4 ..Taxol/Herceptin x 12 wks then herceptin 1 yr
Rads x 36 ..oophorectomy August '06
Currently taking Arimidex..
June 2011 osteopenia/ zometa x1 yearly- stopped Zometa 2015 as Dexa show normal bone density.
Stopped Arimidex July 2014- Restarted Arimidex 2015 for a further two years on the advice of my Onc.
2014 Normal Dexa scan
2018 Mammo all clear, still NED!
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Old 08-29-2018, 02:46 PM   #5
Jean
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Re: study determines optimum time 2 start herceptin in early bc pts is<12 wks after d

Like Becky I had treatment later. I was dx. in 4/2005. I was told that hercetpin was not the protocol for early stage (I was stage 1 6mm.) I had lumpectomy and then radiation. I continued to search and fight for treatment. I did start TCH later. Dr. Salmon was convinced that I should and all women should be treated with Her2, regardless of being stage 1.

So far so good - I remain following up with my onc. every 6 months, I still continue to Femara.

Best Wishes,
Jean
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Stage 1, Grade 1, 3/30/05
Lumpectomy 4/15/05 - 6MM IDC
Node Neg. (Sentinel node)
ER+ 90% / PR-, Her2+++ by FISH
Ki-67 40%
Arimidex 5/05
Radiation 32 trt, 5/30/05
Oncotype DX test 4/17/06, 31% high risk
TOPO 11 neg. 4/06
Stopped Arimidex 5/06
TCH 5/06, 6 treatments
Herceptin 5/06 - for 1 yr.
9/06 Completed chemo
Started Femara Sept. 2006
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