Ding-Dong! the anthracyclines are dead! SABCS presentation by Dr Slamon shows anthra-

[Lani]

cyclines like doxyrubicin, epirubicin add toxicity (cardiac damage, leukemia, etc) to adjuvant treatment without adding any incremental benefit to a taxane+ carboplatin+herceptin regimen for her2+ breast cancer patients

REPRINT: Study Identifies Highly Effective Treatment Option for Patients With HER2-positive Breast Cancer
[American Association for Cancer Research]
SAN ANTONIO — Combining the chemotherapy drugs docetaxel and carboplatin with the HER2-targeted therapy trastuzumab was identified to be an ideal postsurgery treatment option for patients with HER2-positive breast cancer, regardless of tumor size and whether or not disease has spread to the lymph nodes, according to results from the BETH study presented here at the 2013 San Antonio Breast Cancer Symposium, held Dec. 10-14.

"Worldwide, anthracyclines such as doxorubicin [Adriamycin] and epirubicin have dominated breast cancer treatment for decades because of a perceived incremental benefit of 3 to 5 percent in disease-free survival and overall survival that was observed in meta-analysis overview studies that viewed breast cancer as a single disease," said Dennis J. Slamon, M.D., Ph.D., director of clinical/translational research at the University of California, Los Angeles (UCLA) Jonsson Comprehensive Cancer Center, and professor of medicine and chief of the Division of Hematology/Oncology at the UCLA Department of Medicine. "It turns out that anthracyclines were particularly active in the treatment of HER2-positive disease once we applied molecular subtype analyses to breast cancers. These data were derived from treatments used before the development of trastuzumab. In HER2-positive breast cancers, anthracyclines improved outcomes dramatically while adding little or no incremental benefit to the other subtypes that represent 75 to 80 percent of the disease. Unfortunately, the long-term side effects of anthracyclines in all groups include congestive heart failure and leukemia. We and others have previously shown that adding trastuzumab to anthracycline-based therapy in adjuvant disease increases this cardiac toxicity between three- to fivefold.

"Our new results, which surpassed our expectations, show that it really is not necessary to include an anthracycline as part of the treatment regimen to obtain really ideal results for patients with HER2-positive breast cancer, even if they have a large tumor or have node-positive disease," added Slamon, who is also a leader of a Stand Up To Cancer Dream Team. "The importance of the results lies in the fact that the TCH [docetaxel, carboplatin, and trastuzumab] combination has a much better safety profile than anthracycline and trastuzumab combinations and is now equally effective."

[StephN]

Everything was pointing to this outcome!!!

"Our new results, which surpassed our expectations, show that it really is not necessary to include an anthracycline as part of the treatment regimen to obtain really ideal results for patients with HER2-positive breast cancer, even if they have a large tumor or have node-positive disease," added Slamon,

[norkdo]

Hooooooly Crap!!!!!!
Blowing my mind here.

[JillaryJill]

My onc was way ahead of the curve. 3 years ago she told me this. I probably asked her the Anthracycline question 20 different times, 20 different ways, she insisted on TCH being equally effective.

[Bellaokc]

Oh wow! I almost can't believe that!

[suzan w]

I had to go the adriamyacin/cytoxin route in order to get herceptin in 2005. The long term effects were discussed, yet, for me, stage 1...no herceptin without A/C...Glad to have had the herceptin!!

[AlaskaAngel]

And then there is me, a stage 1 HR+ HER2 positive possible "late" recurrer, who had CAF but no taxane and no trastuzumab.

It would be so helpful to know from documented study just "how much" it helps to exercise, and maintain proper weight, and take vitamin D, and take metformin (which deals with the stem cells that taxanes and doxorubicin do not), in comparison to all the chemo they continue to hang onto using.

['lizbeth]

I'm with you Alaska Angel!

The problem with early stage breast cancer is that 3 women of 10 benefit from chemo in the current system with NCCN guidelines.

The other 7, who 6 would likely benefit more from avoiding chemo are not being identified with the current system of care.

We all would benefit from more exercise, healthier diets with more organic veggies and less saturated fats, adequate Vitamin D, and some of us with metformin.

How many of us have even been tested for Vitamin D levels and then subsequently monitored?

The are many false premises in cancer treatment that both the industry and patients hold onto - there is "finding a cure" and there is finding an "acceptable cure".

[suzan w]

I am curious as to the statistics (yea, I know...numbers schumbers) for incidents of leukemia as a result of chemo...or perhaps it might be as a result of herceptin...it is still such a guessing game. I do know that maintaining a healthy lifestyle is critical. And, yes, at my last regular dr appointment, I had my vitamin D level tested and it is OK!!

[AlaskaAngel]

Hi Suzanw,

You and I are in the same boat about that. The problem there is that because the number of patients exposed to doxycycline when doxycycline expanded to adjuvant use for those with much earlier stage I patients is still considered so recent that they don't yet have all the information to predict the increased incidence of leukemia due to exposure to doxycycline.

My understanding is that leukemia occurrence is usually late (as in decades later), so the "crowd" of us stage I's who were exposed to it still haven't reached that point in time.

If there are long-term problems with the increased usage of the taxanes (and I don't know that there are), the experience with them is even newer so it could take longer to find out what they might be.

[norkdo]

so the anthra drugs i got might kill me from congestive heart failure. nice. we've cured the disease but killed the patient.

[AlaskaAngel]

I agree that based on the ongoing dependence on chemotherapy, it is progress to have some comparison of the various chemotherapies.

But the mindset is still far from being focused on the BEST possible treatments for early stage HER2 positive breast cancer patients.

"Our new results, which surpassed our expectations, show that it really is not necessary to include an anthracycline as part of the treatment regimen to obtain really ideal results for patients with HER2-positive breast cancer, even if they have a large tumor or have node-positive disease," added Slamon

['lizbeth]

Yeah SuzanW! You got your vitamin D tested!

The leukemia risk is why I skipped the anthracycline and went with the taxane.

We are certainly all pioneers in these treatments - and new ones now with Herceptin, Tykerb, Perjeta, Kadcyla, etc It will take decades for everything to settle out. By then we will have even more new treatments. It's a roll of the dice . . . we make the best decisions based on the information available at the time.

May we all be blessed with good health.

[tricia keegan]

I think the Dr's gave us what what they felt was right at the time, I was dx in 2005 and had A/c but thankful it gave me so many years of NED and if it leads to issue's in the future so be it it, we can only go with what we know at the time and I'm grateful for the treatments and time I've had.

[AlaskaAngel]

At the time I was treated, my onc followed the path of the majority of oncs at the time in 2002 and did not tell me anything about the trials for the use of trastuzumab, even though the trastuzumab trials had accumulated enough data to be quite indicative of success. I would only have been eligible for one of those trials under the criteria, BUT I had specifically asked to participate in any such trials that were available. Although it turned out that I remain NED despite never having had trastuzumab, it could well have made a crucial difference for me.

I'm sure my onc considered his care to be conscientious, professional, and caring at the time.

What continues to be a mystery to me is the ethical dilemma of how it will ever be possible to transition to regimens that do not include chemotherapy with a researcher physician mindset that openly states that the continuing practice of including chemotherapy is part of an "ideal" regimen for all HER2 patients, despite the knowledge that the vast majority who are receiving chemotherapy get ZERO benefit from it.

[StephN]

Hello everyone -
The two instances I know where leukemia developed in members of this group, it happened very early on. So I don't have direct experience of anyone with a late onset.
One had the normal (standard of care) treatment and perhaps a year later was showing symptoms.
The second member was stage IV and treated for a few years when her leukemia developed.
They both went through stem cell transplants - one in Buffalo and one in Seattle - but eventually passed away from various other health issues.

[Jean]

OMGoodness, Dr. Salmon told me this when I saw him in 2006....shame that he had to endure years more of having dr. use A/C when he was aware so early in the trials.

As our Brenda would say....
" crap on a crap stick. "

[Mtngrl]

This is great news for people diagnosed in the future.

I didn't have any anthracylines. Small blessing.

I just read a study that showed that in stage IV, people who got Herceptin and a taxane had a median overall survival of 40+ months--almost double the time for all metastatic bc diagnoses lumped together. I recall another study in the last year or so that said Taxol seems to help train the immune system to handle the cancer. Taxanes stopped the cancer in my liver after only 12 doses. Speaking anecdotally, I can't really jump on the chemo-skeptic bandwagon with my history.

I know it might be (probably is) different for early stage disease. I hope they do get past "slash, burn and poison" for you guys.

[Adriana Mangus]

Glad to hear that, at least the new comers won't have to go through these unnecessary chemo treatment.

About time.

[Becky]

I also thought leukemia occured early. It did in two personal people I know and then there's the TV personality, Robin Roberts, of which it also happened early.