10 fast facts about HER-2–positive breast cancer

'lizbeth · 05-28-2014, 01:49 PM

10 fast facts about HER-2–positive breast cancer

May 28, 2014

Increased knowledge about breast cancer subtypes has led to the development of highly targeted treatments for these subtypes. Although breast cancers with an overexpression of HER-2 may grow more quickly, recent studies have found that they respond favorably to some of the newer agents.

In particular, newer drugs such as trastuzumab and ado-trastuzumab emtansine have yielded impressive results on patients with HER-2–positive breast cancer.
However, these newer agents have not yet become cost effective: in 2013, HemOnc Today reported that ado-trastuzumab, a front-runner in the treatment of HER-2–positive disease, cost about $9,800 per month. Given the median PFS of 9.6 months associated with the drug, a complete course of treatment would cost approximately $94,080.
Yet if these newer, targeted agents prove to be the “game changers” they show signs of becoming, this may be well worth the cost. HemOnc Today presents 10 “fast facts” clinicians should consider with regard to the identification, treatment and management of patients with HER-2–positive breast cancer.
1. Adding everolimus to a regimen of trastuzumab and vinorelbine may improve PFS.
According to a recent randomized, double-blind, phase 3 study, the addition of everolimus to a combination of trastuzumab and vinorelbine yielded a median PFS of seven months in women with HER-2–positive breast cancer. Read more
2. Recent ASCO guidelines recommend chemotherapy, trastuzumab and pertuzumab as first-line systemic therapy for advanced HER-2–positive breast cancer.
In 2014, The American Society of Clinical Oncologists (ASCO) released two clinical practice guidelines for treating patients with advanced HER-2–positive breast cancer. In the first guideline, ASCO advised a first-line treatment of chemotherapy, trastuzumab and pertuzumab for the systemic treatment of patients with inoperable, locally advanced and metastatic HER-2–positive breast cancer. Read more
3. For brain metastases linked to advanced HER-2–positive disease with a good survival prognosis, ASCO recommends surgery and/or radiotherapy.
ASCO’s second guideline pertained to brain metastases, which occur in 30 to 40% of patients with HER-2–positive breast cancer. For patients with a poor prognosis for survival, ASCO advised options such as surgery, whole brain radiation therapy and systemic therapies. Read more
4. In patients with stage I HER-2-positive breast cancer, adjuvant paclitaxel and trastuzumab may extend disease-free survival.
A study presented at the San Antonio Breast Cancer Symposium found that women with stage I HER-2–positive disease had increased disease-free survival with a regimen of adjuvant paclitaxel and trastuzumab. The researchers noted, however, that patients with T1a tumors may not require trastuzumab-based chemotherapy. Read more
5. HER-2–positive patients who showed progression after treatment with trastuzumab and lapatinib had improved PFS when treated with ado-trastuzumab emtansine vs. other medications.
According to recent findings from the phase 3 TH3RESA trial, patients with HER-2–positive breast cancer that continued to advance after treatment with trastuzumab and lapatinib had significantly longer median PFS with a regimen of ado-trastuzumab emtansine, vs. physician’s choice of treatment.

'lizbeth · 05-28-2014, 01:55 PM

6. A combination of ado-trastuzumab emtansine and pertuzumab appear to have significant antitumor activity in patients with HER-2–positive breast cancer.

A recent Phase 2a study found that in patients with HER-2–positive, locally advanced breast cancer, a combined regimen of ado-trastuzumab emtansine yielded significant antitumor activity and an adequate safety profile. Read more

7. Patients with HER-2–positive, HR-negative breast cancer may achieve a higher rate of complete response with chemotherapy plus neratinib.
A study presented at the American Association for Cancer Research Annual Meeting found that in patients with the HER-2–positive, HR-negative subtype of breast cancer may derive greater benefit from chemotherapy plus neratinib vs. the standard approach of chemotherapy plus trastuzumab. Read more
8. Trastuzumab combined with docetaxel and carboplatin may yield favorable results in patients with HER-2–positive disease, without the use of an anthracycline.
A study presented at the 2013 San Antonio Breast Cancer Symposium found that a regimen consisting of trastuzumab combined with the chemotherapy drugs docetaxel and carboplatin resulted in “excellent” postsurgical results, and was non-inferior to a regimen that included an anthracycline. Read more
9. PIK3CA mutation may predict pathologic complete response to neoadjuvant treatment in patients with HER-2–positive disease.
In women with HER-2–positive, HR-positive breast cancer, a PIK3CA genetic mutation was independently associated with pathologic complete response to neodjuvant therapy, according to two studies presented at the 2013 San Antonio Breast Cancer Symposium. Read more
10. In cases of inflammatory or locally advanced HER-2–positive disease, neoadjuvant chemotherapy plus trastuzumab, followed by adjuvant trastuzumab yielded “durable” EFS.
In updated phase 3 results, a higher percentage of patients treated with chemotherapy plus trastuzumab achieved five-year event-free survival than those undergoing chemotherapy alone. Read more

mjm · 05-30-2014, 04:19 AM

Thanks 'Lizbeth!