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Old 09-21-2018, 05:48 PM   #1
Lani
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Join Date: Mar 2006
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For HER2+ Breast Cancer, Anthracyclines and Trastuzumab Are Safer in Sequence

News > Reuters Health Information
For HER2+ Breast Cancer, Anthracyclines and Trastuzumab Are Safer in Sequence

By Lorraine L. Janeczko
September 21, 2018


NEW YORK (Reuters Health) - Treating operable HER2-positive breast cancer with anthracyclines and trastuzumab in sequence works as well as giving them together, and it's safer, researchers suggest.
"Anthracyclines, which are so important in the systemic therapy of breast cancer treatment, do not need to be delivered concurrently with trastuzumab in order to achieve the best clinical outcomes," said Dr. Kelly K. Hunt of the University of Texas MD Anderson Cancer Center in Houston.
"If we cure our patients' breast cancer, we don't want to give them heart failure," she told Reuters Health by phone. "Anthracyclines and trastuzumab both have cardiac toxicity, which may cause problems for long-term health when delivered together. It is very reassuring that physicians can safely give anthracyclines but don't need to deliver these agents at the same time as trastuzumab, so they're less likely to see cardiac toxicity."
Dr. Hunt and her colleagues treated 280 adult women with invasive operable HER2-positive breast cancer in the ACOSOG Z1041 randomized phase 3 trial to determine their disease-free survival (DFS) and overall survival (OS). The women ranged in age from 28 to 76 years and both groups were demographically similar, the team notes in JAMA Oncology, online September 6.
As reported earlier, pathologic complete response rates (pCR) were similar in women treated with either concurrent or sequential administration of trastuzumab with fluorouracil, epirubicin and cyclophosphamide (FEC): 56.5% for FEC followed by paclitaxel and trastuzumab compared to 54.2% for paclitaxel and trastuzumab followed by FEC and trastuzumab.
Over a four-year period beginning in 2007 at 36 centers in the continental U.S. and Puerto Rico, the sequential-treatment group of 138 women received FEC every three weeks for 12 weeks followed by paclitaxel plus trastuzumab weekly for 12 weeks.
The concurrent group of 142 participants received paclitaxel plus trastuzumab weekly for 12 weeks followed by FEC every three weeks and weekly trastuzumab for 12 weeks.
After five years, both groups had similar rates of DFS and OS.
The sequential group reported 18 recurrences and two second primary cancers, and the concurrent group reported 22 recurrences and three second primary cancers; eight deaths occurred in the first group and 12 in the second.
Dr. Mateusz Opyrchal, an assistant professor of oncology at Roswell Park Comprehensive Cancer Center in Buffalo, New York, told Reuters Health by email, "The addition of trastuzumab to neoadjuvant treatments has revolutionized treatment for HER2-positive breast cancer; therefore, it is becoming increasingly difficult to show small differences between treatment arms."
"This study confirms the current paradigm of administering anti-HER2 therapy sequentially rather than concurrently with anthracyclines. These results won't affect the current standard, but they provide important reinforcement that current approaches are appropriate," added Dr. Opyrchal, who was not involved in the study.



Reuters Health Information © 2018
Cite this article: For HER2+ Breast Cancer, Anthracyclines and Trastuzumab Are Safer in Sequence - Medscape - Sep 20, 2018.



Medscape Consult

lucio laudadio, MD
Oncology, Medical
Adjuvant treatment breast cancer pT1c pN0 HER2+++ ER+
J






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