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Old 09-21-2018, 05:43 PM   #1
Lani
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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.
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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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Old 09-22-2018, 09:57 AM   #2
SoCalGal
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Re: For HER2+ Breast Cancer, Anthracyclines and Trastuzumab Are Safer in Sequence

I'm working on an art project, and incorporating collage in with my art - finally found good use for all those anthem EOB's that I saved. The hall of fame EOB's with the turn downs and tone of voice change regarding "salvage therapy" not covered and independent medical reviews, etc. Meanwhile, also in this "SAVE" file are so many emails from when I first joined the site. From Chrissy, Brenda, and so many other wonderful women from 2007 era. And so many threads of yours, Lani, with pink highlighter and my comments "save this" all over the place. So, thank you again, for contributing so much. With much appreciation!! Flori
__________________
1996 cancer WTF?! 1.3 cm lumpectomy Er/Pr neg. Her2+ (20nodes NEGATIVE) did CMF + rads. NED.
2002 recurrence. Bilateral mastectomy w/TFL autologous recon. Then ACx2. Skin lymphatic rash. Taxotere w/Herceptin x4. Herceptin/Xeloda. Finally stops spreading.
2003 - Back to surgery, remove skin mets, and will have surgery one week later when pathology can confirm margins.
‘03 latisimus dorsi flap to remove skin mets. CLEAN MARGINS. Continue single agent Herceptin thru 4/04. NED.
‘04 '05 & 06 tiny recurrences - scar line. surgery to cut out. NED each time.
1/2006 Rads again, to scar line. NED.

3/07 Heartbreaking news - mets! lungs.sternum. Try Tykerb/Xeloda. Tykerb/Carbo/Gemzar. Switch Oncs.
12/07 Herceptin.Tykerb. Markers go stable.
2/8/08 gamma knife 13mm stupid brain met.
3/08 Herceptin/tykerb/avastin/zometa.
3/09 brain NED. Lungs STABLE.
4/09 attack sternum (10 daysPHOTONS.5 days ELECTRONS)
9/09 MARKERS normal!
3/10 PET/CT=manubrium intensely metabolically active but stable. NEDhead.
Wash out 5/10 for tdm1 but 6/10 CT STABLE, PET improving. Markers normal. Brain NED. Resume just Herceptin plus ZOMETA
Dec 2010 Brain NED, lungs/sternum stable. markers normal.
MAR 2011 stop Herceptin/allergy! Go back on Tykerb and switch to Xgeva.
May-Aug 2011 Tykerb Herceptin Xgeva.
Sept 2011 Tykerb, Herceptin, Zometa, Avastin.
April 2012 sketchy drug trial in NYC. 6 weeks later I’m NED!
OCT 2012 PET/CT shows a bunch of freakin’ progression. Back to LA and Herceptin.avastin.zometa.
12/20/12 add in PERJETA!
March 2013 – 5 YEARS POST continue HAPZ
APRIL 2013 - 6 yrs stage 4. "FAILED" PETscan on 4/2/13
May 2013: rePetted - improvement in lungs, left adrenal stable, right 6th rib inactive, (must be PERJETA avastin) sternum and L1 fruckin'worsen. Drop zometa. ADD Xgeva. Doc says get rads consultant for L1 and possible biopsy of L1. I say, no thanks, doc. Lets see what xgeva brings to the table first. It's summer.
June-August 2013HAPX Herceptin Avastin Perjeta xgeva.
Sept - now - on chemo hold for calming tummy we hope. Markers stable for 2 months.
Nov 2013 - Herceptin-Perjeta-Avastin-Xgeva (collageneous colitis, which explains tummy probs, added Entocort)
December '13 BRAIN MRI ned in da head.
Jan 2014: CONTINUING on HAPX…
FEB 2014 PetCT clinical “impression”: 1. newbie nodule - SUV 1.5 right apical nodule, mildly hypermetabolic “suggestive” of worsening neoplastic lesion. 2. moderate worsening of the sternum – SUV 5.6 from 3.8
3. increasing sclerosis & decreasing activity of L1 met “suggests” mild healing. (SUV 9.4 v 12.1 in May ‘13)
4. scattered lung nodules, up to 5mm in size = stable, no increased activity
5. other small scattered sclerotic lesions, one in right iliac and one in thoracic vertebral body similar in appearance to L1 without PET activity and not clearly pathologic
APRIL 2014 - 6 YRS POST GAMMA ZAP, 7 YRS MBC & 18 YEARS FROM ORIGINAL DX!
October 2014: hold avastin, continue HPX
Feb 2015 Cancer you lost. NEDHEAD 7 years post gamma zap miracle, 8 years ST4, +19 yrs original diagnosis.
Continue HPX. Adding back Avastin
Nov 2015 pet/ct is mixed result. L1 SUV is worse. Continue Herceptin/avastin/xgeva. Might revisit Perjeta for L1. Meantime going for rads consult for L1
December 2015 - brain stable. Continue Herceptin, Perjeta, Avastin and xgeva.
Jan 2016: 5 days, 20 grays, Rads to L1 and continue on HAPX. I’m trying to "save" TDM1 for next line. Hope the rads work to quiet L1. Sciatic pain extraordinaire :((
Markers drop post rads.
2/24/16 HAP plus X - markers are down
SCIATIC PAIN DEAL BREAKER.
3/23/16 Laminectomy w/coflex implant L4/5. NO MORE SCIATIC PAIN!!! Healing.
APRIL 2016 - 9 YRS MBC
July 2016 - continue HAP plus Xgeva.
DEC 2016 - PETCT: mets to sternum, lungs, L1 still about the same in size and PET activity. Markers not bad. Not making changes if I don't need to. Herceptin/Perjeta/Avastin/Xgeva
APRIL 2017 10 YEARS MBC
December 2017 - Progression - gonna switch it up
FEB 2018 - Kadcyla 3 cycles ---->progression :(
MAY30th - bronchoscopy, w/foundation1 - her2 enriched
Aug 27, 2018 - start clinical trial ZW25
JAN 2019 - ZW25 seems to be keeping me stable
APRIL 2019 - ONE DOZEN YEARS LIVING METASTATIC
MAY 2019 - progression back on herceptin add xeloda
JUNE 2019 - "6 mos average survival" LMD & CNS new single brain met - one zap during 5 days true beam SBRT to cord met
10/30/19 - stable brain and cord. progression lungs and bones. washing out. applying for ds8201a w nivolumab. hope they take me.
12/27/19 - begin ds8401a w nivolumab. after 2nd cycle nodes melt away. after 3rd cycle chest scan shows Improvement, brain MRI shows improvement, resolved areas & nothing new. switch to plain ENHERTU. after 4th cycle, PETscan shows mostly resolved or improved results. Markers near normal. I'm stunned but grateful.
10/26/20 - June 2021 Tucatinib/xeloda/herceptin - stable ish.
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Old 09-23-2018, 07:02 PM   #3
Lani
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Re: For HER2+ Breast Cancer, Anthracyclines and Trastuzumab Are Safer in Sequence

You are most welcome!!

Lani
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