HER2 Support Group Forums - View Single Post - Types of chemo tx, neo-adj vs. adj. etc

Lani · 11-12-2006, 10:17 PM

Their paper hypothesized that when this was the case Anthracyclines would
be more effectively combined with herceptin than when this was not the case and proposed that IF THIS PROVED OUT IN THE LONG-RUN that perhaps one could save thousands of patients the toxicity of anthracyclines and markedly reduce the cardiotoxicity of herceptin (as it seems to be the combination of the anthracycline caused damage and the herceptin caused damage which causes most cases of herceptin-induced cardiotoxicity)

Dr. Slamon gave a preliminary report on a relatively small number of patients treated with TCH instead of A/C T and H which showed survival benefit of approximately 42-45% instead of 50% (numbers not exact, but not far off) compared to chemotherapy alone. Again, he proposed that if these numbers continued to show
similar results as the study matured that perhaps TOPO IIa testing MIGHT BECOME the new standard of care, with those testing negative for TOPO IIa PERHAPS receiving TCH, with anthracyclines(ie A/C+TH) reserved for those who were TOPO IIa positive.

Since San Antonio I have read two papers, from other groups stating that topoIIa positivity is not always associated with anthracycline efficacy. Perhaps the story is not so simple or perhaps their study was done in some different way or their patients tended to have different tumor subtypes than Dr. Slamon's. It appears there are different types of her2+ tumors besides the ER+PR+, ER+PR- and ER-PR-.

I think some oncologists went home from San Antonio thinking this WOULD
become the new standard of care. Since all those being treated off protocol with adjuvant and neoadjuvant herceptin for early breast cancer are still being treated with a drug which has not been FDA approved for the purpose, oncologists feel they can have some leeway in how they treat any individual patient.

Neoadjuvant chemotherapy is in general as I understand it only offered to those with larger tumors in order to allow them to have breast conserving surgery instead of a mastectomy. This allows one to tell if the treatment is working or not
(change in the tumor by exam, US, MRI, PET/CT,etc). Some patients are now getting neoadjuvant hormonal therapy in clinical trials.

Having recently helped an 84 year old with her2+ breast cancer with information on which to base her decisions I can say that it is a good thing that there is no one way to treat all her2+ breast cancers. Would you want chemotherapy as an 84 year old?

11-12-2006, 10:17 PM	#3
Lani Senior Member Join Date: Mar 2006 Posts: 4,782	continued... Their paper hypothesized that when this was the case Anthracyclines would be more effectively combined with herceptin than when this was not the case and proposed that IF THIS PROVED OUT IN THE LONG-RUN that perhaps one could save thousands of patients the toxicity of anthracyclines and markedly reduce the cardiotoxicity of herceptin (as it seems to be the combination of the anthracycline caused damage and the herceptin caused damage which causes most cases of herceptin-induced cardiotoxicity) Dr. Slamon gave a preliminary report on a relatively small number of patients treated with TCH instead of A/C T and H which showed survival benefit of approximately 42-45% instead of 50% (numbers not exact, but not far off) compared to chemotherapy alone. Again, he proposed that if these numbers continued to show similar results as the study matured that perhaps TOPO IIa testing MIGHT BECOME the new standard of care, with those testing negative for TOPO IIa PERHAPS receiving TCH, with anthracyclines(ie A/C+TH) reserved for those who were TOPO IIa positive. Since San Antonio I have read two papers, from other groups stating that topoIIa positivity is not always associated with anthracycline efficacy. Perhaps the story is not so simple or perhaps their study was done in some different way or their patients tended to have different tumor subtypes than Dr. Slamon's. It appears there are different types of her2+ tumors besides the ER+PR+, ER+PR- and ER-PR-. I think some oncologists went home from San Antonio thinking this WOULD become the new standard of care. Since all those being treated off protocol with adjuvant and neoadjuvant herceptin for early breast cancer are still being treated with a drug which has not been FDA approved for the purpose, oncologists feel they can have some leeway in how they treat any individual patient. Neoadjuvant chemotherapy is in general as I understand it only offered to those with larger tumors in order to allow them to have breast conserving surgery instead of a mastectomy. This allows one to tell if the treatment is working or not (change in the tumor by exam, US, MRI, PET/CT,etc). Some patients are now getting neoadjuvant hormonal therapy in clinical trials. Having recently helped an 84 year old with her2+ breast cancer with information on which to base her decisions I can say that it is a good thing that there is no one way to treat all her2+ breast cancers. Would you want chemotherapy as an 84 year old?