HER2 Support Group Forums - View Single Post - Herceptin More than 12 Months Out Revisited

06-23-2005, 02:56 PM

Dear Cynthia,

On the HERA trial, the risk reduction overall was 46%, but there is a chart in the presentation on slide 15 out of 21 that shows that the recurrence reduction after anthracyclines was 57% (1 - .43 (the hazard ratio)) , but the recurrence reduction after anthracyclines + taxanes was just 23% (1-.77) Whenever a line on the chart passes above the number one on the bottom of the chart, that means that the finding was not "statistically significant" for that group. In other words, there is more than a 5% chance that herceptin is not of benefit for that particular group. So, while it is true that both arm B of the U.S. trial and HERA found a reduction in risk when herceptin was given sequentially after an anthracycline/taxane combo, they weren't able to prove that this reduced risk wasn't just a fluke. For women who only received an anthracycline, however, the benefit of herceptin was clearly statistically significant. Just eyeballing it, I would say that the benefit is likely to be a risk reduction of at least 42%.

Of course, nobody knows that the risk reduction would be like for women who got the Walter Reed vaccine and also got herceptin.

I checked the heart risk for arm B and it was 2.2%. My best guess for the reason why HERA had fewer heart problems was that in some regions, like Europe, the anthracycline normally used is epirubicin rather than adriamycin, and epirubicin is much easier on the heart. In fact, M.D. Anderson did a very successful phase I trial of concurrent epirubicin and herceptin and didn't notice heart problems. So she's right that arm B's cardiotoxicity problems would be the ones that are relevant for you.

It would be interesting to see a combined analysis would yield (all of the anthracycline + taxane -> herceptins contrasted with anthracycline + taxane alone for arm B and HERA combined).

I need to talk to my oncologist about his reasoning for why I need herceptin, but I suspect in my case it may be that my cancer hardly responded to pre-surgery epirubicin (I had taxotere afterwards, so a non-standard combo) and that I had a very bad mix of risk factors, so any percentage improvement is important.

Best of luck,

Christine MH (not to be confused with the main Christine. I just try to keep the same username and password for all my cancer-related stuff)

06-23-2005, 02:56 PM	#6
Christine MH Guest Posts: n/a	Dear Cynthia, On the HERA trial, the risk reduction overall was 46%, but there is a chart in the presentation on slide 15 out of 21 that shows that the recurrence reduction after anthracyclines was 57% (1 - .43 (the hazard ratio)) , but the recurrence reduction after anthracyclines + taxanes was just 23% (1-.77) Whenever a line on the chart passes above the number one on the bottom of the chart, that means that the finding was not "statistically significant" for that group. In other words, there is more than a 5% chance that herceptin is not of benefit for that particular group. So, while it is true that both arm B of the U.S. trial and HERA found a reduction in risk when herceptin was given sequentially after an anthracycline/taxane combo, they weren't able to prove that this reduced risk wasn't just a fluke. For women who only received an anthracycline, however, the benefit of herceptin was clearly statistically significant. Just eyeballing it, I would say that the benefit is likely to be a risk reduction of at least 42%. Of course, nobody knows that the risk reduction would be like for women who got the Walter Reed vaccine and also got herceptin. I checked the heart risk for arm B and it was 2.2%. My best guess for the reason why HERA had fewer heart problems was that in some regions, like Europe, the anthracycline normally used is epirubicin rather than adriamycin, and epirubicin is much easier on the heart. In fact, M.D. Anderson did a very successful phase I trial of concurrent epirubicin and herceptin and didn't notice heart problems. So she's right that arm B's cardiotoxicity problems would be the ones that are relevant for you. It would be interesting to see a combined analysis would yield (all of the anthracycline + taxane -> herceptins contrasted with anthracycline + taxane alone for arm B and HERA combined). I need to talk to my oncologist about his reasoning for why I need herceptin, but I suspect in my case it may be that my cancer hardly responded to pre-surgery epirubicin (I had taxotere afterwards, so a non-standard combo) and that I had a very bad mix of risk factors, so any percentage improvement is important. Best of luck, Christine MH (not to be confused with the main Christine. I just try to keep the same username and password for all my cancer-related stuff)