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Hi Rhonda,
This somewhat depends on the trial. In the U.S. trials, herceptin after three weekly AC->taxol reduced recurrence by 13% over AC->taxol whereas adding herceptin to the taxol part slightly more than halved recurrence over AC->taxol. There were hardly any node-negative women in these trials.
In the international HERA trial, however, herceptin given after chemotherapy showed a dramatic 46% difference in recurrence. HERA was did not include a herceptin-based chemo arm, just a two year's of herceptin arm that has yet to report out (November maybe?).
Potential reasons for the difference between the two trials:
1. Most of the women in the HERA trial just got an anthracycline. For the women who got a taxane in the HERA trial, the reduction in risk of recurrence was 23%, whereas for women who just got an anthracycline, it was much, much larger (I think 67% maybe). So, looking at the two studies it could be that the true benefit of herceptin after an anthracycline + taxane combo would be somewhere between 13% and 23%.
2. One third of the women on the HERA trial were node-negative.
It should be noted that concurrent herceptin seems to be slightly harder on the heart than sequential herceptin, but not by much. However, an article in the NCI Bulletin said: "Importantly, after 6 months of
terminating or completing trastuzumab therapy, a substantial
proportion of these women were safely taken off their cardiac medicine,
indicating that the toxicity may be reversible.
Experts cautioned that long-term follow-up data will need to be collected to really know what this risk is.
Personally, if I had just been diagnosed, I would go for herceptin-based chemo if I could get it.
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