ALLTO trial-update

[Ellie F]

Hi all
I have posted this on the newcomers section but decided to post here also so this information is not missed.
Whilst on another board I noticed that the drug company have STOPPED the one year arm of tykerb in the ALLTO trial as it has be shown to be LESS effective than herceptin.
They are continuing with the other 3 arms, herceptin for one year, herceptin for 6 months then tykerb for 6 months and vice versa.
This trial started just too late for me and I often wondered if having tykerb would have been more effective.We won't know the full story till all the data is available in a couple of years.
Meanwhile women on the discontinued arm are being told to discuss options with their oncs!!

Ellie

[krcll]

I was on the Tykerb-only arm and this scares the bejeezes out of me. Does anyone have some figures as to how much worse than Hercetin alone it turned out to be? I saw on the ASCO website announcement that we all will be offered Herceptin, even if we were finished with Tykerb. Does anyone know how long we will be offered? Has anyone talked to their onc yet? I have an appointment next week and would like to gather as much info before-hand as possible. Ugh, the thought of a whole more year of nail, nose, fatigue issues (common SE's for both Tykerb and Herceptin) is not pleasant, but a girl's gotta do what she's gotta do;-)

[Becky]

First, I was not part of the trial but I also was diagnosed before Herceptin was available.

About 4 months after I finished chemo, Herceptin was available and I did Herceptin alone. Giving Herceptin alone was the way a big European trial gave Herceptin (after chemo and radiation) while here in the USA, the trial was giving Herceptin with chemo (now it is done everywhere with chemo).

That said, statistics are still kept on recurrence free and survival on both these trials (with chemo and without). The Herceptin alone trial reports a 30% reduction in recurrence versus no Herceptin.

I would have a candid discussion with my oncologist on whether Herceptin monotherapy is right for you. You should also understand that you are in it for a year, every 3 weeks.

Herceptin should be offered to you since I read about the results of your arm and it seemed to me that you would be offered something. IF your onc turns you away, immediately get a copy of your file and get a second opinion.

Late Herceptin works - I am still here and am celebrating my 7th year of survivorship right now.

[Ellie F]

Hi Becky
Here in the UK herceptin is still given after chemo at most major centres. I suspect one of the main reasons is the potential cardiac effect of giving herceptin with an anthracycline chemo. As you are probably aware FEC or AC is often given for early node positive bc SOMETIMES with a taxane afterwards dependent on the onc.
Ellie

[Debbie L.]

I don't know if they have published any results on the ALLTO trial but the news on the NeoALLTO one was one of the highlights at SABCS last year, remember? I am in a rush and don't have time to find it on the SABCS website, but here's medpage's write-up (below). There was a trilogy of neoadjuvant HER2+ trials presented -- and pertuzumab was part of some arms.

http://www.medpagetoday.com/MeetingCoverage/SABCS/23858

Also interesting about this is the question of whether response to neoadjuvant treatment is a reliable indicator of benefit (overall survival). It is beginning to seem that for HER2+ (at least, some HER2+?), it may be so. While for other subtypes, perhaps not. So many questions.

Okay, here it is (couldn't resist, and it came up quickly) -- the SABCS general session webcast (you'll see the actual presentation, and the slides) that included the 3 neoadjuvant studies. http://sabcs10.m2usa.com/sabcs.html . I'm not sure this link will work, (it pops up a new window to watch the presentation, and this URL looks pretty generic). You can access it by going here: http://www.sabcs.org/PastSymposia/index.asp#webcast , choosing SABCS2010 Webcasts (first choice) and clicking on: Friday Dec 10th, general session 3, then choose each of the first 3 sessions by clicking and watching them, one at a time.