AC>TH v. TCH adjuvant regimen

[CPA]

There has been an ongoing debate here on this board and among oncologists as to the best decision for adjuvant chemo for her2+ patients. I just read the second interim results from the BCIRG 006 study (Dr. Slamon, et al) presented at San Antonio.

The presentation summarized:

The 006 update for HER2 positive malignancies shows the difference in number of DFS events and breast cancer deaths in favor of AC-TH, neither of which are statistically significant, is now exceeded by the number of critical adverse events. These include grade III/IV CHF and AC- related leukemia as well as a small AND sustained loss of LVEF for 18% (189 pts) both of which are highly statistically significant…

Go to www.bcirg.org for a pdf of the presentation

Did anybody at SABCS sit through this presentation? Any comments? I am mostly interested because my wife chose TCH as her adjuvant chemo option because she feared potential cardiac issues from the anthracycline regimen. At first, it looked like she may have taken a bit of a risk, but with the newer results, it looks like it may have been a good decision. Am I reading this correct?

[CPA]

sorry about the formatting... I guess I cannot cut/paste very well today

[Becky]

You are reading it correctly. I personally attended this and made comment on the SABCS area on this site.

[Karen W]

So, are they saying that because of the risks involved with AC-TH, it is not as good a treatment as TCH? Or, are they saying that AC-TH is not as effective as TCH?

I hope it was an effective treatment because that is what I did.



Hugs,

Karen

[Becky]

In the beginning of this trial, AC followed by TH was superior to TCH versus the arm that had no Herceptin. Now both Herceptin arms are similar. The AC followed by TH is slightly more effective than TCH but not that much more. So little more that the risks of CHF and the rare but existing chance of leukemia may not be worth the risk.


Perhaps in the past, without the use of adjuvant Herceptin, adriamycin or any anthracycline was the best possible choice but now, it seems it may be equal to less toxic regimes. Time will tell as this is just going out 2 years versus one year. Let's see how the curves are next year.

[CPA]

Becky,

You are absolutely right. I think the most important thing to remember is that these options often evolve over time. We are really on the cutting edge with these treatments. It can be frustrating having to wait years for outcomes from these studies.

I have some background in stats, and it is still sometimes confusing to interpret all of these different results and studies.

-Rich

[Karen W]

Thanks Becky. Sometimes trying to understand all the graphs and stats gets a little much for me.

Karen