Abstract
Breast cancer positive for HER2 (human epidermal growth factor receptor 2) is associated with a poor prognosis for patients with both early-stage and metastatic breast cancer. Trastuzumab has been shown to be effective and is now considered the standard of care for early-stage patients with HER2-positive breast cancer. In that population, trastuzumab has been studied in six randomized clinical trials. Overall, use of this agent leads to a significant reduction in risk of disease recurrence and improvement in overall survival. Despite the strong evidence for the use of trastuzumab in managing HER2-positive early breast cancer (EBC), a number of clinical controversies remain. The authors of this paper undertook a review of the available scientific literature on adjuvant trastuzumab to produce practical considerations from Canadian oncologists. The panel focused their discussion on five key areas: Management of node-negative disease with tumours 1 cm or smaller in size. Management of HER2-positive EBC across the spectrum of the disease (that is, nodal and steroid hormone receptor status, tumour size) Timing of trastuzumab therapy with chemotherapy for early-stage disease: concurrent or sequential. Treatment duration of trastuzumab for EBC. The role of non-anthracycline trastuzumab-based regimens.
Highlights
About 23,000 new cases of breast cancer will be diagnosed in Canada in 2010 1
The nsabp B-31 trial was a U.S.-based phase iii multicentre randomized open-label trial in her2-positive ebc that assessed the addition of trastuzumab to an anthracycline-based regimen [doxorubicin and cyclophosphamide followed by paclitaxel every 3 weeks for 4 cycles] with 1 year of trastuzumab [ac→th (Figure 1)]
While there continues to be a dfs benefit of sequential trastuzumab over chemotherapy alone, the dfs benefit was superior for the concurrent trastuzumab arm relative to the sequential trastuzumab arm
Summary
About 23,000 new cases of breast cancer will be diagnosed in Canada in 2010 1. The 11th St. Gallen international expert consensus meeting was not able to provide a definitive recommendation regarding the use of anti-her[2] therapy for patients with her2-positive node-negative tumours smaller than 1 cm in size, because of the absence of data to suggest an increased risk of disease recurrence or a significant benefit from treatment 14. The 2010 National Comprehensive Cancer Network (nccn) guidelines recommend the need to balance the known cardiotoxicity risk of trastuzumab against the uncertain absolute benefits that may exist before considering trastuzumab treatment 15. The goal of this manuscript is to discuss the optimal utilization of adjuvant trastuzumab in the management of her2-positive ebc in the context of common clinical scenarios:. ● Treatment duration of trastuzumab for ebc ● Role of non-anthracycline trastuzumabbased regimens
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