Two Important Determinants May Play a Role in the Success of the FinHer Trial

Abstract

TO THE EDITOR: We read with great interest the article by Joensuu et al, in which the authors demonstrated that a brief course of trastuzumab for 9 weeks administered concomitantly with docetaxel followed by three cycles of fluorouracil, epirubicin, and cyclophosphamide was safe and effective in women with human epidermal growth factor receptor 2–positive cancer with axillary node– positive or high-risk node-negative breast cancer. We propose two important determinants that may play a role in the success of this regimen. Compared with other adjuvant trastuzumab trials, trastuzumab was administered earlier. In two US trials, trastuzumab was administered after completion of four cycles of adriamycine and cyclophosphamide. In the HERA (Herceptin Adjuvant) trial, trastuzumab was used after completion of all chemotherapy. Second, there has been concern about the sequencing of taxanes and anthracyclines. In a recent randomized phase III study by the Hellenic Oncology Research Group, docetaxel administered every 3 weeks followed by combination epirubicin/cyclophosphamide (E/C) was compared with a regimen of epirubicin/cyclophosphamide/fluorouracil as adjuvant chemotherapy in women with axillary node–positive early breast cancer. Five-year disease-free survival was found to be better in the group receiving sequential docetaxel followed by E/C (72.6% v 67.2%; P .041). Furthermore, the first report of the Neo-tAnGo (Neoadjuvant Study of Sequential Epirubicin with Cyclophosphamide and Paclitaxel With or Without Gemcitabine) study, a neoadjuvant randomized phase III trial of E/C and paclitaxel gemcitabine in high-risk early breast cancer also concluded that the sequence of the taxane-first regimen had a significant advantage in pathologic complete response rate compared with the sequence of the anthracyclinefirst regimen (20% v 15%; P .03). Therefore, administration of taxane followed by anthracycline in the FinHer (Finland Herceptin) trial may also lead to better results.