Combination of Herceptin® with Non–anthracycline-based Chemotherapy Appears to Be Effective

Posted on December 15th, 2009 by

Among women with early, HER2-positive breast cancer, the addition of Herceptin® (trastuzumab) to adjuvant chemotherapy reduces the risk of cancer recurrence and improves survival. Herceptin provides a benefit in combination with either anthracycline- or non–anthracycline-based chemotherapy regimens. These results were presented at the 2009 San Antonio Breast Cancer Symposium.

Twenty to 25 percent of breast cancers overexpress (make too much of) a protein known as HER2. Overexpression of this protein leads to increased growth of cancer cells and a worse breast cancer prognosis. Fortunately, the development of drugs such as Herceptin that specifically target HER2-positive cells has improved prognosis for women with HER2-positive breast cancer.

Herceptin may be used in addition to chemotherapy. Anthracycline-based chemotherapy regimens (regimens that include drugs such as doxorubicin) are common, but are linked with heart problems in some women.

To explore the combination of Herceptin with anthracycline- and non–anthracycline-based chemotherapy regimens, researchers conducted a study known as BCIRG 006. The study enrolled more than 3,200 HER2-positive breast cancer patients. Patients were assigned to one of three treatment groups:

  1. Anthracycline-based chemotherapy
  2. Anthracycline-based chemotherapy plus Herceptin
  3. Non–anthracycline-based chemotherapy plus Herceptin

The anthracycline-based regimen consisted of doxorubicin, cyclophosphamide, and Taxotere® (docetaxel). The non-anthracycline-based regimen consisted of Taxotere and Paraplatin® (carboplatin).

  • Recurrence rates and survival were better in the two Herceptin groups than in the group that did not receive Herceptin. Compared with patients treated with chemotherapy alone, risk of recurrence was reduced by 36% among patients treated with anthracycline-based chemotherapy plus Herceptin, and by 25% among patients treated with non-anthracycline-based chemotherapy plus Herceptin.
  • The differences in recurrence and survival between the two Herceptin groups were not statistically significant, suggesting that the differences could have occurred by chance alone. This means that the addition of Herceptin to anthracycline-based chemotherapy was not clearly better than the addition of Herceptin to non–anthracycline-based chemotherapy.
  • Heart complications were more common among women treated with the anthracycline-based regimen than among women treated with the non–anthracycline-based regimen.

These results confirm that the addition of Herceptin to chemotherapy reduces the risk of recurrence and improves survival among women with early, HER2-positive breast cancer. The results also suggest that the combination of Herceptin with non–anthracycline-based chemotherapy may provide effective cancer control with fewer heart complications. Use of non–anthracycline-based chemotherapy remains controversial, however.

Reference: Slamon D, Eiermann W, Robert N et al. Phase III Randomized Trial Comparing Doxorubicin and Cyclophosphamide Followed by Docetaxel (AC?T) with Doxorubicin and Cyclophosphamide Followed by Docetaxel and Trastuzumab (AC?TH) with Docetaxel, Carboplatin and Trastuzumab (TCH) in Her2neu Positive Early Breast Cancer Patients: BCIRG 006 Study. Presented at the 32nd CTRC-AACR San Antonio Breast Cancer Symposium. December 9-13, 2009. San Antonio, TX. Abstract 62.

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