Pre-Operative
Herceptin ® Highly Effective in Breast Cancer
According to results presented at the 40th annual meeting
of the American Society of Clinical Oncology (ASCO), the addition
of Herceptin ® (trastuzumab) to chemotherapy prior to surgery
significantly improves anti-cancer responses in patients with
HER-2 positive breast cancer.
Breast cancer is diagnosed in approximately 250,000 individuals
annually in the United States. Patients with early-stage breast
cancer, or cancer that has not spread outside the breast to
distant sites in the body, have a high cure rate with standard
therapeutic approaches. Standard treatment for early breast
cancer may include chemotherapy prior to surgery, referred
to as neoadjuvant therapy. Neoadjuvant therapy reduces the
size of the cancer, allowing for optimal chances of a complete
surgical removal of the cancer with breast-sparing surgery,
versus a mastectomy where the entire breast is removed. Studies
are continuing to evaluate the effects of neoadjuvant therapy
on long-term survival compared to adjuvant therapy in early
breast cancer.
Herceptin ® is a monoclonal antibody that is targeted
against the human epidermal growth factor-2 (Her-2) pathway.
The Her-2 pathway is associated with growth and replication
of cancer cells. Some cancer cells overexpress Her-2, and
are referred to as Her-2 positive. Herceptin ® binds to
distinct components of HER2-positive cells, and disrupts cellular
replication. The addition of Herceptin ® to chemotherapy
had demonstrated improved outcomes, including survival, in
patients with HER-2 positive metastatic breast cancer, and
studies are ongoing to evaluate Herceptin ® in different
stages of the disease.
Researchers from the M.D. Anderson Cancer Center recently
conducted a clinical trial to evaluate the addition of Herceptin ®
to chemotherapy as neoadjuvant therapy in patients with early
breast cancer. This trial included 42 patients with HER-2
positive breast cancer. Approximately half of the patients
were treated with Herceptin ® plus chemotherapy (5-fluorouracil,
epirubicin and cyclophosphamide), and approximately half of
the patients were treated with the same chemotherapy regimen
only prior to surgery for early breast cancer. Following neoadjuvant
therapy, 67% of patients treated with Herceptin ®/chemotherapy,
compared to only 25% of patients treated with chemotherapy
alone had no detectable cancer. Treatment was well tolerated.
The trial’s Data Monitoring Committee stopped the trial
early due to the superiority and tolerability of the addition
of Herceptin ® to chemotherapy in this group of patients.
Longer follow-up is needed to determine long-term survival
benefits.
The researchers concluded that the addition of Herceptin ®
to chemotherapy as neoadjuvant therapy in Her-2 positive breast
cancer significantly improves anti-cancer responses and is
well tolerated. The researchers at M.D. Anderson have adopted
this treatment regimen as the standard treatment for this
group of patients. Patients with early, Her2-positive breast
cancer may wish to speak with their physician about the risks
and benefits of neoadjuvant therapy including Herceptin ®
or the participation in a clinical trial evaluating novel
therapeutic options. Two sources of information regarding
ongoing clinical trials include the National Cancer Institute
(cancer.gov) and www.cancerconsultants.com. Personalized clinical
trial searches are also performed on behalf of patients at
cancerconsultants.com
Reference: A. U. Buzdar, K. Hunt, T. Smith, et al. Significantly
higher pathological complete remission (PCR) rate following
neoadjuvant therapy with trastuzumab (H), paclitaxel (P),
and anthracycline-containing chemotherapy (CT): Initial results
of a randomized trial in operable breast cancer (BC) with
HER/2 positive disease. Proceedings from the 40th annual meeting
of the American Society of Clinical Oncology. New Orleans,
LA. June 2004. Abstract #520.
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