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Shorter Herceptin Course Not So Helpful

Posted 7/8/2013

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  There are often studies looking at  reducing the length of a particular adjuvant treatment.  We all know that receiving chemotherapy is unpleasant and the drugs are potentially dangerous--both for our QOL (quality of life) and to save our bodies from the possible complications of more durgs, both short and longterm, it would be preferable to do less. There are also the considerations of cost, of course. Fewer cycles are cheaper than more cycles. This study from France found that six months of Trastuzumab (herceptin) is not as effective as twelve months; a year's worth of herceptin is the current standard of care.

  Sometimes these studies have different results. Thirty years ago the standard adjuvant therapy for early breast cancer was two years of CMF chemotherapy.  Around the late 70s, that was reduced to one year, and shortly thereafter, by 1980, the standard course became six months. When I received six months of CMF in 1993, I thought often of those women who had suffered through two years worth, and I could not imagine how they did it.  Conversely, as you likely know, many recent studies have found that taking hormonal therpies (tamoxifen and the AIs) for more than five years is often helpful, and up to ten years may become the routine.

  But I digress. Back to this French study about herceptin. Here is the start of a report from Reuters and Cure Today and then a link to read more.

Shorter trastuzumab course no help in early breast cancer
JULY 2, 2013

NEW YORK (Reuters Health) - In HER2-positive early-stage breast cancer, six months of adjuvant trastuzumab is not equivalent to the standard 12 month course, according to French researchers.

"After 3.5 years follow-up, we failed to show that six months of treatment with trastuzumab was non-inferior to 12 months of trastuzumab," they said in a June 11th online paper in The Lancet Oncology. "Despite the higher rates of cardiac events, 12 months of adjuvant trastuzumab should remain the standard of care."

The authors, led by Dr. Xavier Pivot of University Hospital J Minjoz, Besançon, note that a shorter course has been advocated to alleviate cardiac concerns.

The new study was an open-label trial involving more than 3300 patients who received at least four cycles of chemotherapy, breast-axillary surgery, and up to six months of trastuzumab. They were randomly assigned to stop trastuzumab or continue it for another six months.

With follow-up lasting a median 42.5 months, intention-to-treat analysis showed two-year disease-free survival rates of 93.8% in the 12-month group and 91.1% in the six-month group (p for noninferiority = 0.29).


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