N Engl J Med 2011 Oct 6
Adjuvant trastuzumab in HER2-positive breast cancer.
Related Questions
What alternate neo-adjuvant backbone chemotherapy would you recommend in a patient with ER+ HER2+ clinical stage II breast CA with severe pan-colitis following a cycle of TCHP with docetaxel?
I would switch to weekly paclitaxel and carboplatin with trastuzumab only, but might retry pertuzumab if the patient gets through 6 weeks without recurrent diarrhea. This is actually my preferred version of TCHP (including the pertuzumab), which I find to be better tolerated than the every-3-week do...
Is it acceptable to use TCHP instead of AC-T + trastuzumab as neoadjuvant chemotherapy for HER2+ inflammatory breast cancer?
Yes. With the Neosphere trial demonstrating an impressive PCR rate for the TCHP regimen, the TRAIN-2 trial showing no difference in outcomes with anthracycline containing vs non-anthracycline regimen and the BCIRG-006 trial long term follow showing that only 7 DFS events separating AC-TH and TCH, I ...
For a post-menopausal woman with a pT1c node negative HER2 positive breast cancer, does ER status influence your choice of adjuvant paclitaxel/trastuzumab versus docetaxel/carboplatin/trastuzumab?
Data from pivotal trials addressing adjuvant therapy options for HER2 positive cancers, like BCIRG 006 and APT, doesn't support treating ER positive, HER2 positive cancers any differently than ER negative, HER2 positive cancers.BCIRG 006 that showed TCH regimen to be as good as ACT-H (and superior t...
How would you approach adjuvant therapy for a premenopausal female with HR+, HER2+ breast cancer with N1mic disease?
Assuming that she has had breast surgery, the adjuvant chemotherapy that I would use in this is weekly paclitaxel at 80 mg/m2 x 12 weeks along weekly trastuzumab x 12 weeks followed every 3-week trastuzumab for a total duration of one year. This regimen with median follow-up of 6.5 years (Tolaney et...
Do you offer neoadjuvant therapy to a postmenopausal cT1cN0 , HER2+, ER/PR+ breast IDC or recommend surgery first?
This is currently a very controversial topic, with likely no single straight answer - arguments can be made for both a neoadjuvant approach in light of the KATHERINE trial and for a surgery first approach with treatment de-escalation in light of the APT trial. As others have pointed out, the recentl...
What chemotherapy regimen would you recommend to a patient with local regional recurrent ER negative, HER2 positive breast cancer who received TCH more than 5 years ago?
I would treat this patient with chemotherapy and anti Her-2 therapy. Her-2 positive disease has a higher risk of distant recurrence and as long as the primary tumor is >0.5 cm in size, I recommend chemotherapy with anti Her-2 therapy. The type of anti Her-2 therapy and chemotherapy will depend on th...
Would you switch to TDM-1 in the adjuvant setting in HER-2 positive breast cancer patients with residual disease after neoadjuvant chemotherapy if neoadjuvant chemotherapy did not include anthracyclines?
The introduction of dual HER2 blockade has significantly increased the pathologic complete response rate of HER2+ disease to neoadjuvant therapy. The TRAIN-2 trial demonstrated that anthracycline based therapy did not increase the PCR rate over a taxane based regimen when dual blockade was used. APH...
For patients with HER2 positive breast cancer s/p neoadjuvant chemotherapy with TC-HP who did not have a complete pathological response at surgery, is there any evidence to use an anthracycline-based chemotherapy after the surgery?
There isn't large comparative data comparing giving anthracyclines vs not in non-PCR patients. In NEOSPHERE all the patients got adjuvant anthracycline after nonanthracycline therapy. It appeared that patients with a PCR did numerically better than non-PCR patients despite all getting anthracyclines...
Do you omit anthracyclines in triple positive breast cancer?
The BCIRG 006 trial is relevant for all Her2 positive disease, both ER positive and ER negative. Depending on the risk profile of the patient (T2 disease and beyond), I give TCHP x 6 as neoadjuvant therapy per Neosphere and Tryphanema. For T1cN0 disease that is ER negative, I give adjuvant TH x 12, ...