Breast Cancer Coverage from Every Angle

Shorter Course of Trastuzumab in Some HER2-Positive Early Breast Cancers

By: Joseph Cupolo
Posted: Tuesday, December 4, 2018

According to a subgroup analysis of the Short-HER trial, reported at the European Society for Medical Oncology (ESMO) 2018 Congress in Munich (Abstract 191PD_PR), women with HER2-positive early breast cancer who have small tumors appear to have similar disease-free survival with a 9-week course of adjuvant trastuzumab as those who received 1 year of adjuvant therapy. In addition, the abbreviated course of treatment was associated with a lower risk of cardiac toxicity. Also presented at the Congress (Abstract LBA12_PR), the PERSEPHONE trial showed that a 6-month course of adjuvant trastuzumab was cost-effective compared with 12 months, with an average cost saving of nearly £10,000 (Euros 11,300) per patient and no apparent detriment to quality of life.

“Physicians can stop trastuzumab before 1 year in patients who develop a cardiac event during treatment without compromising efficacy and can consider shorter-duration trastuzumab treatment in patients at risk of cardiac toxicity and a low- or intermediate-risk of breast cancer relapse,” stated lead author of the Short-HER trial, Pierfranco Conte, MD, of the University of Padu, Italy, in an ESMO press release. However, he added, “Based on our data, 1-year trastuzumab remains the standard treatment for women with HER2-positive early breast cancer.”

In the randomized Short-HER trial, 1,254 patients with HER2-positive early breast cancer received either 9 weeks or 1 year of trastuzumab; all patients also received chemotherapy. Women at low- and intermediate-risk of relapse accounted for 89% of patients in the study.

After a median of 6 years of follow-up, patients with low- and intermediate-risk had similar 5-year disease-free survival with a 9-week course of trastuzumab (88%) as with 1 year (89%). However, their risk of cardiac events was nearly three times lower (4.5% vs. 12.8%).

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