Longer trastuzumab duration ( hera : 2 years vs. 1 year ) showed no improvement in dfs or os and a higher rate of cardiac events .
In the neoadjuvant setting ( neoaltto , GeparQuinto , Neosphere ) , trastuzumab alone or in combination with another anti-her2 agent ( lapatinib , pertuzumab ) was compared with either lapatinib or pertuzumab alone and showed superior or equivalent rates of pathologic complete response .
In the adjuvant setting , lapatinib alone or in combination with trastuzumab , compared with trastuzumab alone ( altto ) or with placebo ( teach ) , was not superior in dfs .
BACKGROUND This systematic review addresses the question " What is the optimal targeted therapy for female patients with early-stage human epidermal growth factor receptor 2 (her2)-positive breast cancer ? "
Predictability of adjuvant trastuzumab benefit in N9831 patients using the ASCO/CAP HER2-positivity criteria.
The 2007 American Society of Clinical Oncology and College of American Pathologists ( ASCO/CAP ) joint guidelines defined criteria for HER2 positivity of tumors that modified those of the US Food and Drug Administration ( FDA ) , causing some confusion and uncertainty among clinicians . Using data from the HER2-positive breast cancer adjuvant trial N9831 , we compared eligibility for patients who met both criteria , and disease-free survival ( DFS ) was assessed by Cox proportional hazards regression . The number of patients in the N9831 trial retrospectively eligible for trastuzumab therapy was decreased when ASCO/CAP criteria vs FDA criteria were applied to immunohistochemistry and /or fluorescence in situ hybridization results ( 107 [ 3.7 % ] of 2904 patients with immunohistochemistry results , 37 [ 1.3 % ] of 2809 patients with fluorescence in situ hybridization results , and 47 [ 1.7 % ] of 2809 patients with both results ) . Improvement in DFS was similar among patients treated with trastuzumab under either set of criteria ( concurrent trastuzumab and chemotherapy compared with chemotherapy alone : by ASCO/CAP criteria , hazard ratio of DFS = 0.59 , 95 % confidence interval = 0.48 to 0.73 ; by FDA criteria but not ASCO/CAP criteria , hazard ratio = 0.60 , 95 % confidence interval = 0.12 to 3.13 ; number needed to treat to prevent one additional DFS event at 5 years : 10 and 11.2 patients , respectively ) . Following the 2007 ASCO/CAP criteria for HER2 positivity would negate the option of potentially life-saving trastuzumab therapy for a small but meaningful group of patients . We recommend using FDA -approved HER2 criteria for therapeutic decision making
Longer trastuzumab duration ( hera : 2 years vs. 1 year ) showed no improvement in dfs or os and a higher rate of cardiac events .
In the neoadjuvant setting ( neoaltto , GeparQuinto , Neosphere ) , trastuzumab alone or in combination with another anti-her2 agent ( lapatinib , pertuzumab ) was compared with either lapatinib or pertuzumab alone and showed superior or equivalent rates of pathologic complete response .
In the adjuvant setting , lapatinib alone or in combination with trastuzumab , compared with trastuzumab alone ( altto ) or with placebo ( teach ) , was not superior in dfs .
BACKGROUND This systematic review addresses the question " What is the optimal targeted therapy for female patients with early-stage human epidermal growth factor receptor 2 (her2)-positive breast cancer ? "