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 ? "
C-MYC alterations and association with patient outcome in early-stage HER2-positive breast cancer from the north central cancer treatment group N9831 adjuvant trastuzumab trial.
PURPOSE Findings from the human epidermal growth factor receptor 2 ( HER2 ) -positive National Surgical Adjuvant Breast and Bowel Project ( NSABP ) B31 trial suggested that MYC/HER2 coamplification ( > 5.0 copies/nucleus ) was associated with additional benefit from adjuvant trastuzumab in patients with early-stage breast cancer . To further explore this relationship , we investigated associations between MYC amplification and disease-free survival ( DFS ) in a similar adjuvant trastuzumab HER2-positive breast cancer trial-North Central Cancer Treatment Group ( NCCTG ) N9831 . PATIENTS AND METHODS This analysis included 799 patients r and omly assigned to receive chemotherapy alone or with concurrent trastuzumab on N9831 . Fluorescence in situ hybridization ( FISH ) was performed by using a dual-probe mixture for MYC and centromere 8 ( MYC : CEP8 ) on tissue microarrays . MYC amplification was prespecified as MYC : CEP8 ratio > 2.2 or average MYC copies/nucleus > 5.0 . Exploratory variables included polysomy 8 . RESULTS In comparing DFS ( median follow-up , 4.0 years ) between treatments , patients with MYC : CEP8 ratio ≤ 2.2 ( n = 618 ; 77 % ) and > 2.2 ( n = 181 ; 23 % ) had hazard ratios ( HRs ) of 0.46 ( P < .001 ) and 0.67 ( P = .33 ) , respectively ( interaction P = .38 ) . Patients with MYC copies/nucleus ≤ 5.0 ( n = 534 ; 67 % ) and > 5.0 ( n = 265 ; 33 % ) had HRs of 0.52 ( P = .002 ) and 0.48 ( P = .02 ) , respectively ( interaction P = .94 ) . Patients with MYC : CEP8 ratio < 1.3 with normal chromosome 8 copy number ( n = 141 ; 18 % ) and ≥ 1.3 or < 1.3 with polysomy 8 ( n = 658 ; 82 % ) had HRs of 0.66 ( P = .28 ) and 0.44 ( P < .001 ) , respectively ( interaction P = .23 ) . Patients with MYC copies/nucleus < 2.5 ( n = 130 ; 16 % ) and ≥ 2.5 ( n = 669 ; 84 % ) had HRs of 1.07 ( P = .87 ) and 0.42 ( P < .001 ) , respectively ( interaction P = .05 ) . CONCLUSION We did not confirm the B31 association between MYC amplification and additional trastuzumab benefit . Exploratory analyses revealed potential associations between alternative MYC/chromosome 8 copy number alterations and differential benefit of adjuvant trastuzumab
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 ? "