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 ? "
CNS relapses in patients with HER2-positive early breast cancer who have and have not received adjuvant trastuzumab: a retrospective substudy of the HERA trial (BIG 1-01).
BACKGROUND Several r and omised trials have confirmed the benefit of adjuvant trastuzumab for patients with HER2-positive early breast cancer . However , concern has been expressed that adjuvant trastuzumab might be associated with an increased frequency of CNS relapses . We assessed the frequency and course of CNS relapses , either as first event or at any time , using data from the HERA trial . METHODS We estimated the cumulative incidence of first disease-free survival ( DFS ) events in the CNS versus other sites by competing risks analysis in patients with HER2-positive early breast cancer who had been r and omly assigned to receive 1 year of trastuzumab or to observation in the HERA trial after a median follow-up of 4 years ( IQR 3·5 - 4·8 ) . To obtain further information about CNS relapse at any time before death , we circulated a data collection form to investigators to obtain st and ardised information about CNS events that occurred in all patients who had died before July , 2009 . We estimated the cumulative incidence of CNS relapse at any time with a competing risks analysis . RESULTS Of 3401 patients who had been assigned to receive 1 year of trastuzumab or to observation , 69 ( 2 % ) had a CNS relapse as first DFS event and 747 ( 22 % ) had a first DFS event not in the CNS . The frequency of CNS relapses as first DFS event did not differ between the group given 1 year of trastuzumab ( 37 [ 2 % ] of 1703 patients ) and the observation group ( 32 [ 2 % ] of 1698 ; p=0·55 [ Gray 's test ] ) . 481 data collection forms were distributed , of which 413 ( 86 % ) were returned . The proportion of patients who had died and experienced a CNS relapse was numerically higher in the observation group ( 129 [ 57 % ] of 227 ) than in the group given trastuzumab for 1 year ( 88 [ 47 % ] of 186 ; p=0·06 [ Gray 's test ] ) . Most CNS relapses were symptomatic ( 189 [ 87 % ] of 217 ) . CONCLUSION Adjuvant trastuzumab does not increase the risk of CNS relapse in patients with HER2-positive early breast cancer . FUNDING None
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 ? "