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 ? "
Sequential versus concurrent trastuzumab in adjuvant chemotherapy for breast cancer.
PURPOSE NCCTG ( North Central Cancer Treatment Group ) N9831 is the only r and omized phase III trial evaluating trastuzumab added sequentially or used concurrently with chemotherapy in resected stages I to III invasive human epidermal growth factor receptor 2-positive breast cancer . PATIENTS AND METHODS Patients received doxorubicin and cyclophosphamide every 3 weeks for four cycles , followed by paclitaxel weekly for 12 weeks ( arm A ) , paclitaxel plus sequential trastuzumab weekly for 52 weeks ( arm B ) , or paclitaxel plus concurrent trastuzumab for 12 weeks followed by trastuzumab for 40 weeks ( arm C ) . The primary end point was disease-free survival ( DFS ) . RESULTS Comparison of arm A ( n = 1,087 ) and arm B ( n = 1,097 ) , with 6-year median follow-up and 390 events , revealed 5-year DFS rates of 71.8 % and 80.1 % , respectively . DFS was significantly increased with trastuzumab added sequentially to paclitaxel ( log-rank P < .001 ; arm B/arm A hazard ratio [ HR ] , 0.69 ; 95 % CI , 0.57 to 0.85 ) . Comparison of arm B ( n = 954 ) and arm C ( n = 949 ) , with 6-year median follow-up and 313 events , revealed 5-year DFS rates of 80.1 % and 84.4 % , respectively . There was an increase in DFS with concurrent trastuzumab and paclitaxel relative to sequential administration ( arm C/arm B HR , 0.77 ; 99.9 % CI , 0.53 to 1.11 ) , but the P value ( .02 ) did not cross the prespecified O'Brien-Fleming boundary ( .00116 ) for the interim analysis . CONCLUSION DFS was significantly improved with 52 weeks of trastuzumab added to adjuvant chemotherapy . On the basis of a positive risk-benefit ratio , we recommend that trastuzumab be incorporated into a concurrent regimen with taxane chemotherapy as an important st and ard-of-care treatment alternative to a sequential regimen
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 ? "