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 ? "
Trastuzumab-associated cardiac events at 8 years of median follow-up in the Herceptin Adjuvant trial (BIG 1-01).
PURPOSE To document the rate and outcome of trastuzumab-associated cardiac dysfunction in patients following 1 or 2 years of adjuvant therapy .  PATIENTS AND METHODS The Herceptin Adjuvant ( HERA ) trial is a three-arm , r and omized trial comparing 2 years or 1 year of trastuzumab with observation in 5,102 patients with human epidermal growth factor receptor 2 ( HER2 ) -positive early-stage breast cancer . Cardiac function was closely monitored . Eligible patients had left ventricular ejection fraction ( LVEF ) ≥ 55 % at study entry following neoadjuvant chemotherapy with or without radiotherapy .  This 8-year median follow-up analysis considered patients r and omly assigned to 2 years or 1 year of trastuzumab or observation . RESULTS The as-treated safety population for 2 years of trastuzumab ( n = 1,673 ) , 1 year of trastuzumab ( n = 1,682 ) , and observation ( n = 1,744 ) is reported . Cardiac adverse events leading to discontinuation of trastuzumab occurred in 9.4 % of patients in the 2-year arm and 5.2 % of patients in the 1-year arm . Cardiac death , severe congestive heart failure ( CHF ) , and confirmed significant LVEF decrease remained low in all three arms . The incidence of severe CHF ( 0.8 % , 0.8 % , and 0.0 % , respectively ) and confirmed significant LVEF decrease ( 7.2 % , 4.1 % , and 0.9 % , respectively ) was significantly higher in the 2-year and 1-year trastuzumab arms compared with the observation arm . Severe CHF was the same for 2-year and 1-year trastuzumab . Of patients with confirmed LVEF decrease receiving 2-year trastuzumab , 87.5 % reached acute recovery . Of patients with confirmed LVEF decrease receiving 1-year trastuzumab , 81.2 % reached acute recovery . CONCLUSION Long-term assessment at 8-year median follow-up confirms the low incidence of cardiac events for trastuzumab given sequentially after chemotherapy and radiotherapy , and cardiac events were reversible in the vast majority of patients
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 ? "