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 ? "
Adjuvant trastuzumab in HER2-positive breast cancer.
BACKGROUND Trastuzumab improves survival in the adjuvant treatment of HER-positive breast cancer , although combined therapy with anthracycline-based regimens has been associated with cardiac toxicity . We wanted to evaluate the efficacy and safety of a new nonanthracycline regimen with trastuzumab . METHODS We r and omly assigned 3222 women with HER2-positive early-stage breast cancer to receive doxorubicin and cyclophosphamide followed by docetaxel every 3 weeks ( AC-T ) , the same regimen plus 52 weeks of trastuzumab ( AC-T plus trastuzumab ) , or docetaxel and carboplatin plus 52 weeks of trastuzumab ( TCH ) . The primary study end point was disease-free survival . Secondary end points were overall survival and safety . RESULTS At a median follow-up of 65 months , 656 events triggered this protocol -specified analysis . The estimated disease-free survival rates at 5 years were 75 % among patients receiving AC-T , 84 % among those receiving AC-T plus trastuzumab , and 81 % among those receiving TCH . Estimated rates of overall survival were 87 % , 92 % , and 91 % , respectively . No significant differences in efficacy ( disease-free or overall survival ) were found between the two trastuzumab regimens , whereas both were superior to AC-T. The rates of congestive heart failure and cardiac dysfunction were significantly higher in the group receiving AC-T plus trastuzumab than in the TCH group ( P<0.001 ) . Eight cases of acute leukemia were reported : seven in the groups receiving the anthracycline-based regimens and one in the TCH group subsequent to receiving an anthracycline outside the study . CONCLUSIONS The addition of 1 year of adjuvant trastuzumab significantly improved disease-free and overall survival among women with HER2-positive breast cancer . The risk-benefit ratio favored the nonanthracycline TCH regimen over AC-T plus trastuzumab , given its similar efficacy , fewer acute toxic effects , and lower risks of cardiotoxicity and leukemia . ( Funded by Sanofi-Aventis and Genentech ; BCIRG-006 Clinical Trials.gov number , NCT00021255 . )
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 ? "