Adjuvant Docetaxel or Vinorelbine with or without Trastuzumab for Breast Cancer

Abstract

Adjuvant treatment with docetaxel, as compared with vinorelbine, improves recurrence-free survival in women with early breast cancer. A short course of trastuzumab administered concomitantly with docetaxel or vinorelbine is effective in women with breast cancer who have an amplified HER2/neu gene. (International Standard Randomised Controlled Trial number, ISRCTN76560285.).

Cardiotoxicity From Human Epidermal Growth Factor Receptor‐2 (HER2) Targeted Therapies

“…Similar results were reported from the HERA (Herceptin Adjuvant) trial 27. The BCIRG (Breast Cancer International Research Group) 006 trial extended these findings by showing benefit from trastuzumab regimens both with and without anthracyclines 28. Most recently, extremely low risk of recurrence was demonstrated with the use of trastuzumab and a single chemotherapy agent (paclitaxel) in patients with small, node‐negative, early‐stage breast cancer 29…”

Molecular mechanisms of cardiotoxicity of tyrosine kinase inhibition

“…The incidence of cardiac dysfunction ranged from 4% to 7% with trastuzumab alone, to 27% when chemotherapy that included anthracyclines was administered concurrently 13,17 . Subsequently, five randomized trials have demonstrated a benefit for trastuzumab in ERBB2 + patients with breast cancer receiving adjuvant chemotherapy after local regional treatment for a primary tumour 11,12,18 . In four of these trials, significant trastuzumab-associated cardiotoxicity was also observed, with an increase of 5-17% in the frequency of asymptomatic decreased LVEF and of 1-3% in the incidence of symptomatic CHF 19,20 .…”

Human epidermal growth factor receptor 2 expression in early breast cancer patients: a Swiss cost–effectiveness analysis of different predictive assay strategies

“…Eligibility criteria for disease free HER-2-negative patients were WHO performance status 0-1 with a confirmed HER-2-negative status. They had undergone breast surgery with axillary-node dissection or sentinel-node biopsy for invasive breast carcinoma [11].…”

“…The recurrence rates seen in the HERA comparator group were applied to our HER-2-positive group without trastuzumab treatment. In the HER-2-negative situation, transition probabilities were assumed to be unaffected by trastuzumab treatment [11].…”

“…Trastuzumab, a humanized monoclonal antibody, is used successfully in the therapy of HER-2-positive invasive breast carcinomas [7][8][9][10]. In the adjuvant setting, it substantially reduces recurrence rates and overall mortality in combination with chemotherapy [11][12][13][14]. There is now consensus on a life-prolonging effect in metastatic, early node-positive and node-negative HER-2 positive invasive breast cancers.…”