Trastuzumab plus Adjuvant Chemotherapy for Operable HER2-Positive Breast Cancer
Edward H. Romond, M.D., Edith A. Perez, M.D., John Bryant, Ph.D., Vera J. Suman, Ph.D., Charles E. Geyer, Jr., M.D., Nancy E. Davidson, M.D., Elizabeth Tan-Chiu, M.D., Silvana Martino, D.O., Soonmyung Paik, M.D., Peter A. Kaufman, M.D., Sandra M. Swain, M.D., Thomas M. Pisansky, M.D., Louis Fehrenbacher, M.D., Leila A. Kutteh, M.D., Victor G. Vogel, M.D., Daniel W. Visscher, M.D., Greg Yothers, Ph.D., Robert B. Jenkins, M.D., Ph.D., Ann M. Brown, Sc.D., Shaker R. Dakhil, M.D., Eleftherios P. Mamounas, M.D., M.P.H., Wilma L. Lingle, Ph.D., Pamela M. Klein, M.D., James N. Ingle, M.D., and Norman Wolmark, M.D.
Background We present the combined results of two trials thatcompared adjuvant chemotherapy with or without concurrent trastuzumabin women with surgically removed HER2-positive breast cancer.
Methods The National Surgical Adjuvant Breast and Bowel Projecttrial B-31 compared doxorubicin and cyclophosphamide followedby paclitaxel every 3 weeks (group 1) with the same regimenplus 52 weeks of trastuzumab beginning with the first dose ofpaclitaxel (group 2). The North Central Cancer Treatment Grouptrial N9831 compared three regimens: doxorubicin and cyclophosphamidefollowed by weekly paclitaxel (group A), the same regimen followedby 52 weeks of trastuzumab after paclitaxel (group B), and thesame regimen plus 52 weeks of trastuzumab initiated concomitantlywith paclitaxel (group C). The studies were amended to includea joint analysis comparing groups 1 and A (the control group)with groups 2 and C (the trastuzumab group). Group B was excludedbecause trastuzumab was not given concurrently with paclitaxel.
Results By March 15, 2005, 394 events (recurrent, second primarycancer, or death before recurrence) had been reported, triggeringthe first scheduled interim analysis. Of these, 133 were inthe trastuzumab group and 261 in the control group (hazard ratio,0.48; P<0.0001). This result crossed the early stopping boundary.The absolute difference in disease-free survival between thetrastuzumab group and the control group was 12 percent at threeyears. Trastuzumab therapy was associated with a 33 percentreduction in the risk of death (P=0.015). The three-year cumulativeincidence of class III or IV congestive heart failure or deathfrom cardiac causes in the trastuzumab group was 4.1 percentin trial B-31 and 2.9 percent in trial N9831.
Conclusions Trastuzumab combined with paclitaxel after doxorubicinand cyclophosphamide improves outcomes among women with surgicallyremoved HER2-positive breast cancer. (ClinicalTrials.gov numbers,NCT00004067
[ClinicalTrials.gov]
and NCT00005970
[ClinicalTrials.gov]
.)
Source Information
From the National Surgical Adjuvant Breast and Bowel Project, Pittsburgh (E.H.R., J.B., C.E.G., E.T.-C., S.P., S.M.S., L.F., V.G.V., G.Y., A.M.B., E.P.M., N.W.); University of Kentucky, Lexington (E.H.R.); North Central Cancer Treatment Group, Rochester, Minn. (E.A.P., V.J.S., T.M.P., L.A.K., D.W.V., R.B.J., S.R.D., W.L.L., J.N.I.); Mayo Clinic Jacksonville, Jacksonville, Fla. (E.A.P.); University of Pittsburgh, Pittsburgh (J.B., G.Y.); Mayo Clinic, Rochester, Minn. (V.J.S., T.M.P., D.W.V., R.B.J., W.L.L., J.N.I.); Allegheny General Hospital, Pittsburgh (C.E.G., N.W.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (N.E.D.), the Cancer Research Network, Plantation, Fla. (E.T.-C.); Angeles Clinic and Research Institute, Santa Monica, Calif. (S.M.); Norris Cotton Cancer Center, DartmouthHitchcock Medical Center, Lebanon, N.H. (P.A.K.); Cancer Therapeutics Branch, National Cancer Institute, Bethesda, Md. (S.M.S.); Kaiser Permanente Medical Center Northern California, Vallejo (L.F.); Oncology Associates of Cedar Rapids, Cedar Rapids, Iowa (L.A.K.); University of Pittsburgh Cancer Institute, Pittsburgh (V.G.V.); Wichita Community Clinical Oncology Program, Wichita, Kans. (S.R.D.); Aultman Health Foundation, Canton, Ohio (E.P.M.); and Genentech, South San Francisco, Calif. (P.M.K.). Drs. Romond and Perez contributed equally to the article.
Address reprint requests to Dr. Geyer at the Allegheny Cancer Center, 5th Fl., 320 E. North Ave., Pittsburgh, PA 15212, or at cgeyer{at}wpahs.org.
Trastuzumab in Breast Cancer
Gilbert S. G., Banna G. L., Santoro A., Gounaris I. G., Katsumata M., Drebin J. A., Greene M. I., Mastrianni D. M., Mano M., Cameron D., Gelber R. D., the HERA Trial Study Team , Bryant J., Romond E., Perez E. A., Hortobagyi G. N., Barron H.
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N Engl J Med 2006;
354:640-644, Feb 9, 2006.
Correspondence
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