A new study released this Wednesday revealed that breast cancer that is highly aggressive but caught early could be best treated with a combination of Herceptin and chemotherapy.
UCLA researchers conducted a three-armed study looking at women with early-stage breast cancer that is an aggressive type known as HER-2 positive. Survival rates were measured after five years. The three-armed study compared the standard therapy of Adriamycin and Carboplatin followed by Taxotere (ACT), the same regimen plus one year of Herceptin (ACTH), and a regimen of Taxotere and Carboplatin with one year of Herceptin (TCH).
The latest study, of more than 3,200 women over five years, finds that if Herceptin is combined with a carboplatin, used most often for ovarian cancer, the heart risk of heart failure drops more than five fold, while overall measures of heart function improve.
Herceptin targets a protein called Her2 which appears on the surface of the cancer cells in about one quarter of breast cancer patients. As a result of the Her2 protein, women who develop that type of cancer often have a more aggressive form.
Results showed that women who received Herceptin along with various chemotherapy medications had better survival rates than women who did not receive Herceptin. Herceptin targets the genetic mutation that leads to HER-2 positive cancer.
The study finds that overall disease-free survival rates at five years was 75% for women who received Adriamycin and carboplatin plus Taxotere; 84% for those who received the same regimen plus one year of Herceptin and 81% for those taking Taxotere and carboplatin plus one year of Herceptin.
Researchers note that women who did not take the chemotherapy drug Adriamycin - which can cause heart damage when paired with Herceptin, fared as well as those who did take Adriamycin. That suggests that Adriamycin can probably be avoided altogether in the treatment of early-stage breast cancer. The women taking Adriamycin and Herceptin had five times the rate of congestive heart failure and double the rates of having heart problems without symptoms. They also had more side effects such as nausea, neuropathy and fatigue.
“Given the data in this study, it makes one really question what role Adriamycin should play in the treatment of HER-2 positive early breast cancer, or in the treatment of early breast cancer at all,” Dr. Dennis Slamon, the lead author of the study, said. “This trial should impact the way these breast cancers are treated, with a non-anthracycline [Adriamycin] regimen being our preferred option.”
Slamon discovered the HER-2 gene mutation's link to breast cancer in 1987. About 20% to 25% of all breast cancers are HER-2 positive she explained. The study appears in the New England Journal of Medicine.
There is one drawback in this latest study. In the Herceptin-plus-carboplatin group, there were more recurrences of breast cancer. The increase was not statistically significant, but it is enough so that many doctors may not switch immediately to the new regime. Many will reserve it for patients who seem to be at particularly high risk for heart problems. Even so, the latest study offers a new option for a disease where any improvement is very welcome.
An editorial that accompanies the article states that the data in the study “suggest that a non-anthracycline regimen is an acceptable standard of care. The present is clearly brighter for patients with HER-2 positive breast cancer and the future promises to shine even more.”
The study was sponsored by Sanofi-Aventis and Genentech and was funded in part by the Department of Defense, the Revlon/UCLA Women's Cancer Program, the U.S. Army Medical Research and Development Command, the National Cancer Institute, the California Breast Cancer Research Program and the Peter and Denise Wittich Family Project for Emerging Therapies in Breast Cancer.
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