Shorter Treatment of Breast Cancer with Trastuzumab May Lead to Improved Results

A significantly shorter course of trastuzumab achieved improved outcomes for patients.
A significantly shorter course of trastuzumab achieved improved outcomes for patients.

Patients with breast cancer who received trastuzumab (Herceptin) for 9 weeks during postsurgery chemotherapy might experience improved health outcomes compared with patients who received the drug for 12 months.1

Trastuzumab is a monoclonal antibody used to treat HER2 receptor-positive breast cancer.

The British National Health Service (NHS) currently recommends 12 months of trastuzumab. Researchers estimated the 9-week course would save the NHS $121.7 million (£100 million) annually.

In the United States and the United Kingdom, breast cancer is the most common cancer in women. Approximately 1 in 4 women with early-stage breast cancer have HER2-positive disease. HER2-positive breast cancer is more aggressive.

Treatment with trastuzumab along with chemotherapy in the HER2-positive population has resulted in significant increases in survival and has extended remission. Trastuzumab, however, is expensive and can cause serious adverse effects.

The British National Institute for Health and Care Excellence approved trastuzumab in 2006. At the time, the report from the Evidence Review Group stated a need for research on the effects of using trastuzumab for shorter periods of time.

This research assessed health outcomes from 2 trials in which cohorts received no trastuzumab, 9 weeks of trastuzumab, or 12 months of trastuzumab. Each study followed patients for 5 years after trastuzumab administration.

In total, 2149 patients received the drug for 12 months, 54 received the drug for 9 weeks, and 1131 did not receive the drug.

Researchers examined overall survival, rates of secondary cancer, and rates of heart attack. Part of the analysis predicted disease status and quality of life for the next 50 years to suggest long-term effects.

"Overall, our results suggest that the 9-week option could be the best option for both patients and the NHS, as it is apparently just as effective as the 12-month duration, safer in terms of leading to fewer cardiac side effects, and cheaper," said Caroline Clarke, MSci, research associate at University College London Institute of Epidemiology and Health Care, London, England.

Notably, the interpretation of the results is limited especially given the small size of the 9-week cohort.

Reference

1. Clarke CS, Hunter RM, Shemilt I, Serra-Sastre V. Multi-arm cost-effectiveness analysis (CEA) comparing different durations of adjuvant trastuzumab in early breast cancer, from the English NHS payer perspective. PLoS One. 2017;12(3):e0172731. doi: 10.1371/journal.pone.0172731.
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