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Synergistic Trastuzumab-Containing Regimens Improve Outcomes in Breast Cancer: Presented at IBCC

By Alison Palkhivala

BANFF, AB -- August 8, 2003 -- Trastuzumab works synergistically with some chemotherapy combinations to improve outcomes for patients with breast cancer. Research is ongoing to identify the best combinations.

Mark D. Pegram, MD, associate professor of medicine and director, Women's Cancer Program, University of California, Los Angeles, California, United States, provided an update on trastuzumab-containing combinations for the treatment of breast cancer here on August 1^st at the Second Annual Future of Breast Cancer: An International Breast Cancer Congress.

Dr. Pegram and his team completed 2 phase II clinical trials, each involving 62 patients, to assess the safety and efficacy of a TCH regimen, consisting of docetaxel (Taxotere), a platinum salt and trastuzumab (Herceptin) in women with breast cancer. In one trial, they used the combination of docetaxel, carboplatin, and trastuzumab, and in the other they used cisplatin instead of carboplatin.

In addition, a pivotal trial by Slamon et al. compared trastuzumab plus doxorubicin/cyclophosphamide against paclitaxel plus trastuzumab in women with metastatic breast cancer that overexpressed HER2 (N Engl J Med 2001;344:783-792).

Dr. Pegram presented data from a comparison of overall response rates and median times to progression in the 3 trials for patients who were HER2-positive, as determined by fluorescence in situ hybridization (FISH) analysis. His comparison revealed that both overall response rate and time to progression were superior for patients in his 2 trials than for patients taking either of the 2 regimens in the trial by Slamon et al. This finding suggests, he said, that " we're able to change the natural history of HER2-positive disease by using TCH-type treatments,."

Robert et al. conducted a phase III trial examining paclitaxel and trastuzumab versus paclitaxel, carboplatin, and trastuzumab as first-line therapy for metastatic breast cancer (San Antonio Breast Cancer Symposium 2002, Abstract 35). The overall response rate for the triplet was 52%, compared with 32% for the doublet (P=.04). The median time to progression was also significantly longer for patients who received the triplet (13 versus 7 months). Adverse events were similar in both groups, except for greater incidence of myelosuppression with the triplet regimen.

Two ongoing trials by the Breast Cancer International Research Group, BCIRG 007 and 006, are continuing to look for the best trastuzumab-containing combinations for the treatment of breast cancer. One is comparing trastuzumab combined with docetaxel against trastuzumab combined with docetaxel and platinum salts (http://www.bcirg.org/Internet/Studies/BCIRG+006.htm). The other is comparing 2 dosing regimens of trastuzumab combined with paclitaxel and carboplatin (http://www.bcirg.org/Internet/Studies/BCIRG+007.htm).


[Study title: New Insights into Trastuzumab-Based Combinations and Optimal Use.]

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