Do all patients with HER2 positive breast cancer require one year of adjuvant trastuzumab? A systematic review and meta-analysis

Stewart, Paul; Blanchette, Phillip; Shah, Prakesh S.; Ye, Xiang Y.; Boldt, Gabriel; Fernandes, Ricardo; Vandenberg, T.; Raphael, Jacques

doi:10.1016/j.breast.2020.10.003

Cited by 8 publications

(11 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent systematic review and meta-analysis a shorter duration of adjuvant trastuzumab was non-inferior to one year of therapy for DFS in patients with HER2+ disease based on our hazard ratio margin of 1.29, but at the expense of an increase in absolute risk up to 3.9% for 5-year DFS [34]. Thus, potential risks of covid exposure due to repeated hospital visits needs for trastuzamab to be weighed against the higher risk of relapse associated with a shorter duration of treatment [34,35].…”

Section: Condition #3 Processes For People To Follow Were Clearly Documented and Communicatedmentioning

confidence: 90%

“…Although not standard and rarely performed at our hospital prior to the pandemic, consideration for shorter courses of adjuvant trastuzamab treatment can be given to patients at lower risk of relapse and/or higher risk of cardiac toxicity during the pandemic. A recent systematic review and meta-analysis a shorter duration of adjuvant trastuzumab was non-inferior to one year of therapy for DFS in patients with HER2+ disease based on our hazard ratio margin of 1.29, but at the expense of an increase in absolute risk up to 3.9% for 5-year DFS [ 34 ]. Thus, potential risks of covid exposure due to repeated hospital visits needs for trastuzamab to be weighed against the higher risk of relapse associated with a shorter duration of treatment [ 34 , 35 ].…”

Section: Condition #3 Processes For People To Follow Were Clearlymentioning

confidence: 99%

See 1 more Smart Citation

Neoadjuvant Chemotherapy in Breast Cancer: Review of the Evidence and Conditions That Facilitated Its Use during the Global Pandemic

et al. 2021

View full text Add to dashboard Cite

Practice and behaviour change in healthcare is complex, and requires a set of critical steps that would be needed to implement and sustain the change. Neoadjuvant chemotherapy for breast cancer is traditionally used for locally advanced disease and is primarily advantageous for surgical downstaging purposes. However, it does also offer patients with certain biologic subtypes such as the triple negative or Her2 positive breast cancers the opportunity to improve survival, even in early stage disease. During the height of the pandemic, an opportunity and motivation for the increased use of neoadjuvant therapy in breast cancer was identified. This paper describes the conditions that have supported this practice change at the provider and institutional levels. We also include our own institutional algorithm based on tumor biology and extent of disease that have guided our decisions on breast cancer management during the pandemic. Our processes can be adapted by other institutions and breast oncology practices in accordance with local conditions and resources, during and beyond the pandemic.

show abstract

Section: Condition #3 Processes For People To Follow Were Clearly Documented and Communicatedmentioning

confidence: 90%

Section: Condition #3 Processes For People To Follow Were Clearlymentioning

confidence: 99%

Neoadjuvant Chemotherapy in Breast Cancer: Review of the Evidence and Conditions That Facilitated Its Use during the Global Pandemic

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Undoubtedly, the most widely used HER2-targeted agent to date has been trastuzumab (Herceptin ® , Basilea, Switzarland), a humanized monoclonal antibody (mAb) approved by the major drug regulatory agencies for the past two decades for the treatment of both early and metastatic BC [ 5 ]. Trastuzumab (Tmab) has been shown to induce tumor regression through different molecular mechanisms and to significantly increase overall survival of patients in multiple trials [ 6 , 7 ]. For this reason, it is nowadays an established part of adjuvant HER2+ BC treatment along with taxanes [ 6 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Trastuzumab (Tmab) has been shown to induce tumor regression through different molecular mechanisms and to significantly increase overall survival of patients in multiple trials [ 6 , 7 ]. For this reason, it is nowadays an established part of adjuvant HER2+ BC treatment along with taxanes [ 6 , 8 ]. Nonetheless, Tmab intravenous administration also has some downsides.…”

Section: Introductionmentioning

confidence: 99%

Nature-Inspired Nanoparticles as Paclitaxel Targeted Carrier for the Treatment of HER2-Positive Breast Cancer

Nieto

Vega

Valle

2021

Cancers

View full text Add to dashboard Cite

Despite the advances made in the fight against HER2-positive breast cancer, the need for less toxic therapies and strategies that avoid the apparition of resistances is indisputable. For this reason, a targeted nanovehicle for paclitaxel and trastuzumab, used in the first-line treatment of this subtype of breast cancer, had already been developed in a previous study. It yielded good results in vitro but, with the aim of further reducing paclitaxel effective dose and its side effects, a novel drug delivery system was prepared in this work. Thus, polydopamine nanoparticles, which are gaining popularity in cancer nanomedicine, were novelty loaded with paclitaxel and trastuzumab. The effectiveness and selectivity of the nanoparticles obtained were validated in vitro with different HER2-overexpressing tumor and stromal cell lines. These nanoparticles showed more remarkable antitumor activity than the nanosystem previously designed and, in addition, to affect stromal cell viability rate less than the parent drug. Moreover, loaded polydopamine nanoparticles, which notably increased the number of apoptotic HER2-positive breast cancer cells after treatment, also maintained an efficient antineoplastic effect when validated in tumor spheroids. Thereby, these bioinspired nanoparticles charged with both trastuzumab and paclitaxel may represent an excellent approach to improve current HER2-positive breast cancer therapies.

show abstract

“…Several pivotal phase III clinical trials have proved that a 12-month (T-12) treatment duration is superior to observation ( 4 - 7 ), leading to national and international guidelines to recommend T-12 months treatment with or after chemotherapy as the standard-of-care ( 8 - 10 ). A shorter duration of trastuzumab is associated with reduced side effects and costs ( 11 ), the optimum duration of trastuzumab treatment may be hampered by efficacy, toxicity, convenience, and cost ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Optimum adjuvant trastuzumab duration for human epidermal growth factor receptor-2 positive breast cancer: a network meta-analysis of randomized trials

Ma¹,

Tang²,

Hu³

et al. 2021

Transl Cancer Res TCR

View full text Add to dashboard Cite

Background: Adjuvant trastuzumab treatment for 12 months is the standard-of-care for early HER2positive breast cancer; however, the optimal duration is unclear. We performed a network meta-analysis (NMA) to determine the optimal treatment duration.Methods: We identified 16 randomized controlled trials involving 29,837 patients that assessed trastuzumab treatment in HER2-positive early breast cancer. Our NMA compared six trastuzumab durations: observation, T-9 weeks, T-12 weeks, T-6 months, T-12 months, and T-24 months. We assessed overall survival (OS), disease-free survival (DFS), acceptability, and cardiotoxicities and grade 3-4 nonhematologic toxicities, and ranked the durations in terms of efficacy and safety by surface under the cumulative ranking (SUCRA).Results: Pairwise meta-analysis showed that while T-6 months was associated with a significant reduction in DFS compared to T-12 months. In our NMA, increasing or decreasing durations showed a significant benefit in DFS compared to observation; however, decreasing durations was not associated with a significant reduction in DFS compared with T-12 months, regardless of the lymph node and hormone receptor statuses.SUCRA ordered the optimum durations of trastuzumab treatment based on PFS as T-12 months (95.6%), T-24 months (69.6%), T-6 months (53.2%), T-9 weeks (41.2%), T-12 weeks (34.3%) and observation (6.1%).Conclusions: Escalating trastuzumab treatment beyond T-12 months confers no additional survival benefit but increased risk of cardiotoxicities. Furthermore, de-escalating treatment confers no improvement on OS compared to T-12 months. These data suggest that T-12 months is the most appropriate treatment schedule for HER2-positive early breast cancer.

show abstract

Do all patients with HER2 positive breast cancer require one year of adjuvant trastuzumab? A systematic review and meta-analysis

Cited by 8 publications

References 48 publications

Neoadjuvant Chemotherapy in Breast Cancer: Review of the Evidence and Conditions That Facilitated Its Use during the Global Pandemic

Neoadjuvant Chemotherapy in Breast Cancer: Review of the Evidence and Conditions That Facilitated Its Use during the Global Pandemic

Nature-Inspired Nanoparticles as Paclitaxel Targeted Carrier for the Treatment of HER2-Positive Breast Cancer

Optimum adjuvant trastuzumab duration for human epidermal growth factor receptor-2 positive breast cancer: a network meta-analysis of randomized trials

Contact Info

Product

Resources

About