ONCOLOGY AND HEMATOLOGY for May 21, 2013 [Новость добавлена - 22.05.2013]

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Avoiding Chemotherapy in HER2-Positive Breast Cancer
[Summary and Comment | Subscription Required]

Dual targeting of human epidermal growth factor receptor 2 produced
in-breast pathologic complete remission in 27% of patients.
By William J. Gradishar, MD
May 21, 2013
Covering: Rimawi M et al. J Clin Oncol 2013 May 10; 31:1726
http://oncology-hematology.jwatch.org/cgi/content/full/2013/521/1?q=etoc_jwonchem

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Chemotherapy: How Much Is Enough?
[Summary and Comment | Subscription Required]

Maintenance therapy for metastatic breast cancer prolonged survival but
increased hematologic toxicity.
By William J. Gradishar, MD
May 21, 2013
Covering: Park YH et al. J Clin Oncol 2013 May 10; 31:1732
http://oncology-hematology.jwatch.org/cgi/content/full/2013/521/2?q=etoc_jwonchem

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Platinum-Based Chemotherapy for Small-Cell Carcinoma of the Prostate
[Summary and Comment | Subscription Required]

Most patients experienced clinical benefit; bulky tumor mass was associated
with poor outcome.
By Robert Dreicer, MD, MS, FACP
May 21, 2013
Covering: Aparicio AM et al. Clin Cancer Res 2013 May 6;
http://oncology-hematology.jwatch.org/cgi/content/full/2013/521/3?q=etoc_jwonchem

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R-CHOP-21 Remains the Standard for Diffuse Large B-Cell Lymphoma
[Summary and Comment | Subscription Required]

No benefit was observed for R-CHOP administered every 14 days versus every
21 days for newly diagnosed DLBCL.
By Michael E. Williams, MD
May 21, 2013
Covering: Cunningham D et al. Lancet 2013 Apr 22;
http://oncology-hematology.jwatch.org/cgi/content/full/2013/521/4?q=etoc_jwonchem


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Three lifetime prostate-specific antigen tests (age: mid 40s, early 50s,
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[Dermatology | Summary and Comment | Subscription Required]

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By Hensin Tsao, MD, PhD
April 12, 2013
Covering: Klein O et al. J Clin Oncol 2013 Mar 18;
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FREE FULL-TEXT ARTICLE

Summary and Comment

Avoiding Chemotherapy in HER2-Positive Breast Cancer
Dual targeting of human epidermal growth factor receptor 2 produced
in-breast pathologic complete remission in 27% of patients.



The goal of avoiding chemotherapy and its attendant adverse effects is
attractive to breast cancer patients and clinicians. In appropriate
patients with estrogen receptor (ER)-positive breast cancer, the strategy
of exhausting endocrine therapy options has been used to delay time to
chemotherapy and help maintain quality of life. A similar strategy has been
considered in select patients with human epidermal growth factor receptor 2
(HER2)-positive breast cancer. Previous reports have shown that combining
anti-HER2 agents with endocrine agents in ER-positive and HER2-positive
metastatic breast cancer is more effective than endocrine therapy alone.

More recently, a clinical trial involving women with HER2-positive disease
compared various combinations of chemotherapy and anti-HER2 treatment
administered preoperatively, including one that combined pertuzumab and
trastuzumab without chemotherapy (Lancet Oncol 2012 Jan; 13:25). Although
the pathologic complete remission (pCR) rate was higher with chemotherapy,
patients who received only the antibodies still attained a pCR rate of
nearly 20%, suggesting that chemotherapy may be avoided in certain
patients.

To test such a no-chemotherapy approach further, investigators conducted a
multicenter, phase II trial involving 66 patients with stage II-III
HER2-positive disease (62% were ER-positive) who received standard
trastuzumab plus lapatinib (1000 mg daily) for 12 weeks. Women with
ER-positive tumors also received letrozole (plus a luteinizing
hormone-releasing hormone agonist, if premenopausal). Sequential biopsies
were obtained at diagnosis, at weeks 2 and 8, and at surgery. The median
tumor size was 6 cm (range, 1-30 cm).

Overall, the in-breast pCR was 27% (21% for ER-positive disease; 36% for
ER-negative disease). The most common adverse effects were those largely
expected with lapatinib: diarrhea (grades 1-2, 63%; grades 3-4, 3%), rash
(grades 1-2, 55%; grades 3-4, 1%), fatigue (32%), nausea (31%), and
elevated liver function tests (grades 1-2, 18%; grade 3, 5%; grade 4, 2%).

Comment: Dual targeting of HER2 has proven to be an effective strategy for
increasing tumor shrinkage, compared with single-agent HER2 therapy, with
or without chemotherapy. To realize the full potential of this strategy,
clinicians must be able to identify which patients can avoid chemotherapy.
(The serial tumor samples obtained in this trial might possibly be used to
identify a biomarker that could identify such patients.) Until then,
combining chemotherapy with anti-HER2 therapy remains a standard approach
for HER2-positive breast cancer.

-- William J. Gradishar, MD

Published in Journal Watch Oncology and Hematology May 21, 2013
Citation(s):

Rimawi M et al. Multicenter phase II study of neoadjuvant lapatinib and
trastuzumab with hormonal therapy and without chemotherapy in patients with
human epidermal growth factor receptor 2-overexpressing breast cancer:
TBCRC 006 J Clin Oncol 2013 May 10; 31:1726.
(http://dx.doi.org/10.1200/JCO.2012.44.8027) (Subscription may be required)
(Free)

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