Trastuzumab Before Breast Surgery? Large Trial Says Yes But Does Not Quell Debate

Extract

For women with HER2-positive, locally advanced breast cancer, the addition of trastuzumab (Herceptin) to standard chemotherapy before surgery substantially increased event-free survival in the large randomized NOAH trial, presented at the San Antonio Breast Cancer Symposium in December.

The study provides evidence that trastuzumab, given with neoadjuvant, anthracycline-based chemotherapy, can benefit patients. And it supports what is already becoming common clinical practice in some places, said Dennis Slamon, M.D., Ph.D., director of the Breast Cancer Program at the University of California at Los Angeles Health System.

Nevertheless, some oncologists remain wary. The combination of an anthracycline, such as doxorubicin or epirubicin, along with trastuzumab has been associated with cardiotoxicity and sometimes congestive heart failure. Although the NOAH trial and others have shown that this risk may be less than early studies demonstrated, some warn against giving the drugs in combination outside a closely watched clinical trial.

“I’m not sure we want clinicians to start adding trastuzumab to an anthracycline,” said Daniel Hayes , M.D., clinical director of the Breast Oncology Program at the University of Michigan Comprehensive Cancer Center in Ann Arbor.