Breast cancer: 1-year trastuzumab tops shorter courses for OS

  • Niraula S & al.
  • Breast Cancer Res Treat
  • 20 Sep 2018

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • A 1-year course of trastuzumab has superior survival compared with a 6-month or 9-week course in human epidermal growth factor receptor 2 (HER2)-positive breast cancer, according to a meta-analysis.
  • 1-year trastuzumab had higher cardiotoxicity.

Why this matters

  • Evaluation included the recently reported Short-HER trial, which found 9 weeks of trastuzumab inferior to 1 year.
  • Findings suggest that 1 year of trastuzumab therapy should remain the standard of care.

Study design

  • Meta-analysis of 5 randomized controlled trials (RCTs; n=approximately 12,000) that met eligibility criteria after a search of MEDLINE, EMBASE, Cochrane Library, and conference abstracts.
  • 3 RCTs compared 1-year trastuzumab with 6 months; 2 RCTs compared 1-year trastuzumab with 9 weeks.
  • Primary outcomes were DFS and OS.
  • Funding: Pfizer.

Key results

  • 1 year of trastuzumab had longer OS (pooled HR, 1.23; 95% CI, 1.07-1.42) and longer DFS (pooled HR, 1.21; 95% CI, 1.09-1.36) than shorter durations of trastuzumab.
  • Subgroup analysis found no DFS benefit of 1 year of trastuzumab (vs shorter duration) in node-negative (HR, 1.20; P=.11) and estrogen receptor-positive (HR, 1.15; P=.09) patients.
  • 1 year of trastuzumab carried a nearly 2.5-fold greater risk for cardiotoxicity (OR, 2.48; P<.001>

Limitations

  • Most trials were performed a decade ago, when chemotherapy and targeted therapy were different from the current standard of care.

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