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