Even small HER2 tumors may need Herceptinneed

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http://www.nytimes.com/2008/12/13/health/13breast.html

Study of Tumor Recurrence May Change Drug GuidelinesE-MAILPRINTREPRINTSSAVESHAREBy TARA PARKER-POPEPublished: December 12, 2008A particularly fast-growing form of breast cancer should be treated aggressively after surgery even when tumors are very small, according to new research that could alter treatment for one in five women diagnosed with breast cancer.WellShare your thoughts on this column at the Well blog.Go to Well »The research, reported Friday at the San Antonio Breast CancerSymposium, focuses on the 15 percent to 20 percent of women with breast cancer who test positive for an amplification of the HER2 gene, which is typically among the most aggressive forms of the disease.Today, a targeted therapy called Herceptin, made by the biotech company Genentech, has greatly improved the odds for women with HER2-positive cancer. Recent studies show the drug reduces the recurrence of these cancers by about half.But current treatment guidelines do not recommend that the drug be given to women with HER2-positive tumors less than one-half centimeter in size. The guidelines also suggest only that doctors discuss Herceptin treatment with women who have tumors between one-half and one centimeter in size.Researchers at the University of Texas M.D. Anderson Cancer Center reviewed data from 965 women treated from 1990 to 2002 who had tumors less than one centimeter in size. They also studied 350 patients from European institutions.They found that after five years, 23 percent of women with very small HER2-positive tumors experienced a return of the cancer, compared with 6 percent of similar women without HER2 disease. The finding indicates that even among women who detect their cancers early, the risk of recurrence is nearly three times greater if they test positive for HER2 than if they do not. None of the women in the study received Herceptin treatment.Although the data on recurrence strongly suggest that women with early-stage HER2-positive cancer could benefit from aggressive treatment, the study did not examine the effectiveness of Herceptin in women with small tumors. Women with small but fast-growing tumors should be included in clinical trials comparing current practices with more aggressive treatment, said Dr. Ana M. Gonzalez-Angulo, an assistant professor at M.D. Anderson.

The study was financed by a grant from the National Cancer Institute.