Continuing Herceptin after progression in Stage IV

orange1

 From Breast Cancer Resource Networkhttps://mail.google.com/mail/?hl=en&shva=1#inbox/12845e99cdef4db9 Continuing TrastuzumabIn the years following the incorporation of trastuzumab into the routine treatment of HER-positive metastatic breast cancer, a prevailing debate has centered on the appropriateness of continuing trastuzumab in the setting of disease progression. The experience with conventional cytotoxic agents suggests that it is futile to continue therapy beyond progression, but whether this dictum applied to novel biologic agents was unknown. In practice, many oncologists continued trastuzumab into second and greater lines of therapy, while changing the chemotherapy partner drug. This practice was not based on any prospective evidence, however.Two recent randomized studies have finally answered this debate. In the first, patients progressing after trastuzumab-based therapy were randomized to capecitabine with and without trastuzumab.¹⁸ Accrual was halted early after 156 of 482 patients were enrolled, when a preplanned interim analysis indicated a significant improvement in progression-free survival (PFS) from 5.6 to 8.2 months (P = .03) in the patients continuing trastuzumab.A second study investigated the role of continuing trastuzumab in the setting of lapatinib monotherapy.^19,20 A total of 296 patients who had received a median of three prior trastuzumab-containing regimens for HER2-positive metastatic breast cancer were randomized to lapatinib at 1,500 mg daily or lapatinib at 1,000 mg daily plus weekly trastuzumab treatment. Despite a built-in crossover to the combination for patients progressing on lapatinib monotherapy, a significant improvement in overall survival was demonstrated with the combination therapy (HR = 0.74; 95% CI = 0.57–0.97; P = .026). Continued trastuzumab led to an improvement in PFS and clinical benefit rate, with a trend for improved overall survival despite a built-in crossover to the combination for patients progressing on lapatinib monotherapy (HR = 0.75; 95% CI = 0.53–1.07; P = .106). As well as validating the common practice of continuing trastuzumab after progression, this study confirmed a role for combined HER2 blockade, which is a feature of many current studies evaluating novel HER2-targeting agents.

chainsawz

Thanks orange :>  I started out stage IV and been on herceptin since....I feel fortunate to have this and tykerb around!! 

orange1

bump

orange1

bump for Jeroen