Additional Piece: De-Escalating Cancer Therapy for HER2-Positive Breast Cancer Patients: A Promising Approach
Introduction:
Cancer therapy has come a long way in improving patient outcomes and survival rates. However, the aggressive nature of certain cancers like HER2-positive breast cancer often calls for intense treatments, including chemotherapy, which can have severe side effects. In recent years, researchers have been exploring ways to de-escalate cancer therapy, offering patients a less aggressive yet effective approach to treatment. A new study presented at the American Society of Clinical Oncology annual meeting highlights a promising development in the management of HER2-positive breast cancer.
Targeted Therapy for HER2-Positive Breast Cancer:
HER2-positive breast cancer is characterized by the presence of extra copies of the gene that produces the HER2 protein. This type of breast cancer tends to be more aggressive and accounts for about 1 in 5 cases. To combat this specific subtype, targeted therapies such as trastuzumab and pertuzumab have been developed. These drugs directly target the HER2 protein and are usually used in combination with traditional chemotherapy before and after surgery.
The Current Study:
The recent study led by Dr. Javier Cortés and his team sought to determine if some women with HER2-positive early breast cancer could forgo chemotherapy as part of their treatment plan. The study included 356 patients with early-stage, operable HER2+ breast cancer. The patients were divided into two groups: Group A received a combination of chemotherapy along with trastuzumab and pertuzumab, while Group B was designed to forego chemotherapy based on individual progress.
De-Escalation Strategy:
In Group B, patients underwent a positron emission tomography (PET) scan after receiving two cycles of trastuzumab and pertuzumab. If the scan showed positive response to treatment, the patients continued with additional rounds of targeted therapy without the need for chemotherapy. Both groups eventually proceeded to surgery, and after the initial therapy, patients who showed no signs of cancer were able to continue treatment without chemotherapy.
Promising Results and Improved Quality of Life:
The outcomes of the study were highly promising. Overall, about 95% of the patients remained cancer-free after three years. Interestingly, the group that did not receive chemotherapy had an even higher rate of cancer-free survival. Approximately 30% of patients who did not receive chemotherapy achieved excellent three-year survival rates, close to 99%. This underscores the potential of targeted therapy as an effective alternative to chemotherapy in certain cases.
One of the significant advantages of de-escalating therapy is the improved quality of life for patients. Serious side effects associated with chemotherapy were much lower in patients who were able to avoid it. This finding is especially important when considering that HER2-positive breast cancer usually affects younger women, who may have longer life expectancies and can greatly benefit from maintaining a high quality of life during and after treatment.
Implications for Future Treatment:
The study by Cortés and his team opens up possibilities for de-escalating cancer therapy in HER2-positive breast cancer patients. Identifying the patients who can safely avoid chemotherapy and solely rely on targeted therapies, such as trastuzumab and pertuzumab, is crucial. It not only spares patients unnecessary side effects but also reduces the economic burden associated with chemotherapy drugs.
By showcasing the effectiveness and safety of tailored treatment plans, this study paves the way for further research and development of personalized approaches to cancer therapy. The opportunity to investigate de-escalation strategies in various cancer types could revolutionize the field and impact the lives of millions of patients worldwide.
Summary:
The study presented at the American Society of Clinical Oncology annual meeting sheds light on the potential for de-escalating cancer therapy in HER2-positive breast cancer patients. Researchers have found that certain patients who have shown positive response to targeted therapies like trastuzumab and pertuzumab can safely forgo chemotherapy as part of their treatment plan. The study demonstrated high rates of cancer-free survival, with approximately 30% of patients achieving excellent three-year survival rates without the need for chemotherapy.
This development not only improves patient quality of life but also has significant implications for the future of cancer treatment. The ability to personalize therapies based on individual response and characteristics of the cancer opens up opportunities for tailored treatments that are both effective and less aggressive. Further research in de-escalation strategies holds immense potential in changing the landscape of cancer therapy and improving patient outcomes.
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June 15, 2023 – Sometimes less can be more, and researchers are increasingly looking for ways to safely “de-escalate” cancer therapy, making a patient’s care less aggressive without affect their chances of survival. New study shows women with HER2-positive early breast cancer could be successfully treated without chemotherapy thus avoiding its severe side effects.
HER2-positive breast cancer is not as common and is diagnosed in about 1 in 5 women with breast cancer. It means that cancer cells have extra copies of the gene that makes the HER2 protein, and this type of cancer tends to be more aggressive than others.
But a treatment has been developed that is specifically targeted at HER2-positive breast cancer. Trastuzumab and pertuzumab target the HER2 protein, and these two drugs are usually used along with traditional chemotherapy before and after surgery.
However, the current study, presented recently at the American Society of Clinical Oncology annual meeting in Chicago, showed that some women can forego chemotherapy.
Better life quality’
“The introduction of anti-HER2-based therapy has dramatically changed the prognosis of not only HER2-positive metastatic breast cancer, but also HER2-positive early breast cancer,” said study author Javier Cortés, MD, PhD, from the Ramón y Cajal Institute. University Hospital, in Madrid, Spain. “And this has given rise to the opportunity to investigate different de-escalation strategies.”
In this study, Cortés and his team divided 356 patients older than 18 years, who had early-stage, operable HER2+ breast cancer, into two groups, A and B.
Women in Group A received a combination of chemotherapy and trastuzumab and pertuzumab. In contrast, treatment in Group B was designed to forgo chemotherapy based on individual progress.
After those in group B received two cycles of pertuzumab and trastuzumab, they underwent a positron emission tomography (PET) scan. If the scan showed that they had responded to treatment, they underwent additional rounds of treatment but no chemotherapy.
Both groups proceeded to surgery, after their initial therapy. After surgery, patients who did not show signs of cancer continued their treatment without chemotherapy. The rest of the patients received chemotherapy.
All patients in the study responded very well to treatment. About 95% of patients remained cancer-free after 3 years, and this number was even higher in the group that did not receive chemotherapy. Cortés noted that for this 30% of patients, which was basically 1 in 3 patients who did not receive chemotherapy, the three-year survival without a cancer recurrence was excellent, almost 99%.
“In my opinion, this study could identify 30% of patients who may be cured without the need for chemotherapy and will only be treated with a combination of trastuzumab, pertuzumab and endocrine therapy, if appropriate,” Cortés said.
He also noted that the rate of serious side effects was much lower in patients who were able to avoid chemotherapy.
“What we saw in this trial was that there was clearly a benefit in terms of adverse events,” said Justin M. Balko, PharmD, PhD, of Vanderbilt University Medical Center in Nashville, Tennessee, who commented on the study during the meeting. “As someone who studies immune system-related adverse events in my own lab, I thought that while this was not unexpected, it was really powerful to see the data of how much more likely the quality of life is for these patients to be saved or He was saved from chemotherapy.
https://www.webmd.com/cancer/asco-2023-special-report/20230602/some-breast-cancer-patients-may-forgo-chemo?src=RSS_PUBLIC
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