No single standard treatment exists for patients with small, node-negative, human epidermal growth factor receptor type 2 (HER2)–positive breast cancers, because most of these patients have been ineligible for the pivotal trials of adjuvant trastuzumab

Albain, Kathy S.

Barry, William T.

Burstein, Harold J.

Carey, Lisa A.

Dang, Chau T.

Ellis, Matthew

Guo, Hao

Hudis, Clifford A.

Krop, Ian E.

Marcom, P. Kelly

Moy, Beverly

Overmoyer, Beth A.

Partridge, Ann H.

Rugo, Hope S.

Shapira, Iuliana

Tolaney, Sara M.

Winer, Eric P.

Wolff, Antonio C.

Yardley, Denise A.

PubMed

Carolina Digital Repository

Adjuvant Paclitaxel and Trastuzumab for Node-Negative, HER2-Positive Breast Cancer

BackgroundNo single standard treatment exists for patients with small, node-negative, human epidermal growth factor receptor type 2 (HER2)-positive breast cancers, because most of these patients have been ineligible for the pivotal trials of adjuvant trastuzumab.MethodsWe performed an uncontrolled, single-group, multicenter, investigator-initiated study of adjuvant paclitaxel and trastuzumab in 406 patients with tumors measuring up to 3 cm in greatest dimension. Patients received weekly treatment with paclitaxel and trastuzumab for 12 weeks, followed by 9 months of trastuzumab monotherapy. The primary end point was survival free from invasive disease.ResultsThe median follow-up period was 4.0 years. The 3-year rate of survival free from invasive disease was 98.7% (95% confidence interval [CI], 97.6 to 99.8). Among the 12 relapses seen, 2 were due to distant metastatic breast cancer. Excluding contralateral HER2-negative breast cancers and nonbreast cancers, 7 disease-specific events were noted. A total of 13 patients (3.2%; 95% CI, 1.7 to 5.4) reported at least one episode of grade 3 neuropathy, and 2 had symptomatic congestive heart failure (0.5%; 95% CI, 0.1 to 1.8), both of whom had normalization of the left ventricular ejection fraction after discontinuation of trastuzumab. A total of 13 patients had significant asymptomatic declines in ejection fraction (3.2%; 95% CI, 1.7 to 5.4), as defined by the study, but 11 of these patients were able to resume trastuzumab therapy after a brief interruption.ConclusionsAmong women with predominantly stage I HER2-positive breast cancer, treatment with adjuvant paclitaxel plus trastuzumab was associated with a risk of early recurrence of about 2%; 6% of patients withdrew from the study because of protocol-specified adverse events. (Funded by Genentech; ClinicalTrials.gov number, NCT00542451.)

Tolaney, Sara M

Barry, William T

Dang, Chau T

Yardley, Denise A

Marcom, P Kelly

Albain, Kathy S

Rugo, Hope S

Wolff, Antonio C

Carey, Lisa A

Overmoyer, Beth A

Partridge, Ann H

Hudis, Clifford A

Krop, Ian E

Burstein, Harold J

Winer, Eric P

eScholarship - University of California

Sara M. Tolaney

William T. Barry

Chau T. Dang

Denise A. Yardley

Beverly Moy

P. Kelly Marcom

Kathy S. Albain

Hope S. Rugo

Matthew Ellis

Iuliana Shapira

Antonio C. Wolff

Lisa A. Carey

Beth A. Overmoyer

Ann H. Partridge

Hao Guo

Clifford A. Hudis

Ian E. Krop

Harold J. Burstein

Eric P. Winer

Crossref

New England Journal of Medicine

Adjuvant Paclitaxel and Trastuzumab for Node-Negative, HER2-Positive Breast Cancer

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