“The combination of lapatinib (Tykerb) and trastuzumab (Herceptin) is active and well-tolerated when given to patients with human epidermal growth factor receptor 2-positive (HER2) metastatic breast cancer (MBC) who have received up to two lines of therapy for advanced disease, a nonrandomized phase II study now shows.
“What’s more, early metabolic imaging by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) appears to provide the key to selecting patients who can be treated with targeted regimens and spared the toxicity of chemotherapy, Nancy U. Lin, MD, Susan F. Smith Center for Women’s Cancers, Dana-Farber Cancer Institute, Boston, Ma., and colleagues report online in the Journal of Clinical Oncology.
” ‘Because the number of treatment options and their cost for patients with HER2-positive breast cancer continues to increase, a key question is how best to tailor therapies to individual patients,’ said Lin. ‘In the metastatic setting, predictive tests for clinical benefit could spare patients unnecessary toxicity and cost from ineffective therapies and maximize the likelihood of meaningful improvements from treatment. In the early-stage setting, predictive tests may reduce both under- and overtreatment.’ “
“In the phase III BOLERO-1 trial, reported in The Lancet Oncology, Hurvitz et al found that the addition of the mTOR inhibitor everolimus (Afinitor) to trastuzumab (Herceptin)-paclitaxel did not significantly increase progression-free survival among patients with HER2-positive advanced breast cancer. A 7-month prolongation in progression-free survival was observed with everolimus among patients with hormone receptor–negative disease.”
“Results from a phase II trial showed that neoadjuvant TDM-1 is effective in treating HER2-positive, hormone receptor (HR)-positive breast cancer, with or without endocrine therapy, in comparison with trastuzumab and endocrine therapy. Results of the study (abstract 506) were presented at the 2015 American Society of Clinical Oncology (ASCO) Annual Meeting held May 29 to June 2 in Chicago.
“The WSG-ADAPT trial is an umbrella trial that included around 5,000 patients. This sub-study of that trial included patients with HER2-positive, HR-positive early breast cancer; it enrolled 376 patients at 48 sites, and this interim analysis included 130 of those patients. The trial has been closed early because efficacy was reached.
“The patients were randomized to receive either TDM-1 monotherapy (37 patients), TDM-1 with endocrine therapy (48 patients), or trastuzumab with endocrine therapy (45 patients). ‘This was not a low-risk population,’ said study presenter Nadia Harbeck, MD, PhD, of the University of Munich, noting that over half of the patients were premenopausal and about half had tumors that were larger than 2 cm.”
“In an analysis of the NeoALTTO trial reported in JAMA Oncology, Salgado et al found that a higher level of tumor-infiltrating lymphocytes was associated with improved pathologic compete response rate and event-free survival independent of neoadjuvant treatment received in patients with HER2-positive early breast cancer.
“In NeoALTTO, 455 patients were randomly assigned to receive neoadjuvant trastuzumab (Herceptin), lapatinib (Tykerb), or the combination for 6 weeks followed by the addition of weekly paclitaxel for 12 weeks and three cycles of fluorouracil, epirubicin, and cyclophosphamide after surgery. Percentage of tumor-infiltrating lymphocytes were measured by hematoxylin-eosin stained core biopsy sections taken at diagnosis.”
“Breast cancer patients received suboptimal cardiac monitoring during treatment with trastuzumab (Herceptin), according to a large population-based study.
“Among more than 2,000 patients, only 36% of evaluable participants received adequate monitoring for cardiotoxicity in accordance with current guidelines, reported Mariana Chavez-MacGregor, MD, of the MD Anderson Cancer Center in Houston, and colleagues.
“Interestingly, physician characteristics had more influence than patient factors on cardiac monitoring, they wrote in the Journal of Clinical Oncology
” ‘We suspected that the rates of cardiac monitoring were going to be low, but we were surprised on how low, particularly in this high-risk group of patients,’ Chavez-MacGregor, a medical oncologist, told MedPage Today in a separate interview. ‘Of particular concern was that even among patients with cardiac comorbidities the rates of cardiac monitoring were not higher.’ “
“High levels of tumor-infiltrating lymphocytes served as an independent positive predictive marker for EFS and pathological complete response in HER-2–positive early breast cancer treated with chemotherapy and anti-HER–2 agents, according a secondary analysis of the NeoALTTO trial.
“ ‘Increasingly, oncogenic addiction, in which tumors become dependent on a sole oncogenic pathway for growth, is thought to promote a tumor microenvironment conducive to immune escape,’ Sherene Loi, MD, PhD, of the Peter MacCallum Cancer Centre at the University of Melbourne, and colleagues wrote. ‘Although this had not been shown yet for HER-2 oncogenic signaling, one could speculate that anti-HER–2 therapy may not only work in a cell-intrinsic manner but may also reserve HER-2–induced immunosuppression as a mechanism for action.’
“The NeoALTTO trial included 455 women with HER-2–positive early-stage breast cancer between 2008 and 2010. The researchers randomly assigned patients to neoadjuvant treatment with trastuzumab (Herceptin, Genentech), lapatinib (Tykerb, GlaxoSmithKline) or both.
“Patients received the initial treatment for 6 weeks, followed by weekly paclitaxel for 12 weeks and three treatment cycles of fluorouracil, epirubicin and cyclophosphamide after surgery.”
“A phase I study of MM-302, an antibody-drug conjugated human epidermal growth factor receptor 2 (HER2)-targeted liposomal doxorubicin, as a monotherapy or in combination with trastuzumab or trastuzumab and cyclophosphamide had a manageable safety profile and encouraging efficacy results in a group of heavily pretreated women with HER2-positive metastatic breast cancer.
“The results of the study were presented by Patricia LoRusso, DO, professor of medicine in the division of oncology at Yale University in New Haven, Connecticut, at the American Association for Cancer Research (AACR) Annual Meeting.
“Patients in the study who received at least 30 mg/m2 of MM-302 plus trastuzumab had a median progression-free survival of 7.6 months (95% confidence interval [CI], 3.6–10.9); those treated with the addition of cyclophosphamide had a median progression-free survival of 10.6 months (95% CI, 1.8–10.6).
“ ‘We are encouraged by these data on the safety and promising clinical activity of MM-302 in patients who have exhausted many therapeutic options for their disease. Our results support the further evaluation of MM-302 in an anthracycline-naive population in the HERMIONE trial,’ said LoRusso in a prepared statement.”
“An investigational antibody-drug conjugate called MM-302 was safe, tolerable, and showed signs of clinical activity in heavily pretreated patients with metastatic, HER2-positive breast cancer, according to data from a phase I clinical trial presented here at the AACR Annual Meeting 2015, April 18-22.
“MM-302 is an antibody-drug conjugate composed of a HER2-targeted antibody linked to the cytotoxic chemotherapy liposomal doxorubicin. The HER2 antibody delivers the liposomal doxorubicin to HER2-positive breast cancer cells.
” ‘The main purpose of our study was to establish whether MM-302, alone or in combination with trastuzumab, was safe and tolerable for patients with metastatic, HER2-positive breast cancer whose disease had progressed following numerous prior treatments,’ said Patricia LoRusso, DO, associate director of innovative medicine and professor of medicine (medical oncology) at Yale Cancer Center in New Haven, Connecticut, and professor of medicine in the Division of Oncology at Yale University. ‘We found that the drug was well tolerated when administered to these women.’ “
“On May 16, 2005, at about 1:30 p.m. local time, I was one of several hundred fortunate persons crowded into a conference hall at the ASCO Annual Meeting when the wide separation of the DFS curves in the joint analysis of NCCTG 9831 and NSABP B-31 was first shown.
“The benefit of adjuvant trastuzumab was dramatic, and the results changed clinical practice that very next Monday morning.
“Because there was a known cardiac risk of trastuzumab, patients with smaller lymph node-negative breast cancers either were excluded or underrepresented in the initial adjuvant trastuzumab studies, thus making extrapolation of these impressive results somewhat problematic for patients at lower risk for invasive recurrence.”