Standard of Care in HER2-Positive Breast Cancer Unchanged
June 15, 2023 – For most patients with HER2-positive early breast cancer, standard treatment should remain the same, according to new findings.
Most women with this type of breast cancer will receive the drug trastuzumab, along with other therapies and surgery. The usual course of therapy with trastuzumab is 1 year. For the past decade, studies have been done to see whether similar outcomes can be achieved if trastuzumab was given for a shorter period of time.
But at the annual meeting of the American Society of Clinical Oncology, a 10-year update to a long-running study determined that the treatment protocol would stay the same.
“One-year trastuzumab remains standard of care,” said study author Pier Franco Conte, MD, a professor of oncology at the University of Padova in Italy, who presented the results of the study at the meeting.
He also said that women with a more extensive disease, where the cancer has spread to four or more lymph nodes, might especially benefit from treatment for a year.
Trastuzumab is a targeted therapy medicine that is widely used to treat HER2-positive breast cancer. Since it first became available about 15 years ago, the standard of care has been to give it for 1 year after surgery, together with chemotherapy, to reduce the risk of the cancer returning.
But like other cancer treatments, trastuzumab can cause side effects, some of them serious, including possible heart damage. Trastuzumab is also expensive.
In the current study, Conte and his team randomly assigned 1,254 patients with HER2-positive breast cancer to receive either chemotherapy plus 1 year of trastuzumab or 9 weeks of trastuzumab. The women were followed for 9 years.
The researchers looked at several outcomes. One was disease-free survival, which is how long the women lived without the cancer coming back. Disease-free survival and overall survival were very similar between the two groups. They were also similar for women whose disease had spread to between one and three lymph nodes.
“Numerically, at median follow-up of 9 years, 10-year disease-free survival and overall survival of long versus short trastuzumab are quite close, but a stratified analysis suggests that patients with four or more positive nodes and stage III disease may have an advantage both in disease-free and overall survival when treated,” Conte said.
One of the key points of this study was to see if 9 weeks of trastuzumab was as good as 1 year of treatment. In drug studies, this means that that the test product (the 9 weeks of treatment) is not worse than the product it is being compared to (1 year of treatment) by more than a small pre-specified amount. But any benefit of short-duration trastuzumab could not be demonstrated in their study, Conte said.
That said, he added that 9 weeks of trastuzumab may “represent an affordable and effective option for patients with low- or intermediate-risk, HER2-positive breast cancer living in countries where access to trastuzumab may be a problem.”
MARISA WEISS: Hello, I’m Dr. Marisa Weiss, chief medical officer of breastcancer.org, reporting here from ASCO 2023 with WebMD. I just want to tell you about an interesting study that looked at mastectomy rates in women with early-stage breast cancer, compared to breast preservation therapy.
And what they found is that women who had HER2-positive breast cancers were more likely to have mastectomies than women who have hormone receptor-positive breast cancers, or even triple-negative breast cancers. And we don’t really know why. But maybe it’s because people with HER2-positive breast cancer get really worried and think that mastectomy will lead to better outcomes when, in fact, mastectomy does not improve survival for most people.
And so if you are diagnosed with early-stage breast cancer, regardless of the subtype, just be aware that overall, about two-thirds of women have breast preservation therapy, which is usually lumpectomy radiation, instead of mastectomy. And if you have HER2-positive disease, it doesn’t mean that you’re going to do better with mastectomy. So make sure that you don’t let that diagnosis affect your thinking. And make sure that you have full information before you make your decision about lumpectomy radiation, which is breast preservation, versus mastectomy.
MARISA WEISS: Hello, I’m Dr. Marisa Weiss, chief medical officer of breastcancer.org, reporting here from ASCO 2023 with WebMD. And I want to let you know about an important study that looks at support and counseling for our caregivers. Well, as it turns out, about 1 in 10 adults today are caregivers for family members or loved ones who are experiencing a serious illness, and cancer, of course, being one of them.
And what this study found was that for caregivers who receive support in the form of education – like psychosocial support, coping mechanisms, problem-solving, as well as individual counseling – that they had improved quality of life and less depression. And we need to really keep that in mind because the people who care for us are really important. And we have to make sure that it’s just not our health that we’re focused on, but also the health and mental well-being of our caregivers that we lean on so heavily.
MARISA WEISS: Hello, I’m Dr. Marisa Weiss, chief medical officer of breastcancer.org, reporting from ASCO 2023 with WebMD. There’s an important study that looked at the impact of yoga on inflammation. Now, inflammation is basically the stress and strain of our cells, right at the cellular level. And you can actually measure that with various blood tests.
And emotionally, you can probably feel that by the aches and pains and stress and strain of life, especially when you’re going through a breast cancer diagnosis. But what this study did was it compared yoga to another arm, like placebo, effectively, to find out: Does yoga actually help reduce the amount of inflammation in your body? And interestingly, this study of about 502 patients out of Rochester University in New York found that there was a significant drop in the inflammation markers and tests that you can get from blood sampling.
And to the point where we really need to ask our doctors and caregivers: OK, what can I do during and after my treatment to improve my overall health, including reducing the inflammation in my body so that my body is a safer place for my cells to be operating and for me to be living my life, right? And yoga was very helpful at reducing inflammation. And we know from other studies that yoga improves your mental health, your flexibility, your strength, just your ability to use your body in your everyday life.
So really recommend it. Look out for yoga studios near you. And always talk to the yoga teacher up front and let them know what surgeries or treatments you may have had that could influence what you can or cannot do safely. But generally speaking, anybody can do some modified form of yoga. So this is something to check out and ask your doctor about.
MARISA WEISS: Hello, I’m Dr. Marisa Weiss, chief medical officer of breastcancer.org, reporting to you today from ASCO 2023 with WebMD. There’s an important study that came out from Oxford University, which is in the U.K., United Kingdom, that looked at the impact of shutting down the ovaries either by taking them out or by using medicines to shut them down in premenopausal patients who have breast cancer. And what they found is that if you are 45 years of age and younger and you’re still premenopausal with or without your chemotherapy, then shutting down the ovaries with either removing them or using medicines to stop them from working actually led to an improved outcome.
And what I mean by that is about a 12% absolute percentage drop in the risk of recurrence, as well as an 8% improvement in survival. Those are significant numbers. And the treatment is significant. I mean, it is not easy to be 45 years and younger and be thrown into an early menopause just to get that benefit.
So it’s always a matter of balancing the pros and cons of treatment with your doctor over time to really understand what you can do to have the best outcome. And so a lot of places favor the medicines that shut the ovaries down because maybe shutting them down for a period of time is helpful, and you may not need to be thrown into menopause permanently. These are all important questions to ask your doctor to find out what’s best for you, especially if you’re young, 45 years of age or younger, and you’re still premenopausal after your treatment for breast cancer.
MARISA WEISS: Hello. I’m Dr. Marisa Weiss, chief medical officer of breastcancer.org, reporting from ASCO 2023 with WebMD. Just want to let you know about an important study that looked at hope, like how hopeful people were about the future, and what determines hope, what you can do to improve the amount of hope that you feel.
And what it showed was that if you have a better understanding of what to expect, how well you’re going to do or not do, that helped people feel more hopeful. If you have better quality of life – you’re better able to do what you want to do when you want to do it – you’re going to be more hopeful. And if you have less symptoms – so for people who had their symptoms, either treatment-related symptoms or cancer-related symptoms, managed better, they felt more hopeful. That makes sense.
For those people who had just more resilience or more ability to cope, they were more hopeful. And if you’re hearing that and you’re thinking, like, “Great, thanks a lot” – but, basically, these are things you want to learn how to do better. We can all learn how to do things better and to improve how we’re thinking, how we’re feeling, including how hopeful we are.
And finally, for people who had better financial well-being, they were more hopeful. So the bottom line from this is that, for your own emotional well-being and how you feel about the future or your level of hope, then there are things that you can do to improve how you’re feeling.
