Neoadjuvant Herceptin – pro
Guidelines not yet fully supportive of concurrent Herceptin with docetaxel carboplatin. One guideline says: “Trastuzumab should be offered for one year to all patients with HER2-positive node-positive or node-negative, tumour greater than 1 cm in size, and primary breast cancer and who are receiving or have received (neo)adjuvant chemotherapy. Trastuzumab should be offered after chemotherapy.” This is because the data on ehich the recommendation is based is not mature. “There is evidence from the Breast Cancer International Research Group (BCIRG) 006 trial that suggests that the combination of docetaxel, carboplatin, and trastuzumab may be similarly effective to doxorubicin and cyclophosphamide followed by docetaxel and trastuzumab, with reduced cardiac toxicity. However, to date the full details of this trial, particularly the direct comparison of these two regimens, have not been published. Until such time as these results are available, the Breast Cancer DSG cannot make any recommendation regarding the docetaxel, carboplatin, and trastuzumab regimen. ” Data presented at 31st Annual San Antonio Breast Cancer Symposium (SABCS): Abstract 31. Presented December 12, 2008 were positive for superiority of Herceptin neoadjuvantly, although it was with an anthracycline and taxame (NOAH trial)
Trudeau M, Madarnas Y, McCready D, Pritchard KI, Messersmith H, Breast Cancer Disease Site Group. The role of trastuzumab in adjuvant and neoadjuvant therapy in women with HER2/neu-overexpressing breast cancer: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 May 12. 28 p. (Evidence-based series; no. 1-24). [58 references]