The Pharmaceutical Journal
Vol 277 No 7483 p704
22/29 December 2007

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Studies support continued use of trastuzumab

Continuing treatment with trastuzumab (Herceptin) is associated with improved survival in women whose advanced HER2-positive breast cancer has progressed after initial treatment with the drug, according to results from two studies reported last week at the San Antonio Breast Cancer Symposium in Texas.

The first study randomised 482 women to continue with trastuzumab (at a dose of 6mg/kg body weight every three weeks) plus capecitabine (2,500mg/m² on days 1–14, every 21 days) or capecitabine alone.

Interim results reported for 156 patients show that progression-free survival was almost three months longer in those who continued treatment with trastuzumab, increasing from a median of 5.6 months with capecitabine alone to 8.5 months with the combination. The overall response rate was almost double (48.95 per cent) with the trastuzumab combination compared with capecitabine alone (24.6 per cent). Final results from the study should be available in 2008.

A second study retrospectively evaluated routine clinical use of trastuzumab in patients with advanced breast cancer in Germany between 2001 and 2006. Results for 910 women showed that continuing treatment with trastuzumab after disease progression was associated with an increase in overall survival of nearly seven months compared with stopping the drug (median of 20.1 months compared with 13.4 months since first progression, P=0.0014).

Nisha Shaunak, breast cancer specialist pharmacist, Royal Marsden Hospital, London, said: “Both of these studies provide further evidence for the use of Herceptin beyond disease progression.” She cautioned that the numbers were small in the randomised trial and looked forward to further results to clarify how many lines of treatment should be considered.

“As pharmacists, we need a clear understanding of how the signalling pathways are working in terms of making drug choices with targeted agents. But there appears to be a benefit to continuing treatment with Herceptin,” she said.