Targeted agent combinations in focus for breast cancer

Targeted agent combinations in focus for breast cancer

9/12/2013

Breast cancer treatment via targeted agent combinations (including Herceptin, Tykerb, Taxotere, Paraplatin, Avastin, Arimidex and Aromasin) will be in focus at the upcoming San Antonio Breast Cancer Symposium.

The first look at event-free survival in long-term follow-up from the NeoALTTO trial comparing neoadjuvant chemotherapy with trastuzumab (Herceptin) alone or in combination with lapatinib (Tykerb) will be presented that morning.

"That's going to be very interesting to see if neoadjuvant pathologic complete remission rate correlates with long-term outcome," conference co-chair C. Kent Osborne, MD, told MedPage Today.

The trial showed better pathologic complete response rates with the dual HER2 blockade strategy, but results have been mixed with this surrogate endpoint in prior neoadjuvant trials.

A previous trial (known as the NOAH trial) supported a link to progression-free survival, but another trial comparing chemotherapy regimens showed no impact on overall survival at 5 years despite an absolute 20% difference in pathologic complete response.

The same session will also feature results of a trial of neoadjuvant trastuzumab, lapatinib, or both. But the TRIO trial used docetaxel (Taxotere) and carboplatin (Paraplatin) chemotherapy instead of paclitaxel as in NeoALTTO.

"To complete the really exciting trials in HER2-positive disease," Osborne pointed to the BETH trial.

That adjuvant trial randomized patients to trastuzumab alone or in combination with bevacizumab (Avastin) atop a regimen of either docetaxel and carboplatin as the chemotherapy regimen or one that was anthracycline-based.

The study should not only determine whether this is the setting that will be a winner for bevacizumab but whether a chemotherapy regimen easier on the heart is as good for breast cancer outcomes.

Targeting the vascular endothelial growth factor (VEGF) with bevacizumab "so far has been, I think, very disappointing in breast cancer," noted Osborne, director of the Dan L. Duncan Cancer Center at Baylor College of Medicine in Houston.

Another highlight at the conference will be the IBIS-II primary prevention trial using anastrozole (Arimidex) in high-risk women, which, if positive, could add that aromatase inhibitor to the ranks of tamoxifen and exemestane (Aromasin).

Toxicity and tolerability results could be just as important as outcomes, Osborne suggested in an interview.

He also pointed to three surgical trial presentations as important:

• The PRIME 2 trial looking at whether radiation is necessary after breast conservation surgery and hormonal therapy for women 65 and older
• A trial randomizing women to lymph node biopsy in the metastatic setting
• Another randomizing them to surgery or no surgery when presenting with advanced stage breast cancer
• Several trials will also report on the search for biomarkers of resistance to HER2-targeted therapy, which could help identify which women would be good candidates for additional treatments.

 

Source: MedPage Today: http://www.medpagetoday.com/MeetingCoverage/SABCS/43319