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Treatment hope for HER2+ breast cancer patients

Friday October 2nd 2020

Women with early HER2+ breast cancer survive longer if they are prescribed lapatinib and trastuzumab before surgery, the results of a Spanish trial have revealed.

Dr Paolo Nuciforo, principal investigator at Vall d’Hebron Institute of Oncology, Barcelona, will tell delegates at the virtual 12th European Breast Cancer Conference today (2 October 2020) about his findings from nearly ten years of follow-up from the international NeoALTTO BIG-06 trial.

NeoALTTO BIG-06 enrolled 455 women with early HER2-positive cancer to receive either neoadjuvant trastuzumab or lapatinib alone or in combination as neoadjuvant therapy.

After surgery the patients received three cycles of chemotherapy followed by 34 weeks of whichever therapy they had originally been randomised to receive.

A median of 9.7 years of follow-up found there were no signs of cancer recurrence in 69% of patients receiving both drugs, 65% of the trastuzumab-only group and 63% of the lapatinib-only group.

Overall survival rates were 80% in the combination group, 77% in the lapatinib group and 76% in the trastuzumab group, with no statistically significant differences between the groups.

However, when the researchers compared women who had achieved pCR with those that had not in all three treatment groups, they found that 77% of pCR patients survived nine years event-free compared to 61% of non-pCR patients, and 88% of pCR patients were still alive at nine years compared to 72% of non-pCR patients.

Further analysis revealed that these associations were statistically significant in women who received the drug combination or who were hormone receptor negative.

Dr Nuciforo said: “The results from this analysis show that patients who achieve pCR are significantly more likely to survive for longer than those who do not achieve pCR. This validates pCR as an early indicator of long-term outcome for HER2-positive disease and could help doctors decide on the best treatment. On one hand, patients not achieving a pCR may be at higher risk of recurrence and giving extended therapy to them could potentially lower this risk. On the other hand, those patients who do achieve pCR could be spared additional toxic treatments.”

Delegates will also hear from another Spanish study that has identified which benign breast diseases (BBD) are more likely to become cancerous.

Dr Marta Román, a senior researcher in the epidemiology department at the Hospital del Mar Medical Research Institute, will say that that women with a BBD diagnosed from the second screening onwards have a significantly higher subsequent risk of breast cancer than those with a BBD diagnosed on their first mammographic screening.

The research team, led by Professor Xavier Castells, head of the epidemiology department at the Hospital del Mar Medical Research Institute, analysed data from 629,087 women who underwent 2,327,384 screening mammograms between 1995 and 2015, and followed them until 2017.

They found that women diagnosed with incident BBD had a 2.67-fold increased chance of developing breast cancer than women with no BBD, while women with prevalent BBD had a 1.87-fold increased risk.

Women with proliferative BBD had a 3.28-fold increased chance of breast cancer compared to women with no breast disease, while women with non-proliferative BBD had a 1.96-fold increased risk.

Women with an incident, non-proliferative BBD had a 2.39-fold increased chance of subsequently developing breast cancer compared to women with no BBD; women with prevalent, proliferative BBD had a 2.85-fold increased risk; and women with prevalent, non-proliferative BBD had a 1.63-fold increased risk.

The researchers hope their findings could be used to design personalised breast cancer screening strategies to improve their effectiveness.

Meanwhile, another study, to be presented at the conference, has shown that the increased risk of cardiovascular disease in women treated for breast cancer can be predicted with computer analysis of routine scans.

The research, to be presented by Professor Helena Verkooijen, from the Division of Imaging and Oncology at the University Medical Centre Utrecht in The Netherlands, shows that it is possible to spot those at the greatest risk using computer analysis of the CT scans that are taken for planning cancer treatments.

Identifying patients most at risk of cardiovascular disease could allow steps to be taken to lower the risk, she says.

The first large-scale study of its kind involved about 14,000 breast cancer patients who were treated with radiotherapy in three large hospitals in The Netherlands between 2005 and 2016.

The researchers used the coronary artery calcium (CAC) score and developed a deep learning algorithm that could establish the presence and extent of coronary artery calcifications from the CT scans that were already being carried out to help plan each woman’s radiotherapy treatment.

The women were followed for an average of 52 months and results showed that of the women with no calcifications 5% went on to be hospitalised or to die from cardiovascular disease.

In women with a score of between one and ten, 8.9% were hospitalised with or died from cardiovascular disease. In women with a score of 11-100, the figure was 13.5%, in women with a score of 101-400 it was 17.5% and in women with a score above 400, it was 28.3%.

When age and the year of diagnosis were taken into account, there was a 3.7 times increased risk of cardiovascular disease in women with a score above 400 compared with women with no calcifications. The association was greater among women who were treated with anthracycline.

Tags: Cancer | Europe | Pharmaceuticals | Women's Health & Gynaecology

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