The inaugural day of the 2013 San Antonio Breast Cancer Symposium introduced new insights with treatment implications. I believe patients diagnosed with HER2-positive breast cancer(s) will find of two studies of particular interest:
NeoALTTO Trial (Neoadjuvant Lapatinib and/or Trastuzumab Treatment Optimization). This is an ongoing phase III clinical trial that is evaluating if a combination of trastuzumab and lapatinib (two HER2-targeted therapy agents) is better than only one of the HER2-targeted therapies. The published findings showed a moderate benefit to adding lapitinib (tykerb) to trastuzumab (herceptin) prior to surgery while significantly increasing side effects.
The same research team will present the results of the ALTTO trial (Adjuvant Lapatinib and/or Trastuzumab Treatment Optimization) at the 2014 San Antonio Breast Cancer Symposium. This trial, which is closely related to the NeoALTTO trial, is exploring the effectiveness of trastuzumab and lapatinib after breast cancer surgery.
BETH Trial (Bevacizumab and Trastuzumab in HER2-Positive Breast Cancer). The BETH trial includes 3,509 patients diagnosed with HER2-positive, node-positive or high-risk breast cancer. Primary results from the BETH study showed no improved outcome by adding bevacizumab (Avastin) to chemotherapy after a curative surgery.
Additional 2013 SABCS Wednesday Observations
Tumor infiltrating lymphocytes (TILs) was a big topic of discussion on Wednesday. This type of white blood cell, when located within the tumor, suggests an immune response to the cancer and infers a better prognosis. Also, this finding can predict a better response to receiving carboplatin as well as herceptin when used with combination chemotherapy.
Although more research must be done to confirm these early findings, women with HER2-positive breast cancer may receive the largest benefit (compared to other types of breast cancer) from chemotherapy and herceptin prior to surgery (neoadjuvant).