Approximately 237,000 cases of breast cancer are diagnosed in the U.S. each year, and about 20 percent of women are prescribed the drug Herceptin® (trastuzumab), a targeted therapy that has been shown to be effective against aggressive, early stage, and human epidermal growth factor receptor 2-positive (HER2-positive) breast cancers.
The standard treatment is to combine Herceptin with chemotherapy for a year or more after surgery to reduce the risk of the cancer coming back. However, in June 2018, data from the Persephone trial was presented at the American Society of Clinical Oncology’s annual meeting (ASCO) in Chicago. The research suggests that Herceptin is just as effective for women who take it for six months instead of a year, with the additional benefit of fewer side effects.
If the study findings do alter the standard of care for Herceptin, it could be a game-changer for breast cancer patients, doctors, and health plans. However, although these data are important for patients and the medical community, it’s too early in the research process to change the standard of care or make global recommendations for women with breast cancer.
"Although this is exciting news for patients and the medical community, it’s too early in the game to change the standard of care or make global recommendations."
Potential patient benefits from the study
The Persephone trial followed more than 4,000 women who had early stage breast cancer (stages 1, 2 and 3) for up to five years. After four years, 89.4 percent of those treated with Herceptin for six months had no signs of the disease, compared with 89.8 percent of those who took it for 12 months.
Similar to other breast cancer drugs, Herceptin is associated with an increased risk of heart complications over time, and the more treatments, the greater the risk. In fact, for the Persephone trial, 4 percent of women in the 6-month group and 8 percent in the 12-month group dropped out early due to heart problems. Fewer infusions could thus mean a lower risk of cardiovascular side effects.
Additionally, a shorter treatment duration also could reduce costs for patients, doctors, and health insurance companies. And patients would spend less time traveling to and from treatment, potentially improving access to treatment, reducing travel expenditures, and resulting in better quality of life.
What must happen to change treatment standards
The next step is for the data to be analyzed so researchers can determine if certain patients have levels of risk that would call for customized treatment. Those findings would then have to be peer-reviewed, meaning researchers not involved in the study would discuss the data in order to reach a consensus on whether results are valid.
When selecting the right treatment for cancer patients, we must carefully decide on the most effective treatment with the lowest rate of toxicity and risk for every patient. Although a shorter course of treatment of Herceptin might indeed be effective for some women, without solid evidence from a large, peer-reviewed study, it’s too early to change treatment standards for everyone.
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