Experts issue treatment guidelines for aggressive form of breast cancer

May 5, 2014
Experts issue treatment guidelines for aggressive form of breast cancer
Up to one-fifth of patients will have these 'HER2-positive' tumors, oncologists' group says.

(HealthDay)—Two sets of guidelines for treating patients with an aggressive form of breast cancer have been released by the American Society of Clinical Oncology (ASCO).

According to ASCO, about 15 percent to 20 percent of breast cancers are known as "HER2-positive," meaning that they carry high levels of the HER2 protein, which causes tumor cells to grow and divide faster than happens with most other breast cancers. This means that HER2-positive cases are especially aggressive and tough to treat.

However, doctors now "have several treatments for advanced HER2-positive , all of which are associated with improved survival," Dr. Eric Winer, co-chair of the expert panel that developed the guidelines, said in an ASCO news release. "We're very fortunate that now we have multiple studies that give us a clear picture of how these newer agents should be used."

In the first guideline, the group recommends treatments for women newly diagnosed with advanced HER2-positive breast cancer and those with early stage breast cancer that has progressed to an advanced stage.

After examining 19 studies, Winer and his colleagues on the panel advised a combination of standard chemotherapy plus two other drugs, trastuzumab and pertuzumab, as first-line treatment. For certain patients—such as those with contraindications and/or slow-growing hormone receptor-positive cancers—chemotherapy-based treatment may be replaced with hormonal therapy given with or without either trastuzumab or lapatinib, the panelists said.

Trastuzumab emtansine (T-DM1) is recommended as a second-line therapy if the first line of treatment fails, the guideline says.

For third-line therapy and beyond, treatment depends on a patient's previous breast cancer treatments. Options include T-DM1, or chemotherapy with trastuzumab and in some cases with lapatinib, the combination of and lapatinib, or a pertuzumab-based regimen if the patient did not previously receive pertuzumab.

The second set of guidelines outlines treatments for treating cancer that has spread (metastasized) to the brain in women with advanced HER2-positive breast cancer.

Surgery and/or radiation therapy are recommended for patients with a good chance of survival, depending on the size and number of brain tumors, chances of surgical success and symptoms.

Treatment options for patients with a low chance of survival include surgery, whole brain radiation therapy and certain drugs that may prove effective, such as lapatinib and capecitabine.

Other options for these patients include taking part in a clinical trial, supportive care and/or palliative care.

Brain metastases occur in 30 to 40 percent of women with HER2-positive breast cancer. These patients can live two years or more after being diagnosed with brain metastases. This is the first guideline specifically for such patients.

"Brain metastases can compromise neurologic function, and treatments are designed to preserve neurologic function and minimize the decline in quality of life," Dr. Sharon Giordano, co-chair of the panel that developed the guideline, said in the news release.

"But at the same time, some of the treatments for have side effects that can negatively affect cognitive function. We hope that this guideline will help standardize care for these and balance toxicities and benefits of treatment."

Both guidelines were published May 5 in the Journal of Clinical Oncology.

Explore further: Trastuzumab emtansine: Indication of major added benefit in one subpopulation

More information: The U.S. National Cancer Institute has more about breast cancer treatments.

Related Stories

Trastuzumab emtansine: Indication of major added benefit in one subpopulation

April 7, 2014
The antibody-drug conjugate trastuzumab emtansine (trade name: Kadcyla) has been approved since November 2013 for the treatment of patients with unresectable, locally advanced or metastatic breast cancer that is HER2-positive, ...

Trastuzumab and chemotherapy improved survival in HER2-postive breast and brain cancer patients

July 18, 2011
The use of trastuzumab, chemotherapy and surgery among women with HER2-positive metastatic breast cancer significantly improved survival from the time central nervous system metastases were diagnosed.

Researchers to present event-free and overall survival results from NeoALTTO trial

December 11, 2013
Results from the initial analysis of event-free and overall survival for patients enrolled in the randomized, phase III Neoadjuvant Lapatinib and/or Trastuzumab Treatment Optimization (NeoALTTO) trial are to be presented ...

Anti-cancer drug T-DM1 benefits women with advanced breast cancer who've failed previous treatments

September 27, 2013
Amsterdam, The Netherlands: First results from a phase III clinical trial of the combination drug, T-DM1, show that it significantly improves the length of time before the disease worsens in women with advanced HER2 positive ...

PIK3CA gene mutations make HER2- and hormone receptor-positive breast cancers treatment-resistant

December 12, 2013
Women with breast cancer characterized by high levels of the protein HER2 and hormone receptors gained much less benefit from presurgery treatment with chemotherapy and HER2-targeted therapies if their cancer had one or more ...

Experts urge routine test for all patients with invasive breast cancer

October 7, 2013
(HealthDay)—All women with invasive breast cancer should be tested for the HER2 (human epidermal growth factor receptor 2) gene and protein, according to updated guidelines from two expert groups.

Recommended for you

Scientists block the siren call of two aggressive cancers

January 23, 2018
Aggressive cancers like glioblastoma and metastatic breast cancer have in common a siren call that beckons the bone marrow to send along whatever the tumors need to survive and thrive.

'Hijacker' drives cancer in some patients with high-risk neuroblastoma

January 23, 2018
Researchers have identified mechanisms that drive about 10 percent of high-risk neuroblastoma cases and have used a new approach to show how the cancer genome "hijacks" DNA that regulates other genes. The resulting insights ...

Enzyme inhibitor combined with chemotherapy delays glioblastoma growth

January 23, 2018
In animal experiments, a human-derived glioblastoma significantly regressed when treated with the combination of an experimental enzyme inhibitor and the standard glioblastoma chemotherapy drug, temozolomide.

Study: Cells of three advanced cancers die with drug-like compounds that reverse chemo failure

January 23, 2018
Researchers at Southern Methodist University have discovered three drug-like compounds that successfully reverse chemotherapy failure in three of the most commonly aggressive cancers—ovarian, prostate and breast.

Researchers identify a protein that keeps metastatic breast cancer cells dormant

January 23, 2018
A study headed by ICREA researcher Roger Gomis at the Institute for Research in Biomedicine (IRB Barcelona) has identified the genes involved in the latent asymptomatic state of breast cancer metastases. The work sheds light ...

Boosting cancer therapy with cross-dressed immune cells

January 22, 2018
Researchers at EPFL have created artificial molecules that can help the immune system to recognize and attack cancer tumors. The study is published in Nature Methods.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.