Is the duration of adjuvant trastuzumab debate still clinically relevant?
Menés pour l'un en France (essai PHARE, 3 384 patientes), pour l'autre au Royaume-Uni (essai PERSEPHONE, 2 045 patientes), ces deux essais de phase III évaluent la non infériorité, du point de vue de la survie sans maladie, d'un traitement adjuvant par trastuzumab d'une durée de 6 mois par rapport au même traitement dispensé durant 12 mois et analyse les toxicités associées, chez des patientes atteintes d'un cancer du sein de stade précoce (durées médianes de suivi : 7,5 ans et 5,4 ans)
The selection of optimal systemic therapy for early HER2-positive breast cancer has become exceedingly complex. Since the advent of adjuvant trastuzumab, several new drugs have shown substantial incremental benefits.1 Clearly, not all patients should receive these additional therapies. Hence, it is incumbent upon clinicians to carefully select patients who are the most likely to benefit from an escalation strategy. To this end, progress is being made. For example, the recognition that poor response to neoadjuvant therapy is associated with poor outcomes in HER2-positive disease led to the design of the KATHERINE study,in which patients with residual disease after neoadjuvant therapy received adjuvant trastuzumab-emtansine or standard trastuzumab. The 3-year absolute invasive-disease-free survival was improved by more than 10 percentage points (88·3% with trastuzumab-emtansine and 77·0% with trastuzumab; hazard ratio [HR] 0·50, 95% CI 0·39–0·64), akin to the remarkable benefits observed in the first adjuvant trastuzumab studies (...)
The Lancet , commentaire en libre accès, 2018