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This Week in NEJM: Dec 8, 2011


In NEJM this week, researchers in the US, Europe and South Korea report results of a study in which pertuzumab, trastuzumab, and docetaxel were combined to treat metastatic breast cancer. The team randomly assigned 808 patients with HER2-positive metastatic breast cancer to receive either placebo plus trastuzumab plus docetaxel or pertuzumab plus trastuzumab plus docetaxel, and found that the pertuzumab group had a higher progression-free survival time compared to the control group. "The interim analysis of overall survival showed a strong trend in favor of pertuzumab plus trastuzumab plus docetaxel," the authors write. "The combination of pertuzumab plus trastuzumab plus docetaxel, as compared with placebo plus trastuzumab plus docetaxel, when used as first-line treatment for HER2-positive metastatic breast cancer, significantly prolonged progression-free survival, with no increase in cardiac toxic effects."

Also in NEJM this week, a different group of American and European researchers report results from a study of everolimus as a treatment for postmenopausal HR–positive advanced breast cancer. The team randomly assigned 724 patients who had previously been treated with a nonsteroidal aromatase inhibitor to receive either everolimus and exemestane or exemestane and placebo. The researchers observed that median progression-free survival was 10.6 months in the everolimus group, compared to 4.1 months in the placebo group.

And finally in NEJM this week, Northwestern University's William Gradishar says that doctors have "an abundance of riches" when it comes to therapies for HER2-positive breast cancer. The introduction of trastuzumab improved survival time for HER2-positive breast cancer patients, and since then, a number of treatment strategies have been developed to treat the disease, most of which combine trastuzumab with a chemotherapy, Gradishar says. Lapatinib was later to treat patients who don't respond to trastuzumab, he adds. And either of these drugs in combination with chemotherapy or other compounds are considered appropriate for a majority of patients. "The challenge to clinicians going forward will be how best to use the many HER2 therapies that are in development," Gradishar says, adding, "Although HER2-positive breast cancer accounts for only 25 to 30 percent of breast cancers, the increasing therapeutic options provide hope to patients and considerable challenges for clinicians."

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