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Survival of Patients With Small HER2-Positive Breast Tumors Were Improved by Adjuvant Trastuzumab in a Recent Meta-Analysis.

Dr. Ciara C. O'Sullivan and her colleagues from the National Cancer Institute, Bethesda, Maryland concluded from their meta-analysis that survival in women with breast cancer positive for human epidermal growth factor receptor 2 (HER2) with tumor size no larger than 2 cm were further improved with adjuvant trastuzumab. This individual patient data meta-analysis was recently published in the Journal of Clinical Oncology.

4,220 women from five randomized clinical trials were included in their meta-analysis that compares the efficacy of adjuvant trastuzumab against no trastuzumab for women with HER2-positive breast cancer with tumors 2 cm or smaller. Most of the patients included in their meta-analysis had T1c disease rendering it a highly selected subgroup. 2588 patients received adjuvant trastuzumab while the remaining patients did not receive adjuvant trastuzumab. The cumulative incidence of a Disease Free Survival (DFS) event at eight years was lower for women that received trastuzumab than for women who did not receive trastuzumab. Also, the group that received trastuzumab has higher Overall Survival (OS) than the group that did not receive trastuzumab.

In a subgroup analysis for patients with hormone receptor (HR)-positive, and HR-negative disease, the proportional benefit was similar despite differences in an absolute magnitude of benefit and timing of relapses over time. Dr. O’Sullivan believes that these two subgroups of patients with HR-positive and HR-negative disease should be studied differently in future clinical trials because this study has shown that HR-positive/HER2-positive disease is biologically different from HR-negative/HER2-positive disease. Dr. O’Sullivan further added that the efficacy of adjuvant trastuzumab used in T1a or T1b node-negative tumors in patients were still controversial. Since prospective randomized trials to answer the efficacy of adjuvant trastuzumab used in T1a or T1b node-negative tumors in patients would not ever be conducted due to a number of reasons, Dr. O’Sullivan believes that an individualized approach to the management of patients with T1a or T1b node-negative tumors should be adopted by physicians.

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