The small study reviewed here found that when Herceptin (chemical name: trastuzumab) was given in combination with dose-dense chemotherapy, the risk of heart problems from Herceptin was lower than when Herceptin was given with a routine schedule of chemotherapy.
Dose-dense chemotherapy means that the chemotherapy medicines are given every 2 weeks, instead of the routine schedule of every 3 weeks. Herceptin is a targeted therapy used to treat HER2-positive breast cancers. HER2-positive cancers have extra HER2 genes and make too many HER2 protein receptors (also called HER2/neu proteins). Herceptin works by blocking the HER2 protein on the cancer cell's surface.
Because it's harder on the body, the researchers were concerned that dose-dense chemotherapy might actually increase the risk of heart problems from giving Herceptin at the same time. They were pleased to find that this wasn't the case.
Only 1 woman out of 70 in this study (1.4%) had heart failure after getting Herceptin and dose-dense chemotherapy. When Herceptin is given with a routine schedule of chemotherapy, there is a 4% risk of heart problems.
Dose-dense chemotherapy is a relatively new, more intensive way to give chemotherapy. Doctors may recommend a dose-dense schedule for some women because other research has shown that this approach can improve survival and decrease the risk of recurrence more effectively than a routine chemotherapy schedule.
Dose-dense chemotherapy doesn't allow as much time for the immune system and red blood cells to recover between chemotherapy doses. Doctors sometimes use the medicines Neupogen (chemical name: filgrastim) or Neulasta (chemical name: pegfilgrastim) to strengthen the immune system, and Procrit (chemical name: epoetin alfa), Epogen (chemical name: epoetin alfa), or Aranesp (chemical name: darbepoetin alfa) to strengthen the red blood cell system during dose-dense chemotherapy.
If you've been diagnosed with HER2-positive early-stage breast cancer, your doctor will probably consider treating you with both Herceptin and chemotherapy after surgery to lower the risk of the cancer coming back. This study suggests that dose-dense chemotherapy won't increase your risk of heart problems from Herceptin. Together, you and your doctor can decide on a treatment plan that's best for you and your unique medical and personal situation.
Visit the breastcancer.org Targeted Therapies section to learn more about Herceptin and other targeted therapies used to treat breast cancer.
LOS ANGELES (Reuters) - Combining targeted breast cancer treatment Herceptin with a more frequent chemotherapy regimen reduces the risk of heart problems related to the drug, according to researchers at New York's Memorial Sloan-Kettering Cancer Center.
Previous studies have shown that when standard chemotherapy drugs are administered every two weeks -- a treatment plan called "dose-dense" -- the likelihood of survival is improved and the risk of cancer recurrence is lowered.
But some oncologists have hesitated to use Genentech Inc's Herceptin in conjunction with more frequent chemotherapy for fear of heart damage, said Dr. Chau Dang, an oncologist at Sloan-Kettering and the study's lead researcher.
"We are excited about this because we saw that the risk of cardiac toxicity is actually lower," she said.
Herceptin, or trastuzumab, is an antibody-based drug used to treat the 25 percent to 30 percent of breast cancer patients who have tumors that generate a protein called HER-2.
These tumors tend to grow faster and are more likely to recur than tumors that do not carry the protein.
Unlike chemotherapy, which is toxic throughout the body, Herceptin is designed to target tumor cells and spare normal cells, but it still causes side effects, the most serious being congestive heart failure, which occurs in up to 4 percent of patients treated with the injected drug.
The small Sloan-Kettering study demonstrated an even lower risk of cardiac toxicity when standard chemotherapy drugs are administered once every two weeks, instead of once every three weeks, which is the regimen under which previously-published trials evaluated Herceptin.
The study of 70 patients with early-stage breast cancer found that just one patient, or 1.4 percent, experienced congestive heart failure after 28 months of follow-up.
"There is no reason to forego giving a dose-dense regimen of chemotherapy... the toxicities are not worse," said Dr. Dang.
The study will be published in the March 10 issue of the Journal of Clinical Oncology and was supported by grants from Genentech and Amgen Inc.
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