Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer

Sara M. Tolaney, William T. Barry, Chau T. Dang, Denise A. Yardley, Beverly Moy, P. Kelly Marcom, Kathy S. Albain, Hope S. Rugo, Matthew Ellis, Iuliana Shapira, Antonio C. Wolff, Lisa A. Carey, Beth A. Overmoyer, Ann H. Partridge, Hao Guo, Clifford A. Hudis, Ian E. Krop, Harold J. Burstein, Eric P. Winer

Research output: Contribution to journalArticle

Abstract

BACKGROUND No single standard treatment exists for patients with small, node-negative, human epidermal growth factor receptor type 2 (HER2)-positive breast cancers, because most of these patients have been ineligible for the pivotal trials of adjuvant trastuzumab. METHODS We performed an uncontrolled, single-group, multicenter, investigator-initiated study of adjuvant paclitaxel and trastuzumab in 406 patients with tumors measuring up to 3 cm in greatest dimension. Patients received weekly treatment with paclitaxel and trastuzumab for 12 weeks, followed by 9 months of trastuzumab monotherapy. The primary end point was survival free from invasive disease. RESULTS The median follow-up period was 4.0 years. The 3-year rate of survival free from invasive disease was 98.7% (95% confidence interval [CI], 97.6 to 99.8). Among the 12 relapses seen, 2 were due to distant metastatic breast cancer. Excluding contralateral HER2-negative breast cancers and nonbreast cancers, 7 disease-specific events were noted. A total of 13 patients (3.2%; 95% CI, 1.7 to 5.4) reported at least one episode of grade 3 neuropathy, and 2 had symptomatic congestive heart failure (0.5%; 95% CI, 0.1 to 1.8), both of whom had normalization of the left ventricular ejection fraction after discontinuation of trastuzumab. A total of 13 patients had significant asymptomatic declines in ejection fraction (3.2%; 95% CI, 1.7 to 5.4), as defined by the study, but 11 of these patients were able to resume trastuzumab therapy after a brief interruption. CONCLUSIONS Among women with predominantly stage I HER2-positive breast cancer, treatment with adjuvant paclitaxel plus trastuzumab was associated with a risk of early recurrence of about 2%; 6% of patients withdrew from the study because of protocolspecified adverse events. (Funded by Genentech; ClinicalTrials.gov number, NCT00542451.)

Original languageEnglish (US)
Pages (from-to)134-141
Number of pages8
JournalNew England Journal of Medicine
Volume372
Issue number2
DOIs
StatePublished - Jan 8 2015

ASJC Scopus subject areas

  • Medicine(all)

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    Tolaney, S. M., Barry, W. T., Dang, C. T., Yardley, D. A., Moy, B., Marcom, P. K., Albain, K. S., Rugo, H. S., Ellis, M., Shapira, I., Wolff, A. C., Carey, L. A., Overmoyer, B. A., Partridge, A. H., Guo, H., Hudis, C. A., Krop, I. E., Burstein, H. J., & Winer, E. P. (2015). Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer. New England Journal of Medicine, 372(2), 134-141. https://doi.org/10.1056/NEJMoa1406281