Coping with uncertainty: T1a,bN0M0 HER2-positive breast cancer, do we have a treatment threshold?

Hdl Handle:
http://hdl.handle.net/10147/207943
Title:
Coping with uncertainty: T1a,bN0M0 HER2-positive breast cancer, do we have a treatment threshold?
Authors:
Kelly, C M; Pritchard, K I; Trudeau, M; Andreopoulou, E; Hess, K; Pusztai, L
Affiliation:
Department of Medical Oncology, Waterford Regional Hospital, Dunmore Road,, Waterford, Ireland. catherine.kelly@ucd.ie
Citation:
Ann Oncol. 2011 Nov;22(11):2387-93. Epub 2011 Mar 15.
Journal:
Annals of oncology : official journal of the European Society for Medical, Oncology / ESMO
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207943
DOI:
10.1093/annonc/mdq786
PubMed ID:
21406473
Abstract:
BACKGROUND: Recent retrospective studies have suggested that patients with T1a,bN0M0 human epidermal growth factor receptor 2 (HER2)-positive breast cancer are at a higher risk for recurrence and might benefit from adjuvant trastuzumab. The absolute benefits associated with treating this subgroup are uncertain. Design: We reviewed recent studies examining the prognostic value of HER2 in patients with node-negative T1a,b HER2-positive breast cancer. We calculated the number needed to treat (NNT) using baseline risk estimates for untreated T1a,bN0M0 breast cancer and the number needed to harm (NNH) using the incidence of cardiac events in each of the adjuvant trastuzumab clinical trials. RESULTS: Several studies were identified, each with limitations inherent to retrospective database analyses: small cohort sizes, lack of systematic HER2 testing in older specimens, variations in the use of adjuvant therapy and definitions of study end points, and lack of information relating to comorbidities. The 5-year disease-free survival in the pre-trastuzumab era ranged from 77% to 95%. Comparisons between small HER2 -positive and small HER2 -negative cancers showed numerically worse outcome for the HER2-positive cohort in some but not all studies. In many instances, the NNH was larger (26-250) than the NNT (13-35); however, in a subset of patients, the NNH was lower (6) than the NNT (13-35). CONCLUSIONS: Better prediction tools to estimate more precisely the risk for death due to comorbid illness versus breast cancer are needed. In some patients, the risks of therapy could outweigh the benefits. Treatment selection for T1a,bN0 HER2-positive cancers remains in the transition area between evidence- and subjective judgment-based medicine.
Language:
eng
MeSH:
Antibodies, Monoclonal, Humanized/*therapeutic use; Antineoplastic Agents/*therapeutic use; Breast Neoplasms/*drug therapy/*enzymology/pathology; Chemotherapy, Adjuvant; Decision Making; Female; Humans; Neoplasm Staging; Predictive Value of Tests; Prognosis; Receptor, erbB-2/*biosynthesis; Retrospective Studies; Tumor Markers, Biological/*biosynthesis; Uncertainty
ISSN:
1569-8041 (Electronic); 0923-7534 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorKelly, C Men_GB
dc.contributor.authorPritchard, K Ien_GB
dc.contributor.authorTrudeau, Men_GB
dc.contributor.authorAndreopoulou, Een_GB
dc.contributor.authorHess, Ken_GB
dc.contributor.authorPusztai, Len_GB
dc.date.accessioned2012-02-01T10:52:07Z-
dc.date.available2012-02-01T10:52:07Z-
dc.date.issued2012-02-01T10:52:07Z-
dc.identifier.citationAnn Oncol. 2011 Nov;22(11):2387-93. Epub 2011 Mar 15.en_GB
dc.identifier.issn1569-8041 (Electronic)en_GB
dc.identifier.issn0923-7534 (Linking)en_GB
dc.identifier.pmid21406473en_GB
dc.identifier.doi10.1093/annonc/mdq786en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207943-
dc.description.abstractBACKGROUND: Recent retrospective studies have suggested that patients with T1a,bN0M0 human epidermal growth factor receptor 2 (HER2)-positive breast cancer are at a higher risk for recurrence and might benefit from adjuvant trastuzumab. The absolute benefits associated with treating this subgroup are uncertain. Design: We reviewed recent studies examining the prognostic value of HER2 in patients with node-negative T1a,b HER2-positive breast cancer. We calculated the number needed to treat (NNT) using baseline risk estimates for untreated T1a,bN0M0 breast cancer and the number needed to harm (NNH) using the incidence of cardiac events in each of the adjuvant trastuzumab clinical trials. RESULTS: Several studies were identified, each with limitations inherent to retrospective database analyses: small cohort sizes, lack of systematic HER2 testing in older specimens, variations in the use of adjuvant therapy and definitions of study end points, and lack of information relating to comorbidities. The 5-year disease-free survival in the pre-trastuzumab era ranged from 77% to 95%. Comparisons between small HER2 -positive and small HER2 -negative cancers showed numerically worse outcome for the HER2-positive cohort in some but not all studies. In many instances, the NNH was larger (26-250) than the NNT (13-35); however, in a subset of patients, the NNH was lower (6) than the NNT (13-35). CONCLUSIONS: Better prediction tools to estimate more precisely the risk for death due to comorbid illness versus breast cancer are needed. In some patients, the risks of therapy could outweigh the benefits. Treatment selection for T1a,bN0 HER2-positive cancers remains in the transition area between evidence- and subjective judgment-based medicine.en_GB
dc.language.isoengen_GB
dc.subject.meshAntibodies, Monoclonal, Humanized/*therapeutic useen_GB
dc.subject.meshAntineoplastic Agents/*therapeutic useen_GB
dc.subject.meshBreast Neoplasms/*drug therapy/*enzymology/pathologyen_GB
dc.subject.meshChemotherapy, Adjuvanten_GB
dc.subject.meshDecision Makingen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshNeoplasm Stagingen_GB
dc.subject.meshPredictive Value of Testsen_GB
dc.subject.meshPrognosisen_GB
dc.subject.meshReceptor, erbB-2/*biosynthesisen_GB
dc.subject.meshRetrospective Studiesen_GB
dc.subject.meshTumor Markers, Biological/*biosynthesisen_GB
dc.subject.meshUncertaintyen_GB
dc.titleCoping with uncertainty: T1a,bN0M0 HER2-positive breast cancer, do we have a treatment threshold?en_GB
dc.contributor.departmentDepartment of Medical Oncology, Waterford Regional Hospital, Dunmore Road,, Waterford, Ireland. catherine.kelly@ucd.ieen_GB
dc.identifier.journalAnnals of oncology : official journal of the European Society for Medical, Oncology / ESMOen_GB
dc.description.provinceMunster-

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