Cases from the Community: Investigators Provide Their Perspectives on the Practice Implications of Emerging Clinical Research — A Special Video SupplementDuration of HER2-directed therapy
3:09 minutes.
TRANSCRIPTION:
DR LOVE: So another case that was presented by Dr Carolyn Hendricks was an interesting one. It was a 70-year-old woman with HER2-positive metastatic disease. It was interesting. I don’t know if you remember, but she actually went on one of the critical adjuvant trastuzumab studies, the N9831 trial, the Intergroup trial, but unfortunately she got randomized to the control group, didn’t get adjuvant trastuzumab. She actually also was on the TEACH study of delayed lapatinib. She got randomized to placebo. Eventually, unfortunately, she developed metastatic disease. But the remarkable thing about the case was, she ended up on T-DM1 and, you may recall, had a complete clinical response that continues now 5 years later. And Dr Hendricks was just curious about the concept of looking at patients like this to try to figure out why they’re different. And I don’t know if you’ve been involved with any discussions or initiatives of — it always seemed to me to make a lot of sense. Any thoughts about that and about these exceptional responders? DR SMITH: They are really interesting. And of course it’s very exciting and encouraging if you’re a breast cancer specialist to have these. The first issue to my book is, what do you do? Do you just carry on forever, or what? And we have patients on trastuzumab alone, patients on trastuzumab/pertuzumab and patients on T-DM1, all of whom are several years out and in continued complete remission. And most of the colleagues I’ve discussed it with, including American colleagues, are very reluctant to stop, because they say, “What if they relapse? And why’d we just stop? There’s no toxicity.” But, on the other hand, you kind of can’t go on forever. And I think we need to get together as a community and just have a prospective database to stop treatment, say, at 5 years or something and just have a very closely observed prospective database. And we’d very quickly find out whether any of the significant number of them start to relapse. Then you’ve got to scrap it. But I’d be surprised if they did. In terms of identifying these patients, that obviously is the challenge. And people have looked at this. And Luca Gianni did a very detailed analysis of the NeoSphere study to see if he could predict who achieved pathological complete remissions, and he couldn’t. There’s no marker that he looked at that predicted who was going to do well or not. So I’m not aware of a marker that would predict at present. It’s not a crucial thing, because it’s a clinical observation thing. If you’re treating someone with metastatic disease, you’re going to find out whether they’re in complete remission or not without a marker just by watching what happens. And then you’re going to carry on treating for several years. And again, you’re not going to be influenced by a marker in the early stages. But it would be great to know for a long-term basis. |