Cases from the Community: Investigators Provide Their Perspectives on the Practice Implications of Emerging Clinical Research — A Special Video SupplementDuration of trastuzumab/pertuzumab maintenance therapy
2:26 minutes.
TRANSCRIPTION:
DR LOVE: Another question actually relates back to what you were saying before, another case, 55-year-old woman, metastatic disease to the liver and bone at the time of diagnosis 4 years ago and is still now on — got chemo/trastuzumab/pertuzumab and is still, 4 years later, free of disease on trastuzumab/pertuzumab maintenance. How long do you continue, or do you continue? DR SMITH: Yes. How long is a — who knows? That’s the big dilemma. And as I’ve said but will say again, we can’t just continue to ignore this problem. On the other hand, there’s never going to be enough patients to do a randomized trial. But that might be, if the whole world got its act together. But there’s not that many of them. So what I would do initially is to have some prospective database to which anyone could contribute and, after a certain length of time, perhaps 5 years just empirically, you stop treatment. You monitor very carefully, and we watch what happens. And within a year, we might have the answer, because, say 20% to 30% of these patients relapse, that’s the end of story. You have to go on. But if after a year or two there’s no relapses, you can get more bold. And you can maybe even start reducing the time, the duration of treatment, before you stop. I think that’s the way forward. And it’s a question of getting ourselves organized to do it. In terms of what do you do with this patient, what I’d do is discuss it with the patient. But I can tell you most of them do not want to stop. And I don’t blame them. DR LOVE: It kind of reminds me of some of the work that’s been done with CML where they stop the tyrosine kinase inhibitor. And some people are able to continue without treatment, but I guess the key thing there is, the people who relapse, they seem like they’re able to be re-treated very well. Of course we don’t know any of that in breast cancer, but it seems analogous clinically. DR SMITH: That, of course, is a potential outcome, that you might get a minority who do relapse, but you then go back into complete sustained remission if you rechallenge, in which case that would be a further reason for stopping, say, “You probably won’t relapse, but even if you do, we can rescue.” |