Adjuvant trastuzumab benefit in patients diagnosed with triple-positive breast cancer
A partir de données portant sur 5 099 patientes atteintes d'un cancer du sein HER2+ de stade précoce et incluses dans l'essai HERA (durée médiane de suivi : 8 ans), cette étude analyse l'amplitude du bénéfice, en termes de survie sans maladie et de survie globale, lié à un traitement adjuvant par trastuzumab en fonction de résultats d'analyses immunohistochimiques (ER), d'hybridation in situ en fluorescence (HER2) et de nombres de copies des gènes HER2 et ESR1
The article “Effects of Estrogen Receptor and Human Epidermal Growth Factor Receptor-2 Levels on the Efficacy of Trastuzumab: A Secondary Analysis of HERA Trial,” by Loi et al1 in this issue of JAMA Oncology entices the reader with the conclusion that certain human epidermal growth factor receptor-2 positive (HER2+, now known as ERBB2) breast cancers that are also estrogen receptor positive (ER+) “derive significantly less benefit from adjuvant trastuzumab after chemotherapy.”1 The phrase, “significantly less,” has special connotation for scientists and clinicians trained to disregard findings that do not meet statistical significance. This concluding statement questions whether trastuzumab is of value in the patients we have come to call “triple positive” (ER+, progesterone receptor positive, and HER2+), especially if ER expression is high and if concurrently the fluorescent in situ hybridization (FISH) ratio determining HER2 positivity is low (≥2 to <5). Based on this article, should we rethink our use of trastuzumab in these patients?
JAMA Oncology , éditorial en libre accès, 2015