Neil Love, MD

1
Current Patterns of Care in Breast CancerUse
of Adjuvant Trastuzumab

• Neil Love, MD
• September 17, 2005

2
Recent Trends in Adjuvant Systemic Therapy of
Early Breast Cancer

• Chemotherapy
• Taxanes
• Dose-dense chemotherapy
• Use of computer models like Adjuvant!
• Oncotype DX assay
• Endocrine therapy
• Aromatase inhibitors
• Biologic therapy
• Trastuzumab

3
Trastuzumab in the Adjuvant Setting

• 1.2-centimeter, Grade II tumor
• ER-negative, HER2-positive
• 3 positive nodes
• Would you utilize adjuvant trastuzumab off
  protocol?

Source Breast Cancer Update Patterns of Care
Study Vol2(1) February 2005.
4
Clinical Use of Adjuvant Trastuzumab

• Would you recommend adjuvant trastuzumab to a
  65-year-old woman with an ER-negative,
  HER2-positive tumor with 10 positive nodes?

Source Breast Cancer Update Patterns of Care
Study Vol2(1) February 2005.
5
Use of Adjuvant Trastuzumab

• Have you ever utilized adjuvant trastuzumab in a
  nonprotocol setting?

Source Breast Cancer Update Patterns of Care
Study Vol2(1) February 2005.
6
Breast Cancer Survivors Perspectives on
Adjuvant Trastuzumab

• Case scenario 40-year-old woman with
  ER/PR/HER2-positive IDC and 6 positive nodes

Source Love NL et at. San Antonio Breast Cancer
Symposium, 2003. Abstract 142.
7
Current Patterns of Care Case A 1.2-cm IDC,
ER/PR/HER2-positive, 3 positive nodes
Source Breast Cancer Update Patterns of Care
Study Vol2(2) August 2005.
8
Current Patterns of Care Case B
ER/PR-negative, HER2-positive, Grade II
IDCWould You Recommend Trastuzumab?
Source Breast Cancer Update Patterns of Care
Study Vol2(2) August 2005.
9
Current Patterns of Care Case C a 55 yo with a
2.4-cm, Grade II, ER/PR-negative, HER2-positive
IDCWould you start delayed trastuzumab?
Source Breast Cancer Update Patterns of Care
Study Vol2(2) August 2005.
10
Sources of Information about ASCO Adjuvant
Trastuzumab Trials
Source Breast Cancer Update Patterns of Care
Study Vol2(2) August 2005.
11
Case of Dr Barbara Fallon New Britton,
Connecticut

• 42 yo woman ER/PR-negative, HER2-positive IDC, 5
  positive nodes
• Enrolled on NSABP-B-31 randomized to AC g T
• Patient is now 28 months since start of adjuvant
  chemotherapy
• Should trastuzumab be administered at this
  time?
• If she presented today, what would you
  recommend?

12
Case of Dr Gary Steinecker Oak Lawn, Illinois

• 76 yo woman 3.5-cm, ER/PR-negative,
  HER2-positive, node-negative IDC (2/2005)
• CALGB 49909 randomized to A/C g paclitaxel g
  trastuzumab
• Significant toxicity with chemotherapy (colitis)
• Post AC MUGA drop from 66 to 50 not eligible
  for trastuzumab as per protocol
• Repeat MUGA EF 71 2D Echo EF 45
• Should trastuzumab be administered at this
  time?
• If she presented today, what would you
  recommend?

13
Use of Media to Assist with Informed Consent
NCI SBIR Grant R43CA103264-01A1
Sandra Franco, MD
Cynthia Frankel, RN
Richard Margolese, MD
Ms M, a participant in NSABP-B-31
Ms R, a participant in NSABP-B-38
Ms F, a participant in NSABP-B-38
Ms L, a participant in NSABP-B-35
14
Agenda

• 1200 PM Dr Wolmark Introduction
• 1205 PM Dr Love Current patterns of care in
  the community
• 1215 PM Dr Romond Combined analysis
  NSABP-B-31/NCCTG-N9831
• 1235 PM Dr Slamon BCIRG 006 Background,
  design, initial results
• 1255 PM Dr Leyland-Jones First results of the
  HERA trial
• 115 PM Dr Kaufman NCCTG-N9831 Sequential
  versus concurrent trastuzumab and
  chemotherapy
• 135 PM Dr Geyer NSABP-B-31 cardiac toxicity
  data
• 200 PM Close