Less chemo more benefits, even in the long term. For some initial forms of breast cancer, chemotherapy can be reduced without losing efficacy and with advantages in terms of avoided toxicity. The “definitive confirmation” comes from an international study published in ‘The Lancet Oncology’ and accompanied by an editorial signed by Giuseppe Curigliano, director of the Division of New Drugs for Innovative Therapies of the European Institute of Oncology in Milan, professor of Medical Oncology at the State University of the Lombard capital. “This work represents a milestone in the history of breast cancer,” says the specialist.
Breast cancer research
The research concerns Her2-positive tumours, which represent 15% of all new cases of breast cancer – recall the IEO – and are characterized by the overexpression of the Her2 protein which makes them biologically aggressive and resistant to some anticancer drugs. Precisely by virtue of the overexpression of Her2, however, these tumors respond to the monoclonal antibody trastuzumab which is then associated with various chemotherapy in standard treatments. The new research confirms that “adjuvant therapy for patients with Her2-positive breast cancer can be reduced in intensity, obtaining, even in the long term, the same efficacy and lower toxicity”. Curigliano explains: «We have definitively demonstrated that, for initial Her2-positive tumors, less can be done by achieving more».
«The work published today – he underlines – completes a path started by my group in Ieo in 2009, when we demonstrated that early stage Her2-positive tumors actually have a very good prognosis if diagnosed at a very early stage, and therefore can be treated with less aggressive and less toxic chemotherapy therapies. From there the studies on ‘de-escalation’ (intensity modulation) started, which demonstrated that a ‘lighter’ chemotherapy is in fact safe and effective, and allows patients to live long and with fewer side effects on the body. This result immediately changed clinical practice and the work just published now adds an important element: de-escalation maintains its benefit even in the long term, beyond 10 years. Scientific work has also shown that, in the future, we could identify those patients in whom ‘doing more’ could be useful, but also and above all that ‘doing even less’ is possible in other patients, with the use of a new marker named Her2Dx’.
The case of the woman with complete answer
«My worst nightmare as a patient/oncologist is dealing with brain metastases. Most drugs do not penetrate the blood brain barrier and studies often exclude these patients. This is our patient with a near complete response after only 1 dose of T-DXd (trastuzumab)». This was reported on Twitter by Professor Pashtoon Kasi, an oncologist at Weill Cornell Medicine and NewYork-Presbyterian Hospital and a researcher focused on treating patients with gastrointestinal and other solid tumors using new clinical trials and therapies.
Lo studio su Lancet Oncology
“In the work on Lancet Oncology, together with Sara Tolaney and 8 other colleagues from the Dana Farber Cancer Institute, we present an analysis of the 10-year results of the reference study on de-escalation – explains Paolo Tarantino, co-author of the work and researcher of the team di Curigliano allo Ieo – Out of 406 patients involved in the trial, the survival rate linked to breast cancer was 98.8% at 10 years, with only 6 distant recurrences. Our data therefore support the hypothesis that the de-escalated treatment regimen (in technical term Apt, i.e. Adjuvant Paclitaxel Trastuzumab) represents an adequate standard of therapy for small Her2-positive breast cancers, allowing to avoid the side effects of poly- chemotherapy”. «We also concentrated – the expert points out – on a more careful selection of patients, identifying a significant relationship between the value of Her2Dx, a new diagnostic tool capable of describing numerous characteristics of Her2-positive breast cancer, and the evolution of the disease. Her2Dx represents a promising risk biomarker which, if validated, will allow for future customization of treatments based on the biology of each Her2-positive tumour. «Under the aegis of the European Society of Medical Oncology (Esmo) – concludes Dario Trapani, IEO medical oncologist and researcher at the State University of Milan – our group has recently developed a classification tool to define the de-escalation of oncological therapies. The goal is to suggest a methodology for designing de-escalation studies for potentially all types of cancer, and to offer colleagues in regulatory bodies a tool to evaluate innovative therapies and treatment approaches aimed at improving the toxicity profile of treatments oncological treatments, maintaining the same efficacy».