Adjuvant therapy for patients with “HER2-positive” breast cancer can be reduced in intensity, obtaining, even in the long term, the same efficacy and less toxicity: this is confirmed by a research just published in the journal Lancet Oncology, accompanied by an editorial by Prof. Giuseppe Curigliano, Director of the Division of New Drugs for Innovative Therapies of the European Institute of Oncology and Professor of Medical Oncology at the State University of Milan. HER2-positive tumors represent 15% of all new cases of breast cancer 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 therefore associated with various chemotherapy drugs in standard treatments.
“This work represents a milestone in the history of breast cancer: we have definitively demonstrated that for HER2-positive initial tumors, ‘less can be done by achieving more’ – Curigliano declares – The work published today completes a path started by my group in IEO in 2009, when we demonstrated that early stage HER2-positive cancers 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, 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 in other patients, ‘doing even less’ is possible, with the use of a new marker, named HER2DX”.
“At work in Lancet Oncology, together with Sara Tolaney and eight other colleagues from the Dana Farber Cancer Institute, we present an analysis of the 10-year results of the landmark study on de-escalation – explains Dr Paolo Tarantino, co-author of the study and researcher of the team of Curigliano at the IEO – Out of 406 patients involved in the trial, the survival rate linked to breast cancer was 98.8% at 10 years, with only six 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 focused on a more careful selection of patients, identifying a significant relationship between the value of HER2DX, a new diagnostic tool capable of describing many 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 tumor.”
“Under the aegis of the European Society of Medical Oncology (ESMO) our group has recently developed a classification tool to define the de-escalation of oncological therapies, – adds Dario Trapani, IEO medical oncologist and researcher at the State University of Milan – The goal is suggest a methodology for designing de-escalation studies potentially for all types of cancer, and offer colleagues in regulatory bodies a tool to evaluate innovative therapies and treatment approaches aimed at improving the toxicity profile of oncological treatments, while maintaining same efficacy.
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