POC Breast 1 | 2007 - Adjuvant Trastuzumab

Patterns of Care in Patterns of Care in Medical OncologyMedical Oncology

Adjuvant Trastuzumab

Patients with HER2-positive, node-negative Patients with HER2-positive, node-negative breast tumors breast tumors 1-2 cm1-2 cm should generally should generally

receive adjuvant trastuzumab/chemotherapy receive adjuvant trastuzumab/chemotherapy as part of their treatment.as part of their treatment.

ER-negative

Agree 98% 89%

In between 2% 8%

Disagree 0% 3%

ER-positive

Agree 76% 83%

In between 24% 12%

Disagree 0% 5%

Clinical investigators Practicing oncologists

Patients with HER2-positive, node-negative Patients with HER2-positive, node-negative breast tumors breast tumors smaller than 1 cmsmaller than 1 cm should should

generally receive adjuvant generally receive adjuvant trastuzumab/chemotherapy as trastuzumab/chemotherapy as

part of their treatment.part of their treatment.

ER-negative

Agree 37% 48%

In between 49% 37%

Disagree 14% 15%

ER-positive

Agree 18% 27%

In between 47% 40%

Disagree 35% 33%


When using adjuvant trastuzumabWhen using adjuvant trastuzumabfor patients with breast cancer,for patients with breast cancer,which adjuvant chemotherapy which adjuvant chemotherapy regimen do you generally use?regimen do you generally use?

2006 2007

Clinical investigators (CI)

AC paclitaxel qwk 65% 46%

Dose-dense AC paclitaxel q2wk 25% 22%

Docetaxel/carboplatin 2% 20%

AC docetaxel 4% 0%

AC paclitaxel q3wk 2% 0%

Other 2% 12%

When using adjuvant trastuzumabWhen using adjuvant trastuzumabfor patients with breast cancer,for patients with breast cancer,which adjuvant chemotherapy which adjuvant chemotherapy regimen do you generally use?regimen do you generally use?

2006 2007

Practicing oncologists (PO)

AC paclitaxel qwk 44% 34%

Dose-dense AC paclitaxel q2wk 31% 27%

Docetaxel/carboplatin 4% 8%

AC docetaxel 17% 9%

AC paclitaxel q3wk 2% 13%

Other 2% 9%

2006 PO n = 143

Trastuzumab monotherapy is a reasonable Trastuzumab monotherapy is a reasonable nonprotocol adjuvant treatment optionnonprotocol adjuvant treatment optionfor patients with breast cancer who arefor patients with breast cancer who are

unable to receive chemotherapy.unable to receive chemotherapy.

2006 2007

Clinical investigators (CI)

Agree 38% 35%

In between 24% 35%

Disagree 38% 30%

Trastuzumab monotherapy is a reasonable Trastuzumab monotherapy is a reasonable nonprotocol adjuvant treatment optionnonprotocol adjuvant treatment optionfor patients with breast cancer who are for patients with breast cancer who are

unable to receive chemotherapy.unable to receive chemotherapy.

2006 2007

Practicing oncologists (PO)

Agree 37% 50%

In between 36% 33%

Disagree 27% 17%

Approximately what percent of your patients Approximately what percent of your patients on adjuvant trastuzumab fail to complete on adjuvant trastuzumab fail to complete

one year of trastuzumab therapy?one year of trastuzumab therapy?

Mean 10% 13%


Have you used TCH as nonprotocolHave you used TCH as nonprotocoladjuvant therapy for patients withadjuvant therapy for patients with

HER2-positive tumors?HER2-positive tumors?

Percent answering yes 75% 44%


* CI n = 49, PO n = 147

For a woman in average health with a 1.2-cm,For a woman in average health with a 1.2-cm,Grade II, ER-positive/PR-positive, HER2-positive Grade II, ER-positive/PR-positive, HER2-positive

tumor with 3 positive nodes, how would you tumor with 3 positive nodes, how would you compare TCH to your preferred compare TCH to your preferred

anthracycline/taxane/trastuzumab regimen?anthracycline/taxane/trastuzumab regimen?

Efficacy*

TCH is significantly more efficacious 0% 2%

TCH is somewhat more efficacious 2% 13%

Both are similar in efficacy 65% 54%

My preferred regimen is somewhat more efficacious

33% 30%

My preferred regimen is significantly more efficacious

0% 1%


For a woman in average health with aFor a woman in average health with a1.2-cm, Grade II, ER-positive/PR-positive,1.2-cm, Grade II, ER-positive/PR-positive,

HER2-positive tumor with 3 positive nodes, how HER2-positive tumor with 3 positive nodes, how would you compare TCH to your preferred would you compare TCH to your preferred

anthracycline/taxane/trastuzumab regimen?anthracycline/taxane/trastuzumab regimen?

Safety and tolerability†

TCH has significantly better safety and tolerability

20% 12%

TCH has somewhat better safety and tolerability

33% 53%

Both are similar in safety and tolerability

37% 28%

My preferred regimen has somewhat better safety and tolerability

8% 7%

My preferred regimen has significantly better safety and tolerability

2% 0%

Clinical investigators Practicing oncologists † CI n = 49, PO n = 149

How would you feel in general about How would you feel in general about recommending participation in a randomized recommending participation in a randomized

trial of TCH alone or with bevacizumab in trial of TCH alone or with bevacizumab in women with HER2-positive breast cancer?women with HER2-positive breast cancer?

No concerns — I would enter patients 53% 47%

Some concerns — I would enter patients selectively

41% 45%

I would not recommend participation 6% 8%


Are you aware of the new data from the Are you aware of the new data from the BCIRG 006 study comparing BCIRG 006 study comparing

AC AC T to AC T to AC TH and to TCH in the TH and to TCH in the adjuvant treatment of HER2-positive, early adjuvant treatment of HER2-positive, early

breast cancer presented at the 2006breast cancer presented at the 2006San Antonio Breast Cancer Symposium?San Antonio Breast Cancer Symposium?


AC TH = doxorubicin/cyclophosphamide docetaxel/trastuzumab;

TCH = docetaxel/carboplatin/trastuzumab


If yes, please respond to the following If yes, please respond to the following statements about the BCIRG 006 study:statements about the BCIRG 006 study:

THC and AC THC and AC TH had roughly equivalent TH had roughly equivalent efficacy, and each was superior to AC efficacy, and each was superior to AC TT

Agree 90% 85%

In between 10% 11%

Disagree 0% 4%


If yes, please respond to the following If yes, please respond to the following statements about the BCIRG 006 study:statements about the BCIRG 006 study:TCH had lower cardiovascular toxicity TCH had lower cardiovascular toxicity

compared to AC compared to AC THTH


Agree 100% 88%

In between 0% 10%

Disagree 0% 2%

If yes, please respond to the following If yes, please respond to the following statements about the BCIRG 006 study: statements about the BCIRG 006 study: The TOPO II test is useful to determine The TOPO II test is useful to determine

whether an anthracycline should be usedwhether an anthracycline should be usedin the HER2-positive settingin the HER2-positive setting


Agree 6% 31%

In between 24% 43%

Disagree 70% 26%

Have you ever ordered a TOPO II test?Have you ever ordered a TOPO II test?


If yes, how many times? (mean) 4.3 8.6


Would you be comfortable enrolling a Would you be comfortable enrolling a patient with a 1.2-cm, HER2-positive,patient with a 1.2-cm, HER2-positive,ER-negative, node-negativeER-negative, node-negative tumor in tumor ina randomized clinical trial that hasa randomized clinical trial that hasone arm containing lapatinib as theone arm containing lapatinib as the

only anti-HER2 therapy?only anti-HER2 therapy?



Would you be comfortable enrolling a Would you be comfortable enrolling a patient with a 1.2-cm, HER2-positive,patient with a 1.2-cm, HER2-positive,

ER-negativeER-negative tumor with tumor with 3 positive nodes3 positive nodesin a randomized clinical trial that hasin a randomized clinical trial that hasone arm containing lapatinib as theone arm containing lapatinib as the

only anti-HER2 therapy?only anti-HER2 therapy?



POC Breast 1 | 2007 - Adjuvant Trastuzumab

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Transcript of POC Breast 1 | 2007 - Adjuvant Trastuzumab