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Lapatinib plus capecitabine for HER2-positive advanced breast cancer.

Lapatinib plus capecitabine for HER2-positive advanced breast cancer

Geyer CE, Forster J, Lindquist D et al.

New England Journal of Medicine, 2006, 355, 2733-2743

Erratum in New England Journal of Medicine, 2007, 356, 1487

Targeting human epidermal growth factor receptor 2 (HER2) has been the success story of breast cancer therapeutics for this generation of oncologists. Trastuzumab is well established as treatment in the first-line HER2-positive metastatic breast cancer population with or sometimes without chemotherapy. The role of HER2 targeting beyond progression after trastuzumab has hitherto been uncertain. Much hype around the pre-clinical data has been used to promote the use of trastuzumab after progression of disease on trastuzumab.

The results of the trial (EGF100151) reported in this paper show that continued targeting of HER2, in this case with lapatinib, in combination with chemotherapy after progression of the cancer on trastuzumab is beneficial in terms of time to tumour progression (TTP) and also secondary endpoints such as response rate.

Results from the GBG 26 trial (a randomised Phase III trial looking at trastuzumab treatment in patients with HER2-positive metastatic breast cancer) presented at the 2008 annual meeting of the American Society of Clinical Oncology (ASCO) [1] support the concept of continued targeting of HER2. Unfortunately, the GBG 26 trial closed early, partly as a result of the EGF100151 trial results and is consequently underpowered. The improvement in response rates and TTP were similar to those shown with lapatinib plus capecitabine versus capecitabine alone.

It would be interesting to see a direct comparison of these treatments, and hopefully future trials answering clinically important questions will be prioritised within drug companies and academic groups.


[1.] Von Minckwitz G, Zielinski C, Maarteense E et al. Capecitabine vs. capecitabine+trastuzumab in patients with HER2-positive metastatic breast cancer progressing during trastuzumab treatment: The TBP phase III study (GBG 26/BIG 3-05). J Clin Oncol, 2008, 26, Abstr. 1025.

Commentary by Andrew Wardley

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Title Annotation:human epidermal growth factor receptor 2
Author:Wardley, Andrew
Publication:Advances in Breast Cancer
Article Type:Report
Geographic Code:4EUUK
Date:Jun 1, 2008
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