POC Breast 1 | 2007 - Adjuvant Trastuzumab

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POC Breast 1 | 2007 - Adjuvant Trastuzumab

  1. 1. Patterns of Care in Medical Oncology Adjuvant Trastuzumab
  2. 2. Patients with HER2-positive, node-negative breast tumors 1-2 cm should generally receive adjuvant trastuzumab/chemotherapy as part of their treatment. 5% 0% Disagree 12% 24% In between 83% 76% Agree ER-positive ER-negative 0% 2% 98% 3% 8% 89% Disagree In between Agree Clinical investigators Practicing oncologists
  3. 3. Patients with HER2-positive, node-negative breast tumors smaller than 1 cm should generally receive adjuvant trastuzumab/chemotherapy as part of their treatment. 33% 35% Disagree 40% 47% In between 27% 18% Agree ER-positive ER-negative 14% 49% 37% 15% 37% 48% Disagree In between Agree Clinical investigators Practicing oncologists
  4. 4. When using adjuvant trastuzumab for patients with breast cancer, which adjuvant chemotherapy regimen do you generally use? 2007 2006 12% 2% Other 0% 2% AC  paclitaxel q3wk Clinical investigators (CI) 0% 20% 22% 46% 4% AC  docetaxel 2% 25% 65% Docetaxel/carboplatin Dose-dense AC  paclitaxel q2wk AC  paclitaxel qwk
  5. 5. When using adjuvant trastuzumab for patients with breast cancer, which adjuvant chemotherapy regimen do you generally use? 2006 PO n = 143 2007 2006 9% 2% Other 13% 2% AC  paclitaxel q3wk Practicing oncologists (PO) 9% 8% 27% 34% 17% AC  docetaxel 4% 31% 44% Docetaxel/carboplatin Dose-dense AC  paclitaxel q2wk AC  paclitaxel qwk
  6. 6. Trastuzumab monotherapy is a reasonable nonprotocol adjuvant treatment option for patients with breast cancer who are unable to receive chemotherapy. 2007 2006 Clinical investigators (CI) 30% 35% 35% 38% 24% 38% Disagree In between Agree
  7. 7. Trastuzumab monotherapy is a reasonable nonprotocol adjuvant treatment option for patients with breast cancer who are unable to receive chemotherapy. 2007 2006 Practicing oncologists (PO) 17% 33% 50% 27% 36% 37% Disagree In between Agree
  8. 8. Approximately what percent of your patients on adjuvant trastuzumab fail to complete one year of trastuzumab therapy? 10% 13% Mean Clinical investigators Practicing oncologists
  9. 9. Have you used TCH as nonprotocol adjuvant therapy for patients with HER2-positive tumors? 75% 44% Percent answering yes Clinical investigators Practicing oncologists
  10. 10. For a woman in average health with a 1.2-cm, Grade II, ER-positive/PR-positive, HER2-positive tumor with 3 positive nodes, how would you compare TCH to your preferred anthracycline/taxane/trastuzumab regimen? * CI n = 49, PO n = 147 1% 0% My preferred regimen is significantly more efficacious Efficacy* 33% 65% 2% 0% 30% My preferred regimen is somewhat more efficacious 54% 13% 2% Both are similar in efficacy TCH is somewhat more efficacious TCH is significantly more efficacious Clinical investigators Practicing oncologists
  11. 11. For a woman in average health with a 1.2-cm, Grade II, ER-positive/PR-positive, HER2-positive tumor with 3 positive nodes, how would you compare TCH to your preferred anthracycline/taxane/trastuzumab regimen? † CI n = 49, PO n = 149 0% 2% My preferred regimen has significantly better safety and tolerability Safety and tolerability † 8% 37% 33% 20% 7% My preferred regimen has somewhat better safety and tolerability 28% 53% 12% Both are similar in safety and tolerability TCH has somewhat better safety and tolerability TCH has significantly better safety and tolerability Clinical investigators Practicing oncologists
  12. 12. How would you feel in general about recommending participation in a randomized trial of TCH alone or with bevacizumab in women with HER2-positive breast cancer? 8% 6% I would not recommend participation 45% 41% Some concerns — I would enter patients selectively 53% 47% No concerns — I would enter patients Clinical investigators Practicing oncologists
  13. 13. Are you aware of the new data from the BCIRG 006 study comparing AC   T to AC   TH and to TCH in the adjuvant treatment of HER2-positive, early breast cancer presented at the 2006 San Antonio Breast Cancer Symposium? AC  TH = doxorubicin/cyclophosphamide  docetaxel/trastuzumab; TCH = docetaxel/carboplatin/trastuzumab Clinical investigators Practicing oncologists 100% 68% Percent answering yes
  14. 14. If yes, please respond to the following statements about the BCIRG 006 study: THC and AC   TH had roughly equivalent efficacy, and each was superior to AC   T 4% 0% Disagree 11% 10% In between 90% 85% Agree Clinical investigators Practicing oncologists
  15. 15. If yes, please respond to the following statements about the BCIRG 006 study: TCH had lower cardiovascular toxicity compared to AC   TH Clinical investigators Practicing oncologists 2% 0% Disagree 10% 0% In between 100% 88% Agree
  16. 16. If yes, please respond to the following statements about the BCIRG 006 study: The TOPO II test is useful to determine whether an anthracycline should be used in the HER2-positive setting Clinical investigators Practicing oncologists 26% 70% Disagree 43% 24% In between 6% 31% Agree
  17. 17. Have you ever ordered a TOPO II test? 8.6 4.3 If yes, how many times? (mean) 14% 5% Percent answering yes Clinical investigators Practicing oncologists
  18. 18. Would you be comfortable enrolling a patient with a 1.2-cm, HER2-positive, ER-negative, node-negative tumor in a randomized clinical trial that has one arm containing lapatinib as the only anti-HER2 therapy? 82% 73% Percent answering yes Clinical investigators Practicing oncologists
  19. 19. Would you be comfortable enrolling a patient with a 1.2-cm, HER2-positive, ER-negative tumor with 3 positive nodes in a randomized clinical trial that has one arm containing lapatinib as the only anti-HER2 therapy? 69% 53% Percent answering yes Clinical investigators Practicing oncologists

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