Susan G Komen  
I've Been Diagnosed With Breast Cancer Someone I Know Was Diagnosed Share Your Story Join Us And Stay Informed Donate To End Breast Cancer
Home > Understanding Breast Cancer > Breast Cancer Research > Table 50: Trastuzumab (Herceptin) for treatment of metastatic breast cancer

  


Table 50: Trastuzumab (Herceptin) for treatment of metastatic breast cancer

This summary table contains detailed information about research studies. Summary tables offer an informative look at the science behind many breast cancer guidelines and recommendations. However, they should be viewed with some caution. In order to read and interpret research tables successfully, it is important to understand some key concepts. Learn how to read a research table.

Introduction: About 15 to 20 percent of breast cancers have high amounts of a protein called HER2/neu on the surface of the cancer cells (called HER2/neu-positive breast cancer or HER2/neu over-expression) [1-2]. The drug trastuzumab (Herceptin) targets HER2/neu-positive cancer cells.

Studies show trastuzumab can shrink tumors and improve survival in people with HER2/neu-positive metastatic breast cancer.  

Trastuzumab alone and combined with chemotherapy

Trastuzumab may be used alone or in combination with chemotherapy. It is effective as a first treatment for HER2/neu-positive metastatic breast cancer as well as a treatment for metastatic breast cancer that has progressed with chemotherapy. 

Health effects

Trastuzumab tends to cause fewer side effects than standard chemotherapy because it only targets cancer cells with the HER2/neu protein. However, it is not without risks. In rare cases, deaths due to heart and lung problems have been linked to its use.  

Study selection criteria: Phase III clinical trials with 100 or more participants with HER2/neu-positive metastatic breast cancer.  

Study 

Study Population
(number of participants)
 

Percent who had Previous Chemotherapy for Metastatic Breast Cancer 

Drug(s) Used 

Overall Response Rate—Percent who Responded to Treatment
(95% CI)
 

Overall Survival 
at One Year
 

Phase III clinical trials 

Baselga et al. [3]

406

0%

Trastuzumab with chemotherapy
(docetaxel) 

69%

62%*

Blackwell et al. [4-5]

291
women who progressed on chemotherapy with trastuzumab

100%

Trastuzumab with lapatinib

10%
(3-12%)

56%

Andersson et al. [6]

284

0%

Trastuzumab with chemotherapy
(docetaxel)

59%

88%

     

Trastuzumab with chemotherapy
(vinorelbine) 

59%

88%

Valero et al. [7]

263

0%

Trastuzumab with chemotherapy
(doxetaxel) 

73%

89%

     

Trastuzumab with chemotherapy
(doxetaxel and carboplatin) 

73%

91%

Slamon et al. [8]

235

0%

Trastuzumab with chemotherapy
(anthracycline & cyclophosphamide; or paclitaxel)

50%Sig
(44-57%)

78%Sig 

     

Chemotherapy alone
(anthracycline and cyclophosphamide; or paclitaxel)

32%
(26-38%)

67%

Gianni et al. [9]

208

0%

Trastuzumab with chemotherapy
(doxetaxel)

70%

NA

Robert et al. [10]

196

47%

Trastuzumab with chemotherapy
(paclitaxel)

36%
(26-46%)

87% 

 

 

 

Trastuzumab with chemotherapy
(paclitaxel plus carboplatin)

52%
(41-62%)

90% 

Tripathy et al. [11]

154 women who progressed on chemotherapy alone

100%

Trastuzumab with chemotherapy
(paclitaxel; vinorelbine; docetaxel; fluorouracil; cyclophosphamide; cisplastin; docorubicin; gemcitabine)

14%
(8-19%)

NA

Seidman et al. [12]

178

54% 

Trastuzumab with chemotherapy
(paclitaxel)

Paclitaxel weekly:
55%
(45-65%)

Paclitaxel every 3 weeks:
58%
(46-69%)

NA

CI = Confidence interval

Sig = Statistically significant improvement compared to chemotherapy alone

NA = Not available

* Estimated survival at 15 months of follow-up.

† Estimated survival at one year of follow-up. Estimated 4-year survival was 29% for trastuzumab + paclitaxel and 39% for trastuzumab + paclitaxel + carboplatin.
 

References  

1. Carey LA, Perou CM, Livasy CA, et al. Race, breast cancer subtypes, and survival in the Carolina Breast cancer Study. JAMA. 295(21):2492-2502, 2006.

2. National Comprehensive Cancer Network. NCCN Guidelines for patients: Breast cancer. Version 2.2011. http://www.nccn.com, 2011.

3. Baselga J, Cortés J, Kim S, et al. for the CLEOPATRA Study Group. Pertuzumab plus trastuzumab plus docetaxel for metastatic breast cancer. N Engl J Med. 366(2):109-19, 2012. 

4. Blackwell KL, Burstein HJ, Storniolo AM, et al. Randomized study of lapatinib alone or in combination with trastuzumab in women with ErbB2-positive, trastuzumab-refractory metastatic breast cancer. J Clin Oncol. 28(7):1124-30, 2010.

5. Blackwell KL, Burstein HJ, Storniolo AM, et al. Overall survival benefit with lapatinib in combination with trastuzumab for patients with human epidermal growth factor receptor 2-positive metastatic breast cancer: final results from the EGF104900 Study. J Clin Oncol. 30(21):2585-92, 2012.

6. Andersson M, Lidbrink E, Bjerre K, et al. Phase III randomized study comparing docetaxel plus trastuzumab with vinorelbine plus trastuzumab as first-line therapy of metastatic or locally advanced human epidermal growth factor receptor 2-positive breast cancer: the HERNATA study. J Clin Oncol. 29(3):264-71, 2011.

7. Valero V, Forbes J, Pegram MD, et al. Multicenter phase III randomized trial comparing docetaxel and trastuzumab with docetaxel, carboplatin, and trastuzumab as first-line chemotherapy for patients with HER2-gene-amplified metastatic breast cancer (BCIRG 007 study): two highly active therapeutic regimens. J Clin Oncol. 29(2):149-56, 2011.

8. Slamon DJ, Leyland-Jones B, Shak S, et al. Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. N Engl J Med. 344(11):783-92, 2001.

9. Gianni L, Romieu GH, Lichinitser M, et al. AVEREL: a randomized phase III Trial evaluating bevacizumab in combination with docetaxel and trastuzumab as first-line therapy for HER2-positive locally recurrent/metastatic breast cancer. J Clin Oncol. 31(14):1719-25, 2013.

10. Robert N, Leyland-Jones B, Asmar L, et al. Randomized phase III study of trastuzumab, paclitaxel, and carboplatin compared with trastuzumab and paclitaxel in women with HER-2-overexpressing metastatic breast cancer. J Clin Oncol. 24(18):2786-92, 2006.

11. Tripathy D, Slamon DJ, Cobleigh M, et al. Safety of treatment of metastatic breast cancer with trastuzumab beyond disease progression. J Clin Oncol. 22(6):1063-70, 2004.

12. Seidman AD, Berry D, Cirrincione C, et al. Randomized phase III trial of weekly compared with every-3-weeks paclitaxel for metastatic breast cancer, with trastuzumab for all HER-2 overexpressors and random assignment to trastuzumab or not in HER-2 nonoverexpressors: final results of Cancer and Leukemia Group B protocol 9840. J Clin Oncol. 26(10):1642-9, 2008.

Updated 01/13/14