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A new head-to-head study finds the chemotherapy drug docetaxel (sold as Taxotere) beating another, vinorelbine (sold as Navelbine), in helping extend patient survival after breast cancer surgery.
Finnish researchers reporting in the Feb. 23 issue of The New England Journal of Medicine also found that patients who received infusions of trastuzumab (sold as Herceptin) were less likely to get recurrences.
"There were 42 percent less breast cancer recurrences during the first three years of follow-up among women treated with docetaxel as compared to those who received vinorelbine," says Dr.
Heikki Joensuu, corresponding author and a physician at Helsinki University Central Hospital. "However, docetaxel was associated with more adverse effects (such as allergic reactions, swelling and fever)."
Death rates from breast cancer have gone down in recent years, partly due to the use of postoperative chemotherapy, and experts continually test new regimens to determine which drugs best reduce the risk of recurrence.
For this study, Joensuu and his colleagues randomly assigned to more than a thousand women with breast cancer three cycles of either docetaxel or vinorelbine, followed by three cycles of other cancer drugs.
Then a subgroup of 232 women whose tumors had an amplified HER2/neu gene -- known to be associated with cancers that grow and spread more aggressively -- were also assigned either to receive nine weeks of Herceptin infusions or a placebo.
The researchers wanted to determine which regimen was best for recurrence-free survival.
Those who got the Herceptin experienced 58 percent fewer cancer recurrences during the three-year follow-up than those who didn't get the drug, the researchers report.
The docetaxel/vinorelbine results were especially important, Joensuu says. "No prior study has compared single-agent docetaxel with single-agent vinorelbine as adjuvant treatment of breast cancer," he notes.
The study agrees with previous research, Joensuu adds. "A few prior studies have shown that administration of adjuvant trastuzumab (Herceptin) for one year reduces the rate of breast cancer recurrence by approximately 50 percent in the subset of women who have HER2-positive breast cancer," he says. But those studies also found Herceptin to be linked with an increased risk for cardiac failure; that was not the case in this latest study.
However, the Herceptin was given over a much shorter time period -- nine weeks versus a year in the previous trials.
Another expert says the study confirms previous research, but also breaks new ground regarding Herceptin use.
"It is the first to use such a short course," says Dr. Mark Pegram, director of the women's cancer program at the Jonsson Cancer Center at the David Geffen School of Medicine at UCLA. "We don't know the optimal duration of trastuzumab -- is nine weeks as good as one year?" That question remains to be confirmed, he says.
If the nine-week regimen turns out to be ideal, Pegram says, "it could be very good news for patients," sparing them time and much expense.
(The HealthDay Web site is at http://www.HealthDay.com.)
c.2006 HealthDay News
