Trastuzumab in HER2-positive advanced esophagogastric adenocarcinoma
COMMUNITY ONCOLOGY, DECEMBER 2009, p 543
Finding new and effective targets for the treatment of cancer is an ongoing challenge for translational scientists. But finding old targets in new cancer types is exciting, especially when the treatments are effective. The human epidermal growth factor receptor 2 (HER2)/neu receptor is a member of the epidermal growth factor receptor family and is overexpressed in many cancers, including breast, ovarian, lung, gastric, and oral cancers. Recent studies have shown that about 20% of patients with esophagogastric cancer are HER2-positive, whether determined by immune histochemistry or fluorescence in situ hybridization. Clinical trials have shown that the addition of trastuzumab (Herceptin), which targets the HER2 receptor, to standard chemotherapy results in about a 26% reduction in the risk of dying from metastatic esophagogastric cancer. The side effects of trastuzumab are minimal, although patients need to be monitored for cardiac toxicity while taking this drug. It is exciting to see the role of trastuzumab and HER2 targets expanding to other cancer diagnoses. Hopefully, this research endeavor will open ways for exploring other novel HER2-targeted treatments for gastric cancer and other cancers. more»
Risk of Skin Rash Associated with Erlotinib in Cancer Patients
THE JOURNAL OF SUPPORTIVE ONCOLOGY, NOVEMBER/DECEMBER 2009, p 211
Skin rash is a major side effect of erlotinib (Tarceva), an inhibitor of the epidermal growth factor receptor widely used in cancer treatment and clinical trials. This study aims to evaluate the risk of skin toxicity with erlotinib through a systematic review and meta-analysis of randomized controlled clinical trials (RCTs). Eligible studies included prospective RCTs in which erlotinib was compared with controls at the starting dose of 150 mg daily. Incidence, relative risk (RR), and 95% confidence intervals (CIs) were calculated using a random-effects or fixed-effects model based on the heterogeneity of included studies. A total of 2,911 patients with a variety of solid tumors from nine RCTs were included for analysis. The overall incidence of all-grade skin rash associated with erlotinib was 70.4%, with 9.4% being high grade (grade 3 or above). There was a significantly increased risk of all-grade rash with erlotinib in comparison with controls (RR, 3.43; P < 0.001). The incidence of all-grade rash was significantly lower in patients treated with the combination of erlotinib and chemotherapy than with erlotinib alone (risk ratio, 0.84; P = 0.001). In addition, RR of all-grade rash was 4.72 for erlotinib alone and 2.34 for the erlotinib combination. The authors conclude that erlotinib is associated with substantial skin toxicity that may be modified by chemotherapy. more»
Trastuzumab Extends Survival in HER2+ Gastric Cancer
THE ONCOLOGY REPORT, FALL 2009, p 22
Trastuzumab (Herceptin) may be able to do for gastric cancer what it has already done for breast cancer: provide a significant survival advantage for patients whose tumors express the HER2 receptor. The ToGA study is the first randomized study of trastuzumab reported outside of breast cancer. It was a massive effort involving multiple countries and screening almost 4,000 patients to obtain 804 patients with HER2 positivity (21%). Of these, 584 were randomized in the study, which compared standard chemotherapy with and without trastuzumab. They demonstrated an improvement in survival of almost 3 months without any incremental toxicity. It is notable that the outcome, even in the control group, was better than is usually seen in gastric cancer. This study is important for several reasons. First, it establishes a new and better therapy for gastric cancer patients who express HER2. Second, it will stimulate further studies of trastuzumab in other diseases, as well as in earlier stages of gastric cancer. It also points us toward a future when therapy will be defined based upon the molecular features of the cancer and not on the anatomical location of the primary tumor. more»