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Women whose HER2-positive breast cancer was still present at surgery after chemotherapy and trastuzumab had half the risk of relapse if their post-surgery treatment was switched to the antibody-drug conjugate T-DM1 instead of continuing trastuzumab.
Open-label phase 3 trial of 1,486 patients with HER2-positive early breast cancer who had residual invasive disease in the breast or axilla after neoadjuvant taxane- and trastuzumab-based therapy, randomised to 14 cycles of adjuvant trastuzumab emtansine (T-DM1) or trastuzumab. Primary endpoint was invasive disease-free survival.
Three-year iDFS was 88.3% vs 77.0% (HR 0.50). Later follow-up confirmed an overall survival benefit. It established the response-adapted strategy: treat before surgery, then escalate only for those with residual disease.
HER2-positive breast cancer is now routinely treated before surgery so that the pathology result can guide what comes after: patients with no residual cancer continue trastuzumab (with or without pertuzumab), while those with residual disease switch to T-DM1. This model of using the tumour's response as a test has since been copied in triple-negative and other cancers.
Shares Trastuzumab emtansine, Early HER2-positive breast cancer, Pathologic complete response (pCR), Trastuzumab.
Shares Trastuzumab emtansine, Early HER2-positive breast cancer, Trastuzumab, Roche / Genentech.
Shares Zhi-Ming Shao, Charles E. Geyer Jr., Sibylle Loibl, Residual cancer burden (RCB).
Shares DESTINY-Breast03, Trastuzumab emtansine, HER2, HER2-positive breast cancer.
Shares Trastuzumab emtansine, Early HER2-positive breast cancer, Trastuzumab, HER2-positive breast cancer.
Shares DESTINY-Breast03, Trastuzumab emtansine, HER2, HER2-positive breast cancer.
Shares Trastuzumab emtansine, Early HER2-positive breast cancer, HER2-positive breast cancer, Antibody-drug conjugate (ADC).
Shares Trastuzumab emtansine, Early HER2-positive breast cancer, HER2-positive breast cancer, Antibody-drug conjugate (ADC).