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For small HER2-positive tumours, a gentle regimen of weekly paclitaxel plus trastuzumab gives excellent cure rates, avoiding harsher chemotherapy.
APT, trial NCT00542451 sponsored by Dana-Farber and reported in 2015, showed that for small, node-negative HER2-positive breast tumours of three centimetres or less, a gentle regimen of twelve weeks of weekly paclitaxel plus a year of trastuzumab gives excellent cure rates, avoiding harsher chemotherapy. It was a single-arm study of 410 women in which almost all remained free of disease at seven years and free of recurrence at ten, and it became the standard for stage I disease without a randomised trial. OnCo links it to paclitaxel, trastuzumab, Sara M. Tolaney and the bottleneck of wrong doses, and the ATEMPT trial of trastuzumab emtansine alone showed comparable outcomes without a toxicity advantage. Whether even less treatment, such as trastuzumab without chemotherapy, would suffice for the smallest tumours is the open question. Trastuzumab has its own page.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
406 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| 7-year disease-free survivalprimary | Paclitaxel + trastuzumab | 406 | 93% | - | - | link |
A second publication from the trial, later than the first and described in its title as an update or longer-term analysis. Read it with the primary publication linked from the trial page; the record was linked automatically and its figures have not been checked by hand.
Women with small HER2-positive tumours can avoid anthracyclines and multi-agent chemotherapy; the APT regimen is a guideline standard for stage I HER2-positive disease.
Shares Sara M. Tolaney, Early HER2-positive breast cancer, Trastuzumab, Paclitaxel / nab-paclitaxel.
Shares Early HER2-positive breast cancer, Trastuzumab, HER2-positive breast cancer, Monoclonal antibodies.
Shares Early HER2-positive breast cancer, Trastuzumab, HER2-positive breast cancer, Monoclonal antibodies.
Shares Early HER2-positive breast cancer, Trastuzumab, Paclitaxel / nab-paclitaxel, HER2-positive breast cancer.
Shares Early HER2-positive breast cancer, Trastuzumab, Paclitaxel / nab-paclitaxel, HER2-positive breast cancer.
Shares Early HER2-positive breast cancer, Trastuzumab, Paclitaxel / nab-paclitaxel, HER2-positive breast cancer.
Shares Trastuzumab, HER2-positive breast cancer, Monoclonal antibodies, Cytotoxic chemotherapy.
Shares Early HER2-positive breast cancer, HER2-positive breast cancer, Monoclonal antibodies.