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Trastuzumab emtansine improves long-term survival in HER2 breast cancer

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A clinical trial has found that, in patients with high-risk HER2-positive breast cancer, post-surgery, or adjuvant, treatment with trastuzumab emtansine (T-DM1) reduced the long-term risk of death or invasive disease by 46 per cent and improved survival compared to trastuzumab alone.

The findings provide long-term evidence that T-DM1 is an effective adjuvant treatment for this population of breast cancer patients, supporting initial results with three-year follow-up published in the NEJM in 2019, which found that TDM1 reduced the risk of death or invasive disease by 50 per cent.

“KATHERINE is a landmark clinical trial that found T-DM1 had such improved activity relative to trastuzumab that the results were reported earlier than had been anticipated when the study was originally designed. The results changed the standard of care globally for patients with HER2-positive early breast cancer,” said lead author Charles Geyer Jr., professor in the Division of Malignant Hematology and Medical Oncology at the Pitt School of Medicine, UPMC Hillman and UPMC Magee-Womens Hospital.

“We continued to follow patients to understand the full magnitude of the benefit, and we now show that T-DM1 leads to stable long-term improvements in invasive disease-free survival and improves overall survival.”

T-DM1 is an antibody-drug conjugate that combines trastuzumab and a chemotherapy drug called emtansine. When trastuzumab attaches to the HER2 receptor on cancer cells, it acts like a trojan horse, allowing emtansine to more effectively enter the cancer cells and kill them from within.

The KATHERINE trial included 1,486 patients with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer who had residual invasive disease in the breast or axillary lymph node after pre-surgery, or neoadjuvant, treatment with taxane-based chemotherapy and the HER2-targeted agent trastuzumab and surgical removal of the tumour.

These patients are at high risk of cancer recurrence and death.

After surgery, patients were randomly assigned to receive adjuvant standard trastuzumab or T-DM1.

At 7-years follow up, invasive disease-free survival was 80.8 per cent with adjuvant T-DM1 and 67.1 per cent with adjuvant trastuzumab alone. Overall survival was 89.1 per cent with T-DM1 and 84.4 per cent with trastuzumab alone.

Although adverse events were higher in the T-DM1 group (26.1 per cent) compared to patients who received trastuzumab (15.7 per cent), the overall safety of the drug was considered acceptable.

According to Geyer, an important finding was the consistent benefit of T-DM1 across patient subgroups. The analysis showed an approximately 50 per cent reduction in risk of death and invasive disease regardless of the extent of disease at presentation, hormone receptor status, neoadjuvant treatment regimen, pathological node status at surgery, age and race.

“When I started my career in oncology, we knew that some breast cancers were more aggressive, but we didn’t know why,” said Geyer.

“From the excitement of identifying HER2 gene amplification and resultant protein overexpression as a targetable oncogene, through the development of drugs targeting HER2 amplification and evaluating them in landmark clinical trials, I’ve had the privilege of being part of the HER2 story, and it’s incredibly satisfying to have been part of research effort that has led to a new standard of care for patients with this disease.”

Now, Geyer and his colleagues are investigating a promising new antibody-drug candidate called trastuzumab deruxtecan, or T-DXd, for certain groups of patients such as those with lower expression levels of the HER2 protein who didn’t respond as well to T-DM1 as patients with high HER2 expression.

“As oncologists, we are greedy,” said Geyer. “We will never be satisfied until we reach 100 per cent cancer-free survival outcomes for our breast cancer patients.”

Wellness

AstraZeneca drug approved for breast cancer in EU

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AstraZeneca’s breast cancer drug Etcamah has been approved in the EU as part of a combination treatment for advanced disease.

The European Commission acted on a positive opinion from the Committee for Medicinal Products for Human Use, the Cambridge, England-based drug maker said.

The decision followed positive results from the Serena-6 phase III trial, which showed a 56 per cent reduction in the risk of disease progression in advanced oestrogen receptor-positive breast cancer.

A phase III trial is a large, late-stage study used to assess a treatment’s safety and effectiveness before wider regulatory approval.

Oestrogen receptor-positive breast cancer is a form of the disease that can grow in response to the hormone oestrogen.

Etcamah, whose generic name is camizestrant, was tested in combination with a cyclin-dependent kinase 4/6 inhibitor.

Known as CDK4/6 inhibitors, these medicines block proteins that help cancer cells grow and divide.

AstraZeneca said the Etcamah combination has also been approved in Japan, the UAE and Saudi Arabia based on the Serena-6 trial results.

The company said breast cancer remains the leading cause of cancer death among women in Europe, with more than 140,000 deaths and more than 540,000 patients diagnosed in 2024.

AstraZeneca shares were down 0.6 per cent at 12,628 pence in London on Thursday.

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Wellness

Breast cancer patients face 59% higher stroke risk during first year, study finds

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Women newly diagnosed with breast cancer have a 59 per cent higher risk of ischaemic stroke in the first year after diagnosis, research suggests.

Researchers also said survivors who develop sudden stroke symptoms, including one-sided weakness, facial drooping, speech difficulties or vision loss, should seek immediate medical attention.

The multicentre study analysed National Health Insurance Service data from 107,606 women who underwent surgery for newly diagnosed breast cancer and compared them with 322,818 age-matched women with no history of cancer.

The research was conducted by professor Shin Dong-wook of Samsung Medical Center, professor Han Kyung-do of Soongsil University, professor Yong-Moon Mark Park of the University of Arkansas for Medical Sciences and professor Wonyoung Jung of the University of Pennsylvania.

Professor Yong-Moon Mark Park said: “The study demonstrates a time-dependent pattern in which the risk of ischaemic stroke rises sharply immediately after breast cancer diagnosis and treatment before gradually declining.

“The key finding is that we evaluated stroke risk according to different stages following diagnosis and treatment. This suggests that clinicians should consider not only how much the risk increases, but also when it is greatest.”

The study included women aged 18 or older who were newly diagnosed with breast cancer between 2010 and 2016, underwent surgery and had no previous stroke.

Each patient was matched with three women of the same birth year who did not have cancer. Participants were followed for an average of 7.2 years.

The main outcome was ischaemic stroke, also known as cerebral infarction. It occurs when a blocked blood vessel cuts off blood flow to the brain and is a leading cause of death and long-term disability.

During follow-up, ischaemic stroke occurred in 1,155 breast cancer patients, or 1.07 per cent, and 3,698 women in the control group, or 1.15 per cent.

Overall, breast cancer surgery was not linked to a significantly higher long-term risk of ischaemic stroke, and researchers recorded a slight fall in risk over time.

However, a different pattern emerged immediately after diagnosis.

Within one year of diagnosis, patients had a 59 per cent higher risk of ischaemic stroke than women without cancer.

The risk was highest during the first three months, at 2.90 times that of the control group.

It remained elevated within six months, at 2.27 times the control group’s risk, before gradually declining.

The risk was still 17 per cent higher three years after diagnosis.

Researchers said the temporary increase may be linked to cancer-related hypercoagulability, inflammatory responses to surgery and treatment, and cardiovascular stress caused by anticancer therapies.

Hypercoagulability means the blood is more likely than usual to form clots. Cardiovascular refers to the heart and blood vessels.

The increased risk was particularly pronounced among patients with hypertension, type 2 diabetes or a history of current smoking.

Hypertension means high blood pressure. Type 2 diabetes is a long-term condition affecting how the body controls blood sugar.

Breast cancer patients who smoked had a 2.26-fold higher risk of ischaemic stroke than comparable women without cancer.

Principal researcher professor Shin Dong-wook stressed the importance of vigilant care for patients with cardiovascular risk factors, especially during the early phase of breast cancer treatment.

Shin said: “Patients with hypertension, diabetes, or other cardiovascular risk factors, as well as those who smoke, require particularly careful management during the early phase of breast cancer treatment.

“If patients who have undergone breast cancer treatment suddenly develop weakness in one arm or leg, facial drooping, slurred or abnormal speech, or vision loss on one side, ischaemic stroke should be suspected, and they should seek immediate medical evaluation.”

Researchers said survivorship care should include strategies to monitor and manage cardiovascular and cerebrovascular disease risk throughout treatment as advances in breast cancer care continue to improve survival.

Cerebrovascular disease refers to conditions affecting blood flow and blood vessels in the brain.

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Insight

Cancer cells secretly hijacking fertility protein to survive chemo, research finds

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Cancer cells may hijack a fertility protein to repair damaged DNA and survive chemotherapy, research suggests.

The findings could point to a way of making existing cancer treatments more effective.

SYCP1 is a protein normally involved in producing sperm and eggs.

Researchers at the University of Liverpool found that the protein, previously thought to work only in reproduction, can be reactivated in cancer cells, where it helps tumours survive and grow.

SYCP1 usually helps chromosomes pair during meiosis, the form of cell division that produces reproductive cells.

In cancer cells, however, the protein appears to take on another role. It enters the nucleus, the cell’s control centre, binds directly to DNA and regulates genes involved in cell division and DNA repair.

DNA repair is how cells fix damage to their genetic code. In cancer, this process can help tumour cells survive treatment.

The researchers found that removing SYCP1 made cancer cells much more sensitive to chemotherapy drugs that damage DNA.

The findings suggest cancers may use SYCP1 to repair damage caused by treatment and continue growing.

Dr Urszula McClurg, lecturer in biochemistry, cell and systems biology at the University of Liverpool, said: “Our findings show that cancer cells can hijack proteins that normally exist only in reproductive tissues and give them completely new jobs.

“Understanding these unexpected functions opens up exciting opportunities to develop new treatments that make existing cancer therapies more effective.”

The work challenges the long-held belief that proteins active only in fertility have no biological relevance outside the reproductive system.

Researchers say these specialised proteins could provide new treatment targets across many types of cancer.

The study also offers a new view of how cancers evolve by repurposing developmental and reproductive processes.

The findings highlight SYCP1 as a candidate for future precision cancer therapies, which are treatments based on the specific biology of a patient’s cancer.

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