Amplification of ERBB2 (also known as HER2) occurs in 15–25% of breast cancers, and giving the antibody trastuzumab (Herceptin) with chemotherapy increases survival. In a phase III trial of women with breast cancer, the FinHer (Finland Herceptin) Study investigators have shown that a short course — just 9 weeks — of trastuzumab given concomitantly with docetaxel or vinorelbine is effective in patients with amplified ERBB2.

Although survival improves when trastuzumab is given concomitantly with paclitaxel or after chemotherapy for 12 months, there is a risk of heart failure in 1.7–4.1% of women. So, investigators tried a different approach — administering trastuzumab before other cardiotoxic therapies and with potentially synergistic chemotherapy.

A total of 1,010 women with axillary node-positive or high-risk node-negative breast cancer were randomly assigned to receive either docetaxel or vinorelbine. Of these, 232 had amplified ERBB2 and were further randomized to receive trastuzumab or not to receive it. Nine trastuzumab infusions were administered at 1-week intervals starting on day 1 of the first docetaxel or vinorelbine cycle. All patients received fluoruracil, epirubicin and cyclophosphamide (FEC). Median follow-up times were between 35 and 37 months.

Recurrence of breast cancer or death without recurrence was less common among women treated with docetaxel plus FEC than among women treated with vinorelbine plus FEC, but overall survival was not significantly different. Of 115 patients in the trastuzumab group, 12 had recurrent breast cancer or death without recurrence; in the control group (116 patients) 27 such cases occurred. Overall survival also tended to be better if the patient had received trastuzumab. The most common dose-limiting side effect was neutropaenia and neutropaenic infection, especially in the docetaxel-treated group, so dose reductions were made accordingly. Four patients had cardiac infarctions or cardiac failure — none of these patients had received trastuzumab.

These data need to be confirmed in a larger scale study, but the use of 9-week trastuzumab in this schedule holds promise for reducing the numbers of patient visits, decreasing the numbers of cardiac adverse events, and increasing the cost-effectiveness of breast cancer therapy.