Early-stage breast cancer, HER2-positive, Subcentimeter tumors, T1aN0M0, Very small tumors

Trastuzumab, chemotherapy

Trastuzumab is known as Herceptin in the U.S, where it currently is only available in intravenous form, like chemotherapy. Outside the U.S., it’s available in subcutaneous form. Patients can buy a shot at their doctor’s office and take it home to self-administer.

This self-injection form is under trial in the U.S., with Food and Drug Administration approval expected. (*A note on trastuzumab price is at the end of this post.)

Trastuzumab, the drugs that followed, and the drugs in development trials as of December 2018, written by the chief scientist at Cancer Commons: https://www.cancercommons.org/knowledge-blog/breast-cancer/new-herizons-her2-positive-breast-cancer-and-the-legacy-of-herceptin/

Herceptin without chemotherapy might be beneficial for some patients, according to this recent study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759796/

Chemotherapy should be given with Herceptin, except in select cases: https://bmccancer.biomedcentral.com/articles/10.1186/s12885-017-3857-5

Possible toxic cardiac effects may not be worth it for T1a cases, says this medical article: https://www.sciencedirect.com/science/article/pii/S0960977613001641

Indian oncologists reach a general consensus on T1a and T1b HER2-positive tumors: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5909284/ (I found this fascinating.)

Great overview of chemotherapy with or without trastuzumab for T1a patients: https://academic.oup.com/annonc/article/21/suppl_7/vii112/193371 (even though the conclusions are inconclusive, this article reviews all pertinent studies up until the year it was written, which was 2010)

Subcutaneous or intravenous trastuzumab? This study says self-injections are just about as good: https://academic.oup.com/annonc/article/26/2/320/2800595 (early breast cancer cases only)

FDA trial info on self-injected Herceptin in the U.S.: https://clinicaltrials.gov/ct2/show/NCT01959386 (trial completion in September 2018)

Six months or 12 months of trastuzumab for T1a patients: https://academic.oup.com/annonc/article/26/7/1333/165655

Trastuzumab: 1 year or 9 weeks? This Turkish study says patients with very small tumors did just as well with only nine weeks of this drug, and they point out lower cardiotoxic risk and dramatically lower costs: https://www.researchgate.net/profile/Mehmet_Oezen/publication/308763712_Trastuzumab_1-year_vs_9-week_in_early-stage_HER2-positive_lymph_node_negative_breast_cancer_patients/links/57f020df08ae8da3ce4aec4a/Trastuzumab-1-year-vs-9-week-in-early-stage-HER2-positive-lymph-node-negative-breast-cancer-patients.pdf (I have not seen any other study suggesting nine weeks.)

“Small HER2 tumor, big decision” — an interesting case discussion adjuvant drugs for a node-negative, T1b patient who had a lumpectomy instead of a mastectomy: http://theoncologist.alphamedpress.org/content/17/4/508.full

*NOTE ON PRICING AND BIOSIMILARS

Herceptin is expensive. A year-long course in the U.S. can cost $75,000. Outside the U.S., some foreign governments have negotiated that price down a little. If I would have chosen to take the self-injected form when I made my treatment decision, I would have been able to buy it at a doctor’s office for roughly $2,500 — give or take several hundred depending on the country we would be in. It would have been a hassle to travel around and worry about where I was going to get my next Herceptin injection – but it would have been totally possible with advance planning. (I opted to skip it, however.)

Outside the U.S., biosimilars of trastuzumab are available. They cost less – depending on the country and brand, but so far they cost only about 10-15% less. Prices could drop more as more brands come onto the market – especially in Europe. A biosimilar in India appears to be the cheapest so far. Also, Herceptin itself is cheapest in India, thanks to the government there forcing the drug’s maker to lower its price.

Biosimilars are not like generics and so doctors do not recommend changing brands once a patient starts a treatment. So far, biosimilars are only available in subcutaneous form.

MEDICAL DISCLAIMER

The information contained in this blog is not intended to be used for medical diagnosis or treatment. It should not be used in place of the advice of your doctor or other qualified health care provider.

 

🙂

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