Breast cancer is the most common cancer affecting
women the world over. Depending on the stage of the cancer, it is treated with
either surgery, chemotherapy, radiotherapy or a combination of these
in breast cancer may be administered as adjuvant therapy or neoadjuvant therapy. As adjuvant therapy, it is
given after the primary treatment like surgery to prevent recurrence of the
cancer. In neoadjuvant chemotherapy, the medications are given before the
surgery. This is done to shrink the tumor before it can be surgically removed.
A number of anti-cancer drugs are used in the
treatment of breast cancer; trastuzumab and lapatinib are among the newer
drugs. Trastuzumab targets cells that produce too much of HER-2 or are HER-2
positive. HER-2 or the Human Epidermal growth factor Receptor 2 is responsible
for cellular growth and proliferation. Cancers that are HER-2 positive have a
poor outcome and are likely to recur. Lapatinib is another drug used in the
treatment of HER-2 positive breast cancer.
In a recent
study, the benefits and adverse effects of trastuzumab and lapatinib were
compared when used in HER-2 positive breast cancer along with other anticancer
drugs as neoadjuvant treatment.
In the study conducted on 620 HER-2 positive breast
cancer patients, the patients received 4 cycles of the chemotherapeutic drugs
epirubicin plus cyclophosphamide and 4 cycles of docetaxel. In addition to the
chemotherapy, 309 patients received trastuzumab and 311 patients received
The researchers found that 30.3% patients in the
trastuzumab group and 22.7% patients in the lapatinib group responded to
treatment. Trastuzumab treatment was more frequently associated with edema and
breathlessness, whereas treatment with lapatinib was more frequently associated
with diarrhea and skin rash. The number of patients discontinuing lapatinib
treatment was more than double that of those discontinuing trastuzumab (33.1%
versus 14%), with 70 serious adverse effects in the trastuzumab group and 87 in
the lapatinib group.
The study thus
concluded that addition of trastuzumab to other chemotherapy drugs as
neoadjuvant treatment in HER-2 positive breast cancer may be more effective and
safer than using lapatinib.
1. Lapatinib versus trastuzumab in combination with neoadjuvant anthracycline-taxane-based
chemotherapy (GeparQuinto, GBG 44): a randomised phase 3 trial; Prof Michael
Untch et al; The Lancet Oncology Jan 2012.