Addition of trastuzumab to chemotherapy for stomach cancer extends survival by nearly 3 months

Aug 19, 2010

An Article published Online First by The Lancet says that for patients with HER2-positive advanced gastric cancer, addition of tastuzumab to standard cisplatinum/fluoropyrimidine chemotherapy results in a median survival of 13.8 months, compared with 11.1 months with chemotherapy alone. This corresponds to a 26% reduction in the death rate for patients in the trastuzumab group. Thus trastuzumab combined with standard chemotherapy could be considered a new standard option for patients with this condition. However, an accompanying Comment questions the cost effectiveness of the treatment. The Article is by Professor Yung-Jue Bang, Seoul National University College of Medicine, Seoul, South Korea, and Dr Eric van Custem, University Hospital Gathuisberg, Leuven, Belgium, and colleagues.

Trastuzumab is a drug which acts against human 2 (HER2), and is already a standard treatment in many settings for breast cancers that are HER2 positive. There is growing evidence that HER2 is an important biomarker and key driver of tumour growth in , with studies showing amplification or overexpression of HER2 in around one fifth of tumours. The authors investigated trastuzumab in combination with for first-line treatment of HER2-positive advanced gastric or gastro-oesophageal junction .

This randomised controlled phase 3 trial took place in 122 centres in 24 countries. Patients with gastric or gastro-oesophageal junction cancer were eligible for inclusion if their tumours showed overexpression or amplification of HER2. Participants were randomly assigned in a 1:1 ratio to receive a chemotherapy regimen consisting of capecitabine plus or fluorouracil plus cisplatin given every 3 weeks for six cycles or chemotherapy in combination with intravenous trastuzumab every 3 weekes until disease progression.

A total of 584 patients were included in the primary analysis (294 trastuzumab group, 290 chemotherapy only). Median overall survival was 13.8 months in the trastuzumab group and 11.1 months in the chemotherapy only group, a difference of 2.7 months (and a 26% reduction in the death rate for those given trastuzumab). In patients with high levels of HER2, the median survival was 16.0 months in the trastuzumab group and 11.8 months in the chemotherapy only group, a 35% reduction in the risk of death. Rates of adverse events, including those that were serious or heart-related, were similar in both groups.

The authors conclude: "Addition of trastuzumab to chemotherapy improved survival in patients with advanced gastric or gastro-oesophageal junction cancer compared with chemotherapy alone; this improvement was mainly the result of the survival advantage conferred to patients with high expression of HER2 protein. On the basis of these findings, trastuzumab can be considered as a new standard option for patients with HER2-positive advanced gastric or gastro-oesophageal junction cancer when combined with a chemotherapy regimen consisting of capecitabine plus cisplatin or fluorouracil plus cisplatin."

In the linked Comment, Professor Alastair J Munro and Dr Paddy G Niblock, Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, University of Dundee, UK, say: "If we presuppose that only randomised trials produce evidence of sufficient quality to support decisions about the allocation of scarce resources, there is a problem. There is a lot of evidence on the effects of adding expensive new drugs to conventional therapies, but little evidence for when older, less expensive interventions are combined. The evidence we have might not be the evidence we need, and the evidence that we need may never become available."

They add: "There are also problems with affordability. Patients in the ToGA study were treated with trastuzumab every 3 weeks until disease progression. The median time to progression was 6-7 months. When we use the cost estimates of trastuzumab therapy calculated by the UK's National Institute for Health and Clinical Excellence (NICE), this equals an average cost of £13 857 per patient . Cost per life-year gained will therefore be around £55 000. In the 24 countries that contributed to the study, yearly health expenditure per citizen varies from $40 to $5500 (2007 US dollars), which reiterates the important moral question—what is the justification for introducing a treatment that might enable one individual to live a few months longer but, which will consume for each person treated, the total yearly health expenditure for scores of their fellow citizens?"

Explore further: Chronic inflammation linked to 'high-grade' prostate cancer

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

Unraveling the 'black ribbon' around lung cancer

Apr 17, 2014

It's not uncommon these days to find a colored ribbon representing a disease. A pink ribbon is well known to signify breast cancer. But what color ribbon does one think of with lung cancer?

User comments : 0

More news stories

Filipino tests negative for Middle East virus

A Filipino nurse who tested positive for the Middle East virus has been found free of infection in a subsequent examination after he returned home, Philippine health officials said Saturday.

Study says we're over the hill at 24

(Medical Xpress)—It's a hard pill to swallow, but if you're over 24 years of age you've already reached your peak in terms of your cognitive motor performance, according to a new Simon Fraser University study.

NASA's space station Robonaut finally getting legs

Robonaut, the first out-of-this-world humanoid, is finally getting its space legs. For three years, Robonaut has had to manage from the waist up. This new pair of legs means the experimental robot—now stuck ...

Ex-Apple chief plans mobile phone for India

Former Apple chief executive John Sculley, whose marketing skills helped bring the personal computer to desktops worldwide, says he plans to launch a mobile phone in India to exploit its still largely untapped ...

Egypt archaeologists find ancient writer's tomb

Egypt's minister of antiquities says a team of Spanish archaeologists has discovered two tombs in the southern part of the country, one of them belonging to a writer and containing a trove of artifacts including reed pens ...

Airbnb rental site raises $450 mn

Online lodging listings website Airbnb inked a $450 million funding deal with investors led by TPG, a source close to the matter said Friday.