NE Oncology Issue – June 2007

This trial was performed in patients with metastatic breast cancer who had no prior chemotherapy. Paclitaxel is commonly used in many parts of the world where there is no access to drugs like trastuzumab or the ability to test for HER2 status. The study examined the combination of lapatinib with paclitaxel in HER2-negative breast cancer. As lapatinib blocks both HER1 and HER2 signals, it doesn’t intrinsically make a lot of sense to give it to the HER2- negative patients. However some of the patients who are HER2-negative do have EGFR/HER1 overexpression, and that formed the rationale for this particular study. When the whole patient population was observed, the addition of lapatinib to paclitaxel increased response rate but didn’t change time to progression or overall survival. But in the HER2-positive cohort, there was benefit in event-free survival and time to progression with lapatinib and a trend to overall survival benefit. To date, lapatinib has only been tested in first-line, early-stage breast cancer or in patients who have already received trastuzumab, so this study supports the idea that lapatinib may have similar clinical benefit to trastuzumab when combined with a taxane in the treatment of HER2 positive MBC, but without the associated cardiotoxicity.

Overall, this is a positive study and it will be interesting to see this drug move forward in clinical trials and in practice. Once it is approved in Canada, lapatinib will be a good addition to the armamentarium of agents for metastatic breast cancer; however, the issue with all these new agents is obviously cost.

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Vera Hirsh, MD, FRCPC
Chief of the Hematology-Oncology Service, Santa Cabrini Hospital
Associate Professor, Medicine and Oncology, McGill University
Associate Physician, Oncology Service, at the Royal Victoria, Montreal General, and Montreal Chest Hospitals
With a current practice in both hematology and oncology, Dr. Vera Hirsh is an associate professor of medicine and oncology at McGill University. Her research at the Quebec Pulmonary Unit focuses on the treatment of lung cancer, and she continues to chair ongoing international chemotherapy trials. Dr. Hirsh chaired the Quebec Lung Cancer Committee to establish guidelines for the treatment of lung cancer. In addition, she has published abstracts, articles, and book chapters. Dr. Hirsh is a member of advisory boards for many pharmaceutical companies and the Medical Oncology Standing Committee of RTOG.

Christine Cripps, MD, FRCPC
Medical Oncologist, Director,
Continuing Medical Education,
Ottawa Hospital Regional Cancer Centre
Dr. Christine Cripps is a medical oncologist and director of the Continuing Medical Education Department at the Ottawa Hospital Regional Cancer Centre. She also holds a position of Associate Professor, Medicine at the University of Ottawa. A keen teacher, Dr. Cripps’ main areas of interest include gastrointestinal cancer and head and neck cancer. She also enjoys cycling, skiing, and sailing when time permits.

Stephen K. L. Chia, MD, FRCPC
Assistant Professor of Medicine Department of Medicine
University of British Columbia
British Columbia Cancer Agency
Dr. Chia is a staff oncologist with the British Columbia Cancer Agency (BCCA), Vancouver, Canada. He also serves as physician coordinator for both the breast cancer and head and neck cancer clinical trials at the BCCA – Vancouver Cancer Centre. He is an active researcher in phase I-III trials in breast cancer, head and neck cancer and investigational new drugs. He is currently carrying out studies in breast cancer with grant funded research from the National Cancer Institute of Canada, Canadian Breast Cancer Alliance and Canadian Breast Cancer Foundation – British Columbia/Yukon Chapter. Dr. Chia is an active member of the British Columbia Breast Tumor Group, Breast Cancer Systemic Policy Group and Head and Neck Tumor Group.

José Chang, MD, FRCPC
Head of Medical Oncology, RS
McLaughlin Durham Regional Cancer Centre, Oshawa
Dr. José Chang is the principal investigator and site representative for the National Cancer Institute of Canada Clinical Trials Group, and is an examiner for the Medical Council of Canada. His research interests lie in the areas of breast cancer, melanoma, lymphoma, and quality of life during chemotherapy. Dr Chang has presented at major oncology meetings of the American Society of Clinical Oncology, San Antonio Breast Cancer Symposia, and European Breast Cancer Conference. A member of the editorial board of the journal Current Oncology, Dr. Chang has published in journals such as the Journal of Clinical Oncology, European Journal of Cancer, and Canadian Medical Association Journal.