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Professor Dr. Martine Piccart-Gebhart

13 June 2008


Trastuzumab use dependent on risks

Selection of a trastuzumab treatment regimen depends on whether there is more worry about the risk of cardiac failure or an early relapse, says an eminent oncologist. Professor Dr. Martine Piccart-Gebhart, from Universite Libre de Bruxelles in Belgium, said this in her lecture on adjuvant trastuzumab in the treatment of human epidermal growth factor receptor 2 (HER-2) breast cancer. She said if a patient is at low risk of relapse, but at high risk of cardiac failure eg, an older obese woman with a low left ventricular ejection fraction, then the HERA (HERceptin Adjuvant) trial design regimen is most appropriate. However, if there is a high risk of both relapse and cardiotoxicity, the BCIRG006 (Breast Cancer International Research Group 006 Phase III study) nonanthracycline arm ie, the TCH arm, is the best regimen to use. TCH consists of six cycles of docetaxel and carboplatin, with one year of trastuzumab started at the same time as chemotherapy.

Strategies of five trastuzumab trials

All trials had a similar ‘backbone’ of design ie, the women involved were HER-2 3+ by immunohistochemistry
(IHC) or fluorescent in situ hybridization (FISH), and the diagnoses confirmed by a central laboratory. The variables in the trials were the types of chemotherapy and dosing schedule. The BCIRG006 and Finland Herceptin (FinHer) trials involved a regimen of trastuzumab immediately after surgery. NSABP-B31 (National Surgical Adjuvant Breast and Bowel Project-B31) and NCCTG-N9831 (North Central Cancer Treatment Group-N9831) involved a regimen of three months of anthracycline-based chemotherapy in the
form of doxorubicin and/or cyclophosphamide, followed by trastuzumab delivered concomitantly with a taxane. The HERA trial involved trastuzumab after a series of chemotherapy. The trials had several exclusion criteria, such as uncontrolled hypertension, angina, patients older than 70 years, and those who were small-node negative.

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Dr. Piccart-Gebhart received her medical degree (1978, summa cum laude, Prix Fleury Mercier) and her internal medicine certification (1983) at the Universite Libre de Bruxelles, Belgium. She earned her oncology qualification from Division of Oncology at the New York University (NYU) Medical Center. She became certified in European Medical Oncology in London in 1989 and earned her PhD from the ULB in 1993.

Dr. Piccart-Gebhart is a member of numerous professional organizations, including ASCO, the American Association for Cancer Research (AACR), the European Society for Medical Oncology (ESMO), and the European Organisation for Research and Treatment of Cancer (EORTC). She plays an active role in new drug development and has been particularly involved in the development of paclitaxel, docetaxel, capecitabine, trastuzumab, letrozole, exemestane, and pegfilgrastim.

Dr. Piccart-Gebhart has served as author or co-author of more than 250 scientific publications in peer-reviewed journals. She has received numerous awards in recognition of her achievements in the clinical research field including the ESMO Award for Exceptional Contribution to the Advancement of Medical Oncology in Europe (1997). In 2004, she received an award from the Breast Cancer
Research Foundation and the Prix Mois du Cancer du Sein. She was awarded the 14th Claude Jacquillat Award for achievements in clinical oncology during the 17th ICACT meeting in Paris, in February 2006 and received the ESMO-GSK Lifetime Achievement Award in Breast Cancer Research (to the Breast International Group), at the 31st ESMO Congress in Istanbul, Turkey in October 2006. She was recently awarded the "Miami Breast Cancer Conference Award of Excellence for 2007", at the Miami Breast Cancer Conference in February 2007.
 


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