|
Advertisement |
|
|
||
 |
|
|||||
|
|||||
|
 |
||||||
|
||||||
|
||||||
|
Journal of Clinical Oncology, Vol 23, No 6 (February 20), 2005: pp. 1326-1327 © 2005 American Society of Clinical Oncology. DOI: 10.1200/JCO.2005.05.297
In Reply:Fox Chase Cancer Center, Philadelphia, PA Dr Altundag's comments are intriguing, but highly speculative. The percentage of patients with non–small-cell lung cancer (NSCLC) likely to have both HPV16 E6/E7 positivity and HER-2/neu overexpression is exceedingly small. Trastuzumab is unlikely to have much of a role in the adjuvant setting, either now or in the foreseeable future. Dr Kalemkerian's concerns are valid. In the end, however, the Eastern Cooperative Oncology Group investigators of study 2598 differ from him only in nuance, not in substance. Historic controls within the cooperative group (ie, good performance status enrollees onto Eastern Cooperative Oncology Group 1594) had a median survival of 8 months,1 whereas 3+ expressors enrolled onto study 2598 had a median survival of 10 months.2 Obviously, such a difference could be accounted for by patient selection or by chance alone. It should be noted, however, in the intriguing, albeit small, retrospective analysis by Verma et al3 of advanced NSCLC patients receiving platinum-based therapy, that median survival with chemotherapy alone for the 3+ group was little more than half that observed in those who had no HER-2 expression; and in the study by Gatzenmeier et al,4 those with 3+ expression, another small group, enjoyed substantially longer time to progression when treated with combination chemotherapy and trastuzumab, compared with a control group receiving chemotherapy alone. Ultimately, a phase III study, which far exceeds the resources available within the cooperative group structure, would be necessary to tease out the potential benefit of trastuzumab in the relatively small minority of patients who have 3+ expression. More likely, we will witness the emergence of therapies pairing HER-1 and HER-2 inhibition, in which case HER-2 expression may actually help to delineate those who might potentially benefit the most. Finally, we disagree with Dr Kalemkerian's last comment, that our interpretation of the data is overly enthusiastic and will inadvertently encourage clinical oncologists to employ trastuzumab in conjunction with cytotoxic therapy. To date, we have not witnessed this phenomenon. Oncologists, while often eager to experiment with new therapies, are generally quite thoughtful and astute. In the absence of bona fide, phase III data, there is no indication or justification to use trastuzumab for NSCLC outside of the protocol setting. Author's Disclosures of Potential Conflicts of Interest The author indicated no potential conflicts of interest. REFERENCES
1. Langer CJ, Stephenson P, Thor A, et al: Trastuzumab in the treatment of advance non-small cell lung cancer: Is there a role? Focus on Eastern Cooperative Oncology Group study 2598. J Clin Oncol 22:1180-1187, 2004
2. Schiller JH, Harrington D, Belani CP, et al: Comparison of four chemotherapy regimens for advanced non-small cell lung cancer. N Engl J Med 346:92-98, 2002 3. Verma S, Butts C, Au HJ, et al: Incidence of Her-2/neu in advanced non-small cell cancer and response to platinum based chemotherapy. Proc Am Soc Clin Oncol 20:347a, 2001 (abstr 1384)
4. Gatzenmeier U, Groth G, Butts C, et al: Randomized phase II trial of gemcitabine-cisplatin with or without trastuzumab in HER2-positive non-small cell lung cancer. Ann Oncol 15:19-27, 2004
Related Correspondence
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|||||||||||
|
|||||||||||
|
|
Copyright © 2005 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
|
