Adding Herceptin to standard treatment in women with HER2-positive breast cancer, significantly increases survival and curbs the chances of relapse once therapy stops, finds a Cochrane systematic review.
About a fifth of women diagnosed with early breast cancer have HER2-positive tumours that, if untreated, are associated with a worse outlook than HER2-negative tumours. But women given Herceptin have a higher risk of experiencing problems with their heart.
The researchers base their findings on data from eight trials involving just under 12,000 women with HER2-positive operable breast cancer. These women had either been assigned randomly Herceptin or not, in addition to other treatments. Women were monitored for an average of three years.
Deaths from breast cancer fell by a third, but the risk of heart toxicity went up fivefold for women in the Herceptin group.
If 1000 women were given standard therapy with no Herceptin then after three years about 900 would survive, but if 1000 women were treated with standard chemotherapy and Herceptin for one year, about 933 would survive, say the authors.
The researchers conclude that in women at higher risk of recurrence and with no signs of a weak heart, the pros of Herceptin outweigh the cons.
Meanwhile another systematic review shows that preoperative statin treatment can reduce the chances of postoperative atrial fibrillation and shortens hospital stay among cardiac surgery patients.
But this approach had no influence on the overall risk of death, or stroke, heart attack, or kidney failure around the time of the operation, the review shows.
The research team analysed data from 11 randomised controlled trials, involving 984 patients undergoing different forms of heart surgery.
They found that giving statins before surgery reduced the incidence of postoperative atrial fibrillation, compared with those who did not take these drugs.
They also discovered that patients who had statins before the operation tended to leave intensive care about three and a half hours earlier, and left hospital about half a day earlier.
But there was no significant reduction in the proportion of people who subsequently had a heart attack or kidney failure. And statins had no effect on the number of people who died or had a stroke soon after their operation.
The researchers point to one limitation of their findings. “Since the data we analysed had come mainly from patients having coronary artery bypass operations, the results cannot be extrapolated to patients undergoing other cardiac procedures, such as heart valve or aortic surgery,” says lead researcher Oliver Liakopoulos, from the Department of Cardiothoracic Surgery at the University of Cologne’s Heart Centre.
Cochrane Database of Systematic Reviews 2012, Issue 4. Art.No.:CD006243. DOI: 10.1002/14651858.CD006243.pub2
Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD008493. DOI: 10.1002/14651858.CD008493.pub2.