BREAST CANCER EXPERTS found the small differences in benefit for 1 year vs 9 weeks of adjuvant trastuzumab (Herceptin) in the SOLD trial to be provocative.

William Sikov, MD

William Sikov, MD, of Women and Infants Hospital of Rhode Island’s Breast Health Center and the Warren Alpert Medical School of Brown University, Providence, Rhode Island, commented: “I understand that the conclusion is based on disease-specific outcomes, but looking at the overall numbers, it seems that the 1% reduction in distant disease–free survival is more than counterbalanced by the 1.4% increase in congestive heart failure.” 

He expressed hope that correlative studies will help identify “which patients are more likely to benefit from 1 year of trastuzumab, as opposed to exposing 100% of patients to the longer, more toxic duration of therapy.” 

Carlos L. Arteaga, MD

Carlos L. Arteaga, MD, Director of the Harold C. Simmons Comprehensive Cancer Center and Associate Dean of Oncology Programs at The University of Texas Southwestern Medical Center in Dallas, told The ASCO Post, “This attempt at de-escalation of therapy did not tell us if 9 weeks is an option we should consider. It failed to show 9 weeks is not inferior, which means it might be inferior. We’re stuck with 1 year of trastuzumab as the standard.” 

Given that the differences in outcomes are so small, Dr. Arteaga agreed with Dr. Sikov that women with cardiac issues might be well served by the shorter duration of trastuzumab; they might also be considered for adjuvant neratinib (Nerlynx), although there are cardiac concerns with this agent as well, he added. 

“Patient safety is first,” Dr. Arteaga emphasized. “For patients with a risk of heart failure that is greater than their risk of death, you can consider the shorter duration of 9 weeks as supported by this study.” ■

DISCLOSURE: Drs. Sikov and Arteaga reported no conflicts of interest.