Dr. Fader on Trastuzumab/Chemo in HER2+ Uterine Serous Carcinoma

Amanda Nickles Fader, MD, an associate professor of Gynecology and Obstetrics, vice chair of Gynecologic Surgical Operations, director of the Kelly Gynecologic Oncology Service, director of the Center for Rare Gynecologic Cancers, at The Johns Hopkins Hospital, and director of the F.J. Montz Fellowship Program in Gynecologic Oncology at Johns Hopkins Medicine, discusses the utility of trastuzumab (Herceptin) plus chemotherapy in HER2-positive uterine serous carcinoma.

Results from a randomized phase II clinical trial (NCT01367002) demonstrated an improvement in progression-free survival (PFS) and overall survival (OS) with the addition of trastuzumab to carboplatin/paclitaxel in patients with advanced or recurrent, HER2-positive uterine serous carcinoma.

Findings revealed that patients with stage III/IV disease who received the triplet up front derived the greatest benefit in OS and PFS. At a median follow-up of 25.9 months, the median OS had not been reached compared with 25.4 months.

There are many theories as to why the patients who received the triplet up front tended to respond better than those who received it after recurrence, explains Fader. Women with recurrent disease had already been pretreated with carboplatin/paclitaxel, so they could have developed resistance to the regimen, says Fader. Moreover, data show that carboplatin/paclitaxel is not as effective in the recurrent setting compared with the upfront setting.

While additional research is needed, these findings suggest that the addition of trastuzumab is not potent enough to overcome potential resistance to cytotoxic chemotherapy, concludes Fader.