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New way to carry chemotherapy improves survival

Dr. Sunil Verma, study first author and Chair, Breast Medical Oncology at Sunnybrook's Odette Cancer Centre

Doug Nicholson

For the first time in cancer treatment in a study published in the New England Journal of Medicine, Sunnybrook researchers demonstrate better overall survival for breast cancer patients using a new way to combine chemotherapy with targeted therapy through an antibody drug link, as part of a global clinical trial called EMILIA.

T-DM1 (trastuzumab emtansine) is made up of the antibody trastuzumab and the chemotherapy DM1 attached together using a stable linker molecule, and allows chemotherapy to be carried with the targeted therapy, trastuzumab, right to breast cancer cells.

"These findings create the framework for a new direction for the treatment of cancers, and potentially for earlier stages of disease, by improving the way chemotherapies can now be combined with targeted therapies," says Dr. Sunil Verma, study first author and Chair, Breast Medical Oncology at Sunnybrook's Odette Cancer Centre. These updated results were also presented at the European Society of Medical Oncology Congress.

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Updated findings show median overall survival (OS) at 25.1 months with lapatinib plus Xeloda® (capecitabine) chemotherapy (control arm), and 30.9 months with T-DM1 (experimental arm). Since the release of this information, patients in the control arm of this randomized trial can cross over to the experimental arm.

The EMILIA Phase III clinical trial was conducted in 26 countries in 213 centres and evaluated T-DM1 versus Xeloda® (capecitabine) and lapatinib for 991 patients with HER2-positive advanced breast cancer.

Chemotherapy drugs are effective in killing cancer cells but may also harm healthy cells and result in significant side effects. Targeted therapies such as trastuzumab or lapatinib are used to block cancer cell growth and are traditionally delivered along with standard chemotherapy agents.

The Canadian Cancer Society estimates 23,400 Canadians will be diagnosed with breast cancer, and an estimated 5,100 will have died of the disease in 2011.  HER2 positive breast cancer accounts for approximately 20 per cent of breast cancers that overexpress the HER2 receptor.

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