Is HER-2/neu a predictor of anthracycline utility? No.
HER-2 has a well-established role as a prognostic indicator in breast cancer and as a predictor for response to trastuzumab. Recent studies have also suggested that it may serve as a predictor of response to anthracycline-based therapies. This article argues that the data are insufficient to accept this hypothesis as scientifically established. The argument is developed along several lines: first, that the trials used to support a predictive role for HER-2 have real flaws with regard to this hypothesis; second, that HER-2 is a remarkably inconsistent predictor of anthracycline response when examined in a broader context that includes preoperative and metastatic disease; third, that preclinical data fail to support the hypothesis; and finally, that even if accepted, the hypothesis is difficult to extrapolate to the everyday world of breast cancer.
Sledge
G W
GW
Indiana Cancer Pavilion, RT-473, 575 Barnhill Dr., Indianapolis, IN 46202, USA. gsledge@iupui.edu
D018943:Anthracyclines / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism; D002986:Clinical Trials as Topic / Q000592:standards; D005260:Female; D006801:Humans; D015337:Multicenter Studies as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics / Q000378:metabolism*; D015203:Reproducibility of Results
D018943:Anthracyclines; D018719:Erb-b2 Receptor Tyrosine Kinases