T-DM1 improves survival, submitted for FDA approval

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Earlier this week, it was announced that survival data are in for T-DM1, an experimental breast cancer drug for HER2-positive breast cancer, and the results are positive. We just don't know how positive. Survival data will be announced at an upcoming medical meeting. My bet is either the ASCO Breast Cancer Symposium in September or the San Antonio Breast Cancer Symposium in December. We'll soon see how long we have to wait for the results. At the annual meeting of the American Society of Clinical Oncology earlier this summer, it looks like there may be quite a survival curve (read "ASCO Updates: " 'Super Herceptin' Excels in HER2 Breast Cancer"). Although there appeared to be a survival advantage in the T-DM1 arm, researchers could not confirm a positive benefit until a certain number of events were reached. However, at the two-year follow-up, 65.4 percent of patients on T-DM1 were alive compared with 47.5 percent on the standard treatment of Xeloda (capecitabine) and Tykerb (lapatinib). So, a recap: T-DM1 is one of a reformulated class of drugs called antibody-drug conjugates. It fuses together the Herceptin antibody (trastuzumab) to a potent drug called emtansine, packing a powerful punch to cancers that are fueled by overexpression of the HER2 receptor--even in patients whose cancers have progressed with Herceptin. Emtansine's potency is at least 100 times more powerful than paclitaxel, and administration without severe side effects has been a challenge until now. Linking it to Herceptin, which delivers it directly to the cancer cell, reduces those side effects. In fact, T-DM1 had fewer side effects than the standard treatment.In addition, the company that has developed T-DM1 submitted the drug to the FDA for approval this week (read full statement here). Genentech had applied for accelerated approval for T-DM1 back in 2010, but the FDA passed. The agency explained that in that particular study, the patients had not exhausted all treatment options before receiving T-DM1. It would be surprising if the FDA did not approve T-DM1 on the current data, though. You can read more about T-DM1 and updates in HER2-positive breast cancer in our recent article, "Research Unravels New Ways to Treat HER2-Positive Breast Cancer."

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For patients with cancer, the ongoing chemotherapy shortage may cause some anxiety as they wonder how they will receive their drugs. However, measuring drugs “down to the minutiae of the milligrams” helped patients receive the drugs they needed, said Alison Tray. Tray is an advanced oncology certified nurse practitioner and current vice president of ambulatory operations at Rutgers Cancer Institute in New Jersey.  If patients are concerned about getting their cancer drugs, Tray noted that having “an open conversation” between patients and providers is key.  “As a provider and a nurse myself, having that conversation, that reassurance and sharing the information is a two-way conversation,” she said. “So just knowing that we're taking care of you, we're going to make sure that you receive the care that you need is the key takeaway.” In June 2023, many patients were unable to receive certain chemotherapy drugs, such as carboplatin and cisplatin because of an ongoing shortage. By October 2023, experts saw an improvement, although the “ongoing crisis” remained.  READ MORE: Patients With Lung Cancer Face Unmet Needs During Drug Shortages “We’re really proud of the work that we could do and achieve that through a critical drug shortage,” Tray said. “None of our patients missed a dose of chemotherapy and we were able to provide that for them.” Tray sat down with CURE® during the 49th Annual Oncology Nursing Society Annual Congress to discuss the ongoing chemo shortage and how patients and care teams approached these challenges. Transcript: Particularly at Hartford HealthCare, when we established this infrastructure, our goal was to make sure that every patient would get the treatment that they need and require, utilizing the data that we have from ASCO guidelines to ensure that we're getting the optimal high-quality standard of care in a timely fashion that we didn't have to delay therapies. So, we were able to do that by going down to the minutiae of the milligrams on hand, particularly when we had a lot of critical drug shortages. So it was really creating that process to really ensure that every patient would get the treatment that they needed. For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.
Yuliya P.L Linhares, MD, an expert on CLL
Yuliya P.L Linhares, MD, and Josie Montegaard, MSN, AGPCNP-BC, experts on CLL
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