Expert Point of View: Charles Vogel, MD, Larry Norton, MD, and Andrew D. Seidman, MD


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A number of breast cancer specialists commented on the value of the Southwest Oncology Group (SWOG) 0221 data. Charles Vogel, MD, Professor of Medicine at the University of Miami Health System, commented after the presentation, “This is a potentially important abstract because of the wide variety of schedules and dosages of paclitaxel used in the adjuvant setting. This is the first time we have seen a good head-to-head comparison, other than for every-3-week vs weekly paclitaxel, and we know the 3-weekly schedule isn’t as good. Here, you show equivalence in efficacy with lower-dose paclitaxel, with less toxicity. I think these implications are important.”

Larry Norton, MD, Deputy Physician-in-Chief for Breast Cancer Programs; Medical Director, Evelyn H. Lauder Breast Center; and Norna S. Sarofim Chair in Clinical Oncology at Memorial Sloan-Kettering Cancer Center, agreed that the data are reassuring for individualizing treatment. “For patients coming from some distance, treatment every 2 weeks can be advantageous,” he noted. Dr. Norton also reminded listeners that both regimens were actually dose-dense and are superior to a standard every-3-week schedule.

Andrew D. Seidman, MD, a medical oncologist at Memorial Sloan-Kettering, who moderated a press briefing where the results were presented, commented, “It’s remarkable that after 2 decades we are still teaching an old dog new tricks. The differences in terms of safety and tolerability, in the absence of differences in efficacy, were very ­meaningful.”

Dr. Seidman, who led the study of weekly paclitaxel vs every-3-week paclitaxel in metastatic patients,1 said he had long believed that more frequent dosing was best but these data confirmed that. “This will change my practice,” he said. ‘The data suggest I can get the same benefit with less toxicity using weekly paclitaxel, and possibly at lower cost, since the expense of growth factor support is not trivial.”

G. Thomas Budd, MD, a staff physician at the Cleveland Clinic’s Taussig Cancer Institute, who presented the SWOG 0221 study at the Annual Meeting, responded that while no formal pharmacoeconomic analysis has been conducted on the data, “a back-of-the-envelope analysis does show lower treatment costs with weekly paclitaxel.” ■

Disclosure: Dr. Vogel reported no potential conflicts of interest. Dr. Seidman reported no potential conflicts of interest. Dr. Budd served on an advisory board for Amgen, though not for more than 2 years.  Within the past year he has served on advisory boards for and received research funding from Genentech. Dr. Norton reported no potential conflicts of interest.

Reference

1. Seidman AD, Berry D, Cirrincione C, et al: Randomized phase III trial of weekly compared with every-3-weeks paclitaxel for metastatic breast cancer, with trastuzumab for all HER-2 overexpressors and random assignment to trastuzumab or not in HER-2 nonoverexpressors: Final results of Cancer and Leukemia Group B protocol 9840. J Clin Oncol 26:1642-1649, 2008.


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